Chemo and brain fog

For years people with cancer have worried about, joked about and been frustrated by the mental cloudiness they sometimes notice before, during and after cancer treatment. Even though the exact cause isn't known, and chemo brain can happen at any time when you have cancer, this mental fog is commonly referred to as chemo brain.

The sometimes vague yet distressing mental changes cancer patients notice are real, not imagined. They might last a short time, or they might go on for years. 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. Chemo brain affects everyday life for many people with cancer.

What is chemo brain?

Here are just a few examples of what patients call chemo brain:

• Forgetting things that they usually have no trouble recalling (memory lapses)
• Trouble concentrating (they can't focus on what they're doing, have a short attention span, may "space out")
• Trouble remembering details like names, dates and sometimes larger events
• Trouble multitasking, like answering the phone while cooking, without losing track of one task
• Taking longer to finish things (disorganized, slower thinking and processing)
• Trouble remembering common words (unable to find the right words to finish a sentence)

For most people, brain effects happen quickly and only last a short time. Others have long-term mental changes. Usually the changes that patients notice are very subtle, and others around them might 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 don't tell their cancer care team about this problem until it affects their everyday life.

What causes chemo brain?

Beyond the chemo brain symptoms that start during and just after treatment, there are some cases where brain symptoms start and even get worse after treatment is over. Many cancer treatments, including certain kinds of chemo and radiation, can cause short-term, long-term and delayed problems. This is because that along with chemo, many different things can worsen brain function, including any of the following:

• The cancer itself
• Other drugs used as part of treatment, such as steroids, anti-nausea or pain medicines
• Surgery and the drugs used during surgery (anesthesia)
• Low blood counts
• Sleep problems
• Infection
• Tiredness (fatigue)
• Hormone changes or hormone treatments
• Other illnesses, such as diabetes or high blood pressure
• Nutritional deficiencies
• Patient age
• Depression
• Stress, anxiety, worry or other emotional pressure

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

What can you do to manage chemo brain?

Experts have been studying memory for a long time. There are things you can do to help you sharpen your mental abilities and manage chemo brain. Examples include:

• Use a detailed daily planner or your smart phone. Keeping everything in one place makes it easier to find the reminders you may need. You might want to keep track of appointments and schedules, "to do" lists, important dates, websites, phone numbers and addresses, meeting notes and even movies you'd like to see or books you'd like to read.
• Exercise your brain. Take a class, do word puzzles or learn a new language.
• Get enough rest and sleep.
• Move your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert and decreases tiredness.
• Eat veggies. Studies have shown that eating more vegetables is linked to keeping brain power as people age.
• Set up and follow routines. Try to keep the same daily schedule.
• Pick a certain place for commonly lost objects (like keys) and put them there each time.
• Don't try to multitask. Focus on one thing at a time.
• Ask for help when you need it. Friends and loved ones can help with daily tasks to cut down on distractions and help you save mental energy.
• Track your memory problems. Keep a diary of when you notice problems and what's going on at the time. Medicines taken, time of day and the situation you're in might help you figure out what affects your memory. Keeping track of when the problems are most noticeable can also help you prepare. You'll know to avoid planning important conversations or appointments during those times. This record will also be useful when you talk with your doctor about these problems.
• Try not to focus on how much these symptoms bother 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, you probably notice your problems much more than others do. Sometimes we all have to laugh about forgetting to take the grocery list with us to the store.

Tell others

Another thing you can do to better manage chemo brain is tell family, friends and your cancer care team about it. Let them know what you're going through. You may feel relieved once you tell people about the problems you sometimes have with your memory or thinking.

If brain problems cause trouble at work, talk with your doctor to try and pinpoint what's causing your brain fog and what can be done about it.

*Abridged article from the American Cancer Society.