|Understanding Chemo Brain|
Many experts in cancer care agree that there are documented and recognizable cognitive changes during and following chemotherapy. This phenomenon is often termed “chemo brain.”
“Chemo brain does not have a specific medical definition,” says John Ward, MD, professor of medicine and chief of the Oncology Division in the Department of Medicine at the University of Utah School of Medicine in Salt Lake City. “It is a term widely-used to describe cognitive changes, depressive symptoms, and fatigue after chemotherapy.” Dr. Ward says it is difficult to precisely define because of the variety of regimens, varying duration of therapy, accompanying stress of the diagnosis, variety of cancers, presence of depression, and variety of stages and comorbid illnesses among patients.
Chemo brain may not only be the result of chemotherapy. “It may occur following chemotherapy, radiation therapy, and/or such adjuvant therapies and hormonal therapy,” says Terri Ades, DNP, FNP-BC, AOCN, Director, Cancer Information, American Cancer Society’s National Home Office in Atlanta. “Most define it as not being able to remember certain things or having trouble finishing tasks or learning new skills.”
Ades, who is also a doctorally prepared advanced practice oncology nurse, says symptoms are very subtle, but patients who report the changes are very aware of the differences in their abilities to think clearly. “The symptoms make it very difficult for patients to carry out normal activities in their personal and professional life,” she says.
Symptoms, she adds, are usually associated with changes in memory, concentration, and executive function. “Executive function would be such things as planning, decision-making, judgment, and the ability to shift between activities in a flexible way,” Ades clarifies. “So, yes, this would mean multitasking might be difficult. Patients have difficulty staying focused or organized. Changes in concentration might be evidenced by a shortened attention span. And ‘feeling scatterbrained’ might nicely describe how some people might feel.”
Effects on a Patient
Side effects can vary in intensity from patient to patient. "Among other side effects, chemotherapy treatment may cause problems with mental abilities," says Paul Jacobsen, PhD, associate center director for population science at Moffitt Cancer Center in Tampa, Florida. “We can’t pinpoint the exact causes of the effects of chemotherapy on brain function; however, common problems can include forgetfulness, problems with concentration, and difficulty handling multiple mental tasks at the same time.” He says once the patient perceives changes in mental abilities, it’s worth a discussion with a doctor. “There are both medical and nonmedical approaches that can help with these issues,” he advises.
Coping With Chemo Brain
Some strategies might help a person sharpen their mental abilities and manage some of the problems associated with chemo brain, says Ades. “For example, using a daily planner to keep everything in one place makes it easier to find the reminders a person might need. Tracking memory problems through keeping a diary of when problems occur and the events that are going on at the time can help the person prepare for future problems,” she says. It may also help reveal what is triggering the problem.
She suggests exercising the brain by taking a class, doing word puzzles, or learning a new language. She also recommends getting enough rest and sleep, and engaging in some physical activity. “Regular physical activity not only is good for the body, but also improves mood, makes us feel more alert, and decreases tiredness,” she says Slowing down and realizing these limitations are also warranted. “Don't be hesitant to ask for help,” she suggests. “Don't multitask, but rather focus on one task at a time,” Ades adds.
Another helpful suggestion from Dr. Jacobsen is to strengthen a support system of friends and caregivers and to attend support group meetings. “Sometimes it’s helpful and therapeutic to discuss challenges and experiences with others,” he adds. “Most major cancer centers have resources to help match patients with groups.”
Involve Your Doctor
Ades stresses that patients must always discuss any new symptom with their doctor without delay. Cognitive changes can have a number of causes, some not related to the cancer or treatment. “The brain is a site where cancer can spread to, so a patient's doctor will first want to be certain that this has not occurred as well as rule out non-cancer–related causes,” Ades says.