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The American Cancer Society

Chemo Brain: It is Real

April 09, 2012

By Terri Ades, DNP, FNP-BC, AOCN

 

Recently a colleague at work who had just returned from a getting a haircut mentioned to me that his hairdresser, who has lung cancer, was upset because her husband was very worried about her. The hairdresser explained that she had started having some memory problems - couldn't remember what she did yesterday or couldn't remember people's names.  And she had started to tell her husband something and stopped in the middle of her story - not remembering what to say next.  She too acknowledged being a little concerned and was seeing her doctor in 3 days, but she didn't know how to help her husband until then.  I asked if she was receiving chemotherapy and was told yes, so I explained that she might have "chemo brain."  


We've known for some time that radiation therapy to the brain can cause problems with thinking and memory. Now, we are learning that chemotherapy is linked to some of the same kinds of problems. Research has shown that some chemotherapy agents can cause certain kinds of changes in the brain. Though the brain usually recovers over time, the sometimes vague yet distressing mental changes cancer patients notice are real, not imagined. These changes can make people unable to go back to their school, work, or social activities, or make it so that it takes a lot of mental effort to do so.  These changes affect everyday life for many people receiving cancer treatment.


Patients report the following symptoms:

  • Short-term memory lapse -- forgetting things that they usually have no trouble recalling
  • Trouble concentrating -- can't focus on what they're doing, have a short attention span, may "space out"
  • Trouble with word-finding, such as remembering names, not completing sentences, or not being able to think of a word
  • Trouble multi-tasking, like answering the phone while cooking, without losing track of one task
  • Taking longer to finish things-- slower thinking and processing

 

Doctors and researchers refer to these symptoms as a "mild cognitive impairment," but they're commonly called "chemo brain."  For most people, chemo brain happens quickly and only lasts a short time. Others have long-term mental changes. Usually the changes that patients notice are very subtle, and others around them may not even notice any changes at all. Still, the people who are having problems are well aware of the differences in their thinking. Many people do not tell their cancer care team about this problem until it affects their everyday life.


What causes chemo brain?


Studies suggest that there may be more than one cause of chemo brain, especially for the short-term symptoms. Some people with cancer have very real brain problems even though they have not had chemotherapy. Still others notice problems when getting hormone treatments, such as estrogen blockers or androgen deprivation therapy.  For some, problems start after surgery.


Along with chemotherapy, other health problems that might cause or worsen brain function include: the cancer itself;  other drugs; patient age; stress; low blood counts; sleep problems; infection; depression; fatigue; hormone changes or hormone treatments; other illnesses, such as diabetes or high blood pressure; nutritional deficiencies; and anxiety or other emotional distress.


Most of these cause short-term problems, and get better as the underlying problem is treated or goes away. A few factors, such as depression, can cause long-lasting brain problems unless the cause is treated.


What can patients do about it?


So far, there is no way to prevent chemo brain while you are getting cancer treatment.  For some people, treating their cancer will mean trouble with thinking, memory, planning, and word finding. If you are having symptoms, the first step is to discuss them with your cancer care team. They will consider what the underlying cause is, then help you identify some management strategies.

The following are steps that some patients have found helpful in managing their day-to-day living.

  • Write things down. Keep track of appointments and schedules, to-do lists, important dates, phone numbers and addresses.
  • Exercise your brain. Take a class, do word puzzles, or learn to do something new.
  • Exercise your body. Regular physical activity is good for your body; it improves your mood, makes you feel more alert, and helps you feel less tired.
  • Get enough rest and sleep.
  • Eat your veggies. Studies have shown that eating more vegetables can help you keep up your brain power.
  • Set up and follow routines. Put the things you often lose in the same place each time you're done with them. Try to keep the same daily schedule.
  • Give yourself permission to focus on one thing at a time.
  • Choose only those activities that are important to you and allow yourself plenty of time to complete tasks.
  • Consider use of relaxation techniques such as yoga or meditation.
  • Track your memory problems. Keep a diary of when you notice problems and the events that are going on at the time. Medicines taken, time of day, and where you are may help you figure out what affects your memory. Don't plan important tasks or events when your memory problems are worse.
  • Do not criticize yourself for not being able to remember. Accepting the problem will help you deal with it. Patients say that being able to laugh about things you can't control can help you cope. And remember, you probably notice your problems much more than others do.


Also, be sure to tell your family and friends what is going on with you. They will be relieved and will worry less.  You are not crazy and you area not losing your mind. Chemo brain is real.


More research is needed


More research is needed so we can better understand chemo brain, but it is not easy to study. For example, researchers may use different tests to measure the problems with thinking and memory, so the results may not compare well with each other. Some people report changes that are so mild that their brain tests look normal and doctors don't have a good way to measure the changes.


There are also differences in when certain kinds of brain problems happen. Some researchers have tested brain function a few weeks after treatment, others months or even years later. If the problem only lasts a few weeks with no long-term changes, late testing can miss it. If the changes last more than a year but the testing stops after 6 months, no one knows how long they last. Another timing problem in studying chemo brain is that most studies didn't test the patients before treatment to compare to results after treatment.


In studies that did test before treatment, some people were seen to have brain function problems before treatment was even started. So it's possible that the cancer itself causes some of the problems, or that some other related problem (like anxiety about having cancer) caused brain function to decline. Studies are needed that test people before the treatment and then follow up to look for changes over time.


