Many people going through treatment for cancer may experience what’s commonly referred to as “chemo brain.” This has been described as mental fogginess or forgetfulness in some people. You don’t have to have chemotherapy to have chemo brain—people living with cancer and undergoing other treatments can also experience it.
Read on to learn more about chemo brain, the factors associated with it, and how to manage symptoms.
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Describing Chemo Brain Symptoms
Symptoms of chemo brain are often likened to “brain fog”—a temporary state of diminished mental capacity, including problems with memory and thinking—but it can be different for each person.
Up to 75% of people report symptoms of chemo brain during treatment, with 35% still reporting symptoms after treatment. For most people these symptoms are not a sign of any other cognitive condition.
Sensation and Intensity
The intensity can vary among individuals and can be impacted by a variety of factors, including age, general health before treatment, the specific chemotherapy drug and dosage, and whether there is any brain involvement of the cancer or any radiation to the brain.
Sensations of chemo brain can include:
- Memory lapses
- Difficulty concentrating
- Trouble remembering things like names, dates, events
- Trouble with multitasking
- Difficulty learning new things
- Trouble finding words
- Feeling disorganized or having slowed thinking
Symptom Onset
Chemo brain can start during or after treatment. The cognitive impairment can vary widely among people, depending on what kind of chemotherapy was used, the kind of cancer being treated, and whether radiation to the brain also was involved.
Symptom Duration
The duration of chemo brain varies greatly. In some people, it goes away after treatment is over; in others, it persists and gets worse. This can depend on the specific chemotherapy given, the cumulative dosage given and how it was administered, whether any brain lesions are present, and any other drug exposure.
Why Exactly Does Chemo Affect the Brain?
Initially, researchers looked at the chemo brain/cognitive impairment in cancer issue purely from a pharmacotoxicology point of view; that is, looking at it solely from how toxic the chemotherapy agent was to the brain and its subsequent effects on cognitive functioning.
However, lately, that has shifted to looking at how a variety of cancer treatments impacts cognition, as well as a variety of other factors that can increase the risk of chemo brain and cognitive impairment. These factors can include:
- Type of treatment
- Stage and type of tumor
- Age, socioeconomic factors, education
- Stress/trauma or anxiety
- Fatigue
- Comorbid diagnoses (other conditions that are also present)
- Lifestyle factors like diet, exercise, and sleep
- Physical factors like heart health, inflammation, and glucose and lipid metabolism
All of these things can have an impact on the brain and cognition.
Cancer can also impact cognition even without chemotherapy. Cognitive changes like trouble with memory, attention, and multitasking can occur during treatment because of things like malaise (generally feeling unwell), sleep disturbances, nausea, stress and anxiety, use of steroids or sedatives, and anemia.
Long-Term Impact
Even minor cognitive impairment has been shown to significantly impact quality of life and self-image.
People have reported feeling a loss of identity, reduced confidence about going back to work, and increased social isolation because of their trouble remembering things, ability to focus, and reduced cognitive functioning. Social interactions may become overwhelming or cause anxiety for some because of fears regarding their reduced cognitive functioning.
The impacts of chemo brain can be long term in some people, and this can vary depending on what caused the cognitive impairment, the person’s age, their overall health, and any other health-related factors. Other treatment modalities like radiation or surgery might have also impacted the brain or nervous system, contributing to the cognitive impairment.
More research is needed to determine the definitive underlying causes, but it is likely a combination of factors.
Chemo Brain vs. Dementia: Related or Unrelated?
While chemo brain and dementia share symptoms, they are two different conditions. Chemo brain is directly caused by chemotherapy and is often reversible or lessens over time. Dementia causes cognitive changes due to degeneration in the brain and is progressive.
That being said, some research has found an association between cancer and dementia, while other studies have found the opposite. These discrepancies point to a need for more research on the matter.
How to Manage Chemo Brain
Tell your treatment team and healthcare providers if you’re experiencing symptoms of chemo brain, or anything out of the ordinary. Sometimes changes are needed to medications. In addition, there are other ways to manage the effects of chemo brain, including:
- Make lists on paper or on your phone, including shopping lists and daily to-do lists.
- Minimize distractions by cleaning up clutter in your environment and working or reading in quiet places.
- Use planners and wall calendars to keep organized and remember appointments.
- Keep your brain active by doing cognitive exercises like crossword puzzles and word games, listening to TED Talks and podcasts, or going to lectures.
- Stay physically active, if possible.
- Maintain a healthy diet.
- Get enough rest and sleep.
- Let people know what you're going through, so they can offer support.
Supporting Brain Health During or After Cancer Treatment
While there is no specific treatment for chemo brain, there are some things you can do to support and encourage brain health, both during and after treatment. These include:
- Meditation: This can help you relax, focus better, and help clear your mind from any distractions.
- Exercise: Regular physical activity can help relieve stress, improve thinking and alertness, and decrease fatigue.
- Movement therapy: Movement therapies such as yoga, tai chi, or Qigong, and may help with focus.
Talk with your treatment team about your options for therapies and rehabilitation that may help focus, memory, and thinking. Before starting any exercise routine, check with your healthcare providers to make sure it's safe to do so.
Summary
Chemo brain affects most people going through cancer treatment. Though it can significantly impact life, the good news is that, in most cases, it tends to be temporary and improves once treatment is over. However, for some people, the symptoms can linger for years. While there is no cure for chemo brain, there are many ways to manage the symptoms and help minimize their impact on day-to-day life.
