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CHEMO BRAIN

Chemobrain

For many years cancer survivors have worried, joked about, and been frustrated with the mental cloudiness they experience before, during, and after chemotherapy -- a side effect commonly called "chemobrain." While long recognized in practice, it is not until recently that this problem has been supported with science.

Recent research has shown that some cancer drugs can, indeed, cause changes in the brain. Imaging tests have shown smaller brain size in the areas of the brain that are part of memory, planning, putting thoughts into action, monitoring thought processes and behavior, and inhibition. Though the brain usually recovers over time, these findings confirm that the sometimes vague, yet distressing mental changes cancer patients experience are real, affect daily activities, and warrant further research.

Chemobrain is real. You are not going crazy. Here we will tell you what chemobrain is, how you can deal with it, and what is being done about it.

What is chemobrain?

Here are just a few examples of what patients have experienced and defined as chemobrain:


memory lapses  
trouble concentrating  
being unable to remember details  
changes in the ability to do more than one thing at a time  
having trouble remembering common words.
For some people these effects happen quickly and only briefly, while others experience mild, long-term mental changes. Usually the changes that patients experience are very subtle, but the people who have problems are well aware of the differences in their thinking. Still, many people do not tell their healthcare team about this problem until it affects their every day life.

Doctors and researchers call chemobrain "mild cognitive impairment" and define it as the inability to remember certain things, complete certain tasks, or learn new skills.

Is chemobrain real?

Yes, chemobrain is real, but its cause is unknown. How often it happens, what may trigger it, or what can be done to prevent it, is also unknown. Studies looking at pictures of the brain have shown changes in the brain activity of breast cancer survivors treated with chemotherapy when compared to untreated women. These changes continued to show up on scans 5 to 10 years after ending treatment.

At this time, medical professionals do not know what causes chemobrain. It could be any of these things:


the cancer itself  
chemotherapy drugs  
other drugs used as part of treatment (such as anti-nausea or pain medicines)  
patient age  
stress  
low blood counts  
depression  
fatigue  
hormone changes
What is known is that chemobrain is a real problem that affects both men and women. Low estimates are that 20% to 30% of people getting chemotherapy will experience it.

What can I do to manage chemobrain?

Day-to-day coping

Experts have been studying memory for a long time and many resources are available to help you sharpen your mental abilities and manage the problems that may come with chemobrain. Some things that you can do include the following:


Use a detailed daily planner. Keeping everything in one place makes it easier to find the reminders you may need. Serious planner users keep track of their appointments and schedules, "to do" lists, important birthdays and anniversaries, phone numbers and addresses, meeting notes, and even movies they'd like to see or books they'd like to read.
Exercise your brain. Take a class, do word puzzles, or learn a new language.
Get enough rest and sleep.
Exercise your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert, and decreases fatigue.
Eat your veggies. Studies have shown that eating more vegetables can help you maintain brain power.
Establish routines. Pick a certain place for commonly lost objects and put them there each time. Try to keep the same daily schedule.
Don't try to multi-task. Focus on one thing at a time.
Track your memory problems. Keep a diary of when you experience problems and the events that are going on at the time. (You might track this in your planner.) Medicines taken, time of day, and the situation you are in may help you figure out what influences your memory. Tracking when the problems are most noticeable can also help you prepare by not planning important conversations or appointments during those times.
Try not to focus so much on how much these symptoms are bothering you. Accepting the problem will help you deal with it. As many patients have noted, being able to laugh about things you can't control can help you cope. And remember, the problems are much more noticeable to you than they are to others. Sometimes we all have to laugh about "forgetting" to take the carefully composed grocery list with us to the store.
Telling others

Another thing you can do to better manage chemobrain is talk about it to family, friends, and your healthcare team. Let them know what you are going through. You will probably feel relieved once you tell people about the problems you have sometimes with your memory or thinking.

You are not stupid or crazy; you just have a side-effect that you have to learn to cope with. Even though this is not a visible change, like hair loss or skin changes, your family and friends may have noticed some things and may even have some helpful input into the problems. For example, your partner may notice that when you are rushed, your thinking is less effective. Explain to them what they can do to help. Getting support and understanding can help you relax and make it easier for you to focus and process information.


Can chemobrain be prevented?

The cause of chemobrain is unknown and at this time there is no way to prevent it. It is known that it seems to happen more commonly with high doses of chemotherapy. However, because it is usually mild and most often disappears with time, proven and effective chemotherapy plans should not be changed to try to prevent this side effect.

What is being done about chemobrain?

Now that chemobrain is recognized as a cancer treatment side effect, studies are being done to learn more about it. Some are looking to find out which chemotherapy drugs are more likely to cause chemobrain. Researchers are also looking at possible ways to prevent chemobrain from happening, as well as strategies to help survivors who continue to experience thinking problems. Researchers are studying other aspects of cancer treatment that may lead to the development of long-term mental changes, too. For example, they are looking at the types and doses of chemotherapy the patients have received and genetic differences among the individuals.

ACS info
Useful quick reference guides from CancerCare:

"Doctor, Can we talk about Chemobrain?"

http://www.cancercare.org/pdf/fact_sheets/fs_chemobrain_doctor_talk.pdf?origin=enews_0805p

"Combating Chemobrain: Keeping Your Memory Sharp"

http://www.cancercare.org/pdf/fact_sheets/fs_chemobrain_memory.pdf?origin=enews_0805p

"Ways to Improve Concentration: Three Key Steps"

http://www.cancercare.org/pdf/fact_sheets/fs_chemobrain_concentration.pdf?origin=enews_0805p

"cognitive Problems after Chemotherapy"

http://www.cancercare.org/pdf/fact_sheets/fs_chemobrain_cognitive.pdf?origin=enews_0805p

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