So, my colleague quickly called his hairdresser and said, "I want you to talk to this oncology nurse practitioner about your symptoms."  And she agreed.  I explained that her symptoms sounded like chemo brain.  I could hear the relief in her voice. Of course she was planning to tell her doctor about her symptoms, but she was going home to tell her husband not to worry!


For more information about chemo brain and other chemotherapy side effects, click here.


Dr. Ades is director of cancer information for the American Cancer Society.

 

Filed Under:

Survivorship | Terri Ades

Comments

4/11/2012 12:34:37 PM #

Molly

I think it's so important to be aware of this side effect and to support and validate the people who experience it. At the same time, it is real, but not inevitable, and I wanted to chime in with my experience that some (maybe many?) of us don't experience it. The publicity around it really worried me before I started chemo, but I had no such effect and was able to work all through chemo and radiation at a demanding job requiring lots of attention to detail, juggling projects, etc. And as a working professional in a fragile economy, it's important to me that we be careful about giving employers another reason to think cancer patients and survivors are necessarily going to be less productive workers - some of us work even harder to compensate! Smile I guess the answer is balance. As with so many aspects of cancer and cancer treatment, people's experiences will be different.

Molly

4/11/2012 1:12:36 PM #

Angelia Carter

I have all the above symptoms.  Is there a cure?

Angelia Carter

4/11/2012 4:06:55 PM #

admin

Hi, Angelia, unfortunately, there is no cure. But talk to your health care professionals, or call our National Cancer Information Center at 1-800-227-2345. They're open 24 hours a day, 7 days a week. And be sure to follow the tips Dr. Ades gives in this blog. Good luck and best wishes.

admin

4/15/2012 1:58:40 PM #

Susan Raiser

Hi everyone. I am a 1 year 9 month breast cancer survivor and life is good, except for the memory. I was a bit scattered before chemo and radiation. Initially I did  not have any more "goldfish" moments, but as time goes on, it has gotten worse. I, too, have times when I cannot remember the names of people closest to me, and am having a very hard time at a new job of 3 months just learning and maintaining the information in my head. While I am at work, it is very frustrating and I almost feel stupid, even though I know what it is going on. I am taking Herceptin which may be adding to this. At home, I don't remember where I put things - but at least there I can laugh about it (sometimes). All I know is, I am alive and doing well. Sometimes I cry about this chemo brain. Yes, it is so real. But I am a survivor. Yea for all of us.

Susan Raiser

4/17/2012 11:44:47 AM #

Jacquelyn Bakewell

Hello everyone today is my one yr surgery date and April 19th will be my one year survior date. I just wanted to comment that I agree with chemo brain but let me tell you radiation brain is also real. It took several months after the radiation stopped befoe my brain started workin! I am 9 months post pelvic radation wow what a ride. I have just made my portfolio so i'm still new at this but more to come..........

Jacquelyn Bakewell

4/21/2012 12:50:07 AM #

Dr Pullen

There is no doubt in my mind as a family physician and the husband of an ovarian cancer patient in her third course of chemo that chemo brain is very real.  Short term memory, attention to detail and general cognition are all unquestionably affected.  

Dr Pullen

4/30/2012 3:24:27 PM #

Maryann Dickman

It took almost 2 years for my chemo brain to shake itself out of my head.  I was frustrated and wondered if it was my age (72 now).  I am back !!!  What a wonderful feeling.  

Maryann Dickman

4/1/2013 7:58:10 PM #

Judy Baker

Oh my! I'm so released to know I'm not totally losing it. I had chemo during Dec. 2012-Feb. 2013, had surgery, and now face more chemo. I dread it like the plague! Here I go with continuous diminished of brain function again. Until today, I thought it was me. Now it has a name. Thank you.

Judy

Judy Baker

4/11/2013 8:59:22 AM #

Zar

I am an 8 year Breast Cancer Survivor. I have most of the symptoms of what is referred to as chemo-brain. I kept waiting for these symptom's to go away.  They have not, and it interferes with my job, my relationships and who I am and who I was. But, I am glad to be alive and here!  I just wish I could find more like me, and that the medical world would quit trying to blame this on depression, neurosis.... I know me and all my quirkiness ( I know when something isn't in sync), and if it's the last thing I do-I will make them all understand --THIS IS REAL, and it hurts it is not validated.

Zar

4/24/2013 9:36:42 PM #

patti steich

My husband had radiation and chemo treatments for throat and lung cancer and had a bad reaction to a chemo drug taxol and has chemo brain  he gets confused and his memory is bad  it has been almost  2 and a half yrs form he was diagnosed with cancer  and treatments   are done but his memory is bad and he gets confused  I try to help him  but he ends up fighting with me a lot I don't know what to do   is this normal?

patti steich

9/27/2013 6:08:52 AM #

Cheri

I have spent the last 11+ years dealing with this.  It is most frustrating dealing with my job.  I used to almost have a photographic memory...reduced to stupid!  I hate it...especially the inability to find the right words in conversation, unable to draft any kind of reports, letters...spelling (which used to be impeccable) typing....including this post... I appear to most I am sure as uneducated ....

Cheri

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