This information explains what chemo brain is and how you can manage it after cancer treatment.
Chemo brain refers to the cognitive changes that people with cancer experience before, during, and after cancer treatment. These changes include having trouble with mental tasks related to attention span, thinking, and short-term memory. Many people describe it as a mental fog.
Chemo brain is common in cancer patients and survivors. Up to 3 out of 4 people with cancer experience cognitive problems during treatment and up to 1 out of 3 people have issues that continue long after treatment.Back to top
Causes of Chemo Brain
Chemo brain can be caused by certain chemotherapies. However, people who do not have chemotherapy also report similar symptoms. These can be caused by:
- Radiation treatment to the head and neck
- Total body irradiation
- Brain surgery
- Hormone therapy, immunotherapy, and other medications such as antinausea medications, antibiotics, pain medications, immunosuppressants, antidepressants, antianxiety medications, heart medications, and medications to treat sleep disorders
- Brain cancer
- Other cancers that have metastasized (spread) to the brain
- Other conditions or symptoms related to cancer or cancer treatments, including anemia, sleep problems, fatigue, hypercalcemia (high blood calcium), and electrolyte imbalances (when the levels of minerals in your body are too high or too low)
- Emotional responses such as stress, anxiety, or depression
- Vitamin and mineral deficiencies, such as not getting enough iron, vitamin B, or folic acid
- Other brain or nervous system disorders unrelated to cancer
Symptoms of Chemo Brain
Symptoms of chemo brain include:
- Memory loss
- Trouble paying attention
- Trouble finding the right word
- Difficulty with new learning
- Difficulty managing daily activities and doing several things at once
- Slowed thinking speed
How severe these symptoms are depends on your:
- Stress level
- History of depression or anxiety
- Coping abilities
- Access to emotional and psychological support services
You may notice these problems during chemotherapy. Within 1 year of treatment, many people find that chemo brain has gone away or gotten much better. However, for some people, chemo brain can continue for years after the end of treatment.
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Managing Chemo Brain
Tell your healthcare provider if you’re having trouble with your memory or notice any other symptoms of chemo brain. He or she can help eliminate some of the factors that can cause cognitive problems. For example, medication to treat nausea can make you less alert and affect your ability to think clearly. A simple change to your prescription may make a difference in the way you feel.
If this doesn’t work, here are some other ways that you can manage chemo brain:
- Make lists. Carry a notepad or your smartphone around with you and write down the things you need to do. For example, keep lists of things to buy, errands to run, phone calls to return, questions to ask at your appointments, etc. Cross items off as you finish them.
- Use a portable planner or organizer (paper or electronic). These can help you stay on top of day-to-day tasks and keep track of appointments and special days like birthdays and anniversaries.
- Get a wall calendar. For some people this works better than a portable planner because you can hang it up in a place that is easy for you to see every day. Put it in a place where you will see it several times a day.
- Set an alarm for when you need to take your medications on your smartphone or tablet.
- Organize your environment. Keep things in familiar places so you’ll remember where you put them. For example, always store your car keys in the same place.
- Avoid distractions. Work, read, and do your thinking in an uncluttered, peaceful environment to help you stay focused.
- Have conversations in quiet places. This minimizes distractions and lets you concentrate better on what the other person is saying.
- Repeat information out loud after someone gives it to you and write down important points.
- Use word play, such as rhyming, to help you remember things.
- Keep your mind active. Do crossword puzzles and word games, or go to a lecture on a subject that interests you.
- Proofread. Double-check the things you write to make sure you’ve used the right words and spelling.
- Train yourself to focus. We often do one thing while thinking about another, which increases our chances of forgetting something important. For example, if you keep misplacing your keys, take extra time to think about or picture what you’re doing every time you put them down. Also say out loud to yourself, “I’m putting my keys on my dresser.” Then look at your keys again, and repeat: “The keys are on my dresser.” Auditory (hearing) cues give your memory an extra boost.
