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.