Lift the Fog of “Chemo Brain”
by Jamie Myers, PhD, RN, AOCNS
Do you sometimes have trouble remembering why you walked into a room, what was said during a recent conversation, or how to drive to a familiar place? Do you have difficulty paying attention, concentrating, or multitasking? Do you often misplace items, like your phone or your keys? Is it sometimes difficult for you to find the right word during conversation?
If you answered yes to any of these questions, you may be experiencing what the cancer community calls chemo brain. “Chemo brain” refers to the thinking and memory problems that cancer survivors experience during and after cancer treatment.
The Name Doesn’t Say It All
Though chemo brain is quite common among cancer survivors, the term can be misleading. Chemotherapy is not the sole cause of cancer-related cognitive dysfunction. These cognitive changes are a result of a complex combination of factors, including the cancer itself, the cancer treatment, and the body’s response to both.
Cancer, as well as many cancer treatments, can increase products of inflammation within the bloodstream. These products are known to be associated with changes in cognitive function. They can also cause fatigue and mood disorders, such as depression. Likewise, certain types of surgery and medications used to treat cancer can cause a rapid decrease in hormones that are important to cognitive function. Additionally, cancer treatment often is associated with sleep disturbance, which can contribute to cognitive difficulties. All these factors, along with the anxiety that can accompany a cancer diagnosis, play a role in the cognitive changes cancer survivors often experience.
Though chemo brain is quite common among cancer survivors, the term can be misleading. Chemotherapy is not the sole cause of cancer-related cognitive dysfunction.
What You Can Do to Help Manage Your Chemo Brain
Currently, there is no established standard of care for preventing or treating chemo brain. However, researchers are working hard to develop and test interventions to manage these cognitive changes. This research is promising in several areas.
Based on the evidence we currently have, researchers believe there are a few things you can do to help manage chemo brain and improve your memory, concentration, and processing speed.
Exercise
Regular exercise has been shown to reduce fatigue, improve sleep, and decrease recurrence for some types of cancer. Research indicates that exercise may also help reduce the products of inflammation in the blood that are associated with changes in cognitive function. Likewise, research has shown that regular exercise increases other products in the blood that are needed for good cognitive function. The National Comprehensive Cancer Network recommends that cancer survivors get 150 to 300 minutes of moderate exercise, or 75 minutes of vigorous exercise, each week.
Mindfulness
The practice of mindfulness also has been shown to reduce stress and improve sleep. Mindfulness is the act of being present in the moment and aware of your thoughts, feelings, and bodily sensations without judgement. Mindfulness practices, such as meditation, often involve a focus on one’s breath and an attempt to clear the mind. Interestingly, mindfulness and forms of mindfulness-based exercise, such as yoga, tai chi, and qigong, have been shown to reduce the body’s stress response, including decreasing the products of inflammation in the blood. Some research has shown that mindfulness and mindfulness-based exercise may help to improve cognitive function.
Nutrition
Our diets may contribute to products of inflammation in the blood. Fried foods, processed foods, and foods high in added sugars and hydrogenated oils have been linked to higher rates of depression and poorer cognitive function. Instead, pack your diet with whole grains, fruit, and legumes, and use olive oil for cooking. Additionally, research is being conducted to evaluate whether increasing our intake of foods high in omega-3 fatty acids may improve cognitive function. Some examples of foods high in omega-3 fatty acids include fish, nuts, flaxseed, and spinach.
Sleep
Consistently poor sleep is known to cause problems with cognitive function. The brain needs sleep so that it can consolidate and integrate information gathered throughout the day into memory. Sleep disturbance also is associated with an increase in products of inflammation in the blood. The greatest problems occur when the sleep disturbance becomes chronic, lasting more than three months. There are a number of things you can do to improve sleep, such as keeping your bedroom dark and cool, restricting sources of light emissions (such as television or other screens) in the bedroom, going to bed and getting up at the same time each day, and avoiding heavy or spicy meals and alcohol close to bedtime. If you’re having difficulty sleeping, you may also want to talk to your doctor about cognitive behavioral training for insomnia, as it has been shown to be the most effective treatment for sleep disturbance.
The most used strategy for coping with chemo brain is a simple one – write things down.
Coping Strategies
A number of different strategies can be used to help you boost your cognitive function and carry out important tasks. The most used strategy for coping with chemo brain is a simple one – write things down. Use a notebook, a day planner, a smartphone app, an online calendar, or an alarm to help you keep track of important dates, to-do lists, and anything else you want to remember. It can also be helpful to figure out when you typically have the most energy and then schedule activities that require more attention and concentration during that time. Additionally, be sure to focus on one thing at a time, instead of multitasking. Lastly, ask your doctor about cognitive training or rehabilitation programs that are available in your area. These programs can help you learn strategies to improve your memory and concentration.
Most people diagnosed with cancer report experiencing changes in cognitive function at some point in their cancer journey. Please know that you are not alone in dealing with chemo brain. The strategies outlined above can help lift the fog of chemo brain so you can focus on what matters most to you.
Dr. Jamie Myers is a research associate professor for the University of Kansas School of Nursing. She is an associate member of the KU Cancer Center Committee and serves as chair of the SWOG Clinical Trials Research Network Nursing Research Subcommittee. Dr. Myers’s research is dedicated to finding better ways to assess cognitive function for survivors of cancer and developing effective interventions to prevent and treat the cognitive issues resulting from cancer and cancer therapy.
You may be eligible to take part in a study that is investigating a new intervention for chemo brain. Visit clinicaltrials.gov to search for available clinical trials.
This article was published in Coping® with Cancer magazine, January/February 2021.