- Exercise, eat well, and get plenty of rest and sleep. Research shows that these things help keep your memory working at its best.
- Tell your loved ones what you’re going through. They may be able to help and encourage you.
Steps to Improve Your Concentration
Concentration is the ability to stay focused on your work without letting people, feelings, thoughts, or activities get in the way. Here are a few strategies for establishing or improving concentration:
- Establish concentration
- Be aware of external distractions. For example, give yourself permission to let your voicemail pick up calls when you’re in the middle of a task.
- Try to recognize internal distractions, such as thoughts, emotions, physical feelings, and hunger, which can interrupt your ability to focus. Do something to limit these internal distractions. For example, if you are hungry, have a snack before starting the task.
- Stop distracting thoughts that pop into your mind as soon as you’re aware of them. You can do this by acknowledging the thought, and then consciously bringing your attention back to the task at hand.
- Keep a notebook or pad of paper handy. If something you need to do pops into your head in the middle of the task, jot it down to get it off your mind and schedule time later in the day to do it.
- Increase concentration
- Set aside time to concentrate. Imagine how you may feel or what you may accomplish after your task is done.
- Use a pencil or highlighter. Take notes or highlight key points in a task such as reading.
- Divide tasks into smaller, more manageable parts.
- Plan breaks according to your concentration span. Take a walk or a lunch break to help clear your head.
- If you find yourself losing focus, stand up. The physical act of standing brings your attention to the fact that you’re losing focus.
- Vary your activities. Change is often as good as taking a break.
- Develop your concentration habits. Like any other skill, you must learn, develop, and practice concentration.
- Determine how long your concentration span is. Find out by recording your start time for a task like reading, and as soon as your mind begins to drift, record this time.
- Learn when your concentration level is at its best. Find a time during the day when you know that you won’t be interrupted and that your energy level matches the particular task. Try to plan your tasks accordingly.
- Find out if there is an environment that improves your ability to concentrate. Remove yourself from distractions for set periods of time to accomplish your work. Figure out what works for you, whether it’s an uncluttered desk, good lighting, or soothing music playing in the background.
Speak with a Neuropsychologist
If 1 year has passed since you finished chemotherapy and you have tried self-help techniques to cope but are still experiencing symptoms of chemo brain, you may want to see a neuropsychologist. Neuropsychologists are people who have special training to assess and treat the symptoms of chemo brain.
Your neuropsychologist will do a complete evaluation and determine if you have any treatable problems such as depression, anxiety, medication side effects, or fatigue. He or she can also identify areas in which you need help, as well as your strengths.
After a complete evaluation, your neuropsychologist may suggest cognitive rehabilitation. This involves working with a professional on problem areas and developing a plan that helps improve your functioning so you can better manage your daily life. Remediation also includes practical ways to address your specific areas of concern.
It’s important to note that some Medicare and Medicaid plans and private insurers pay for these services, but coverage varies, so it is important to have this information before deciding on a treatment plan.Back to top
Resources for People With Chemo Brain
- The Sillerman Center for Rehabilitation has trained occupational therapists who do cognitive rehabilitation therapy for people experiencing memory loss and difficulty concentrating. For more information go to www.mskcc.org/cancer-care/outpatient/sillerman-rehabilitation or call 646-888-1900.
- The Resources for Life After Cancer Center (RLAC) program has support services for cancer survivors and their families. You can talk with a social worker who understands cancer issues. Social workers at RLAC can provide one-on-one support and refer you to various support groups that may be helpful. Call 646-888-8106 for more information.
- Watch a video on managing cognitive changes after cancer treatment: www.mskcc.org/cancer-care/survivorship/videos-survivors/discussion-about-post-treatment-changes-thinking-and-memory
- The American Board of Professional Psychology website has names of highly qualified neuropsychologists in your area. Go to: www.abpp.org
- CancerCare offers free counseling, support groups, education, financial assistance, and practical help. This organization is led by social workers who specialize in cancer. For more information, go to www.cancercare.org