How to combat chemo brain

How to combat chemo brain

Can cancer treatment affect your memory and concentration? Often called "chemo brain," a mental fogginess can sometimes accompany cancer treatment. However, despite the condition's name, chemotherapy is not completely to blame for symptoms, says Erin Dunbar, M.D., a neuro-oncologist at Piedmont.

"Chemo brain is caused by a combination of factors," she says. "I often call it 'treatment brain,' because multiple treatments, including radiation, surgery or immunotherapy, can cause these symptoms."

Symptoms of chemo brain

Chemo brain, or treatment brain, can cause problems with:

  • Completing tasks or projects: Becoming disorganized or slow to complete an activity

  • Concentration: Difficulty focusing on one task at a time, "spacing out"

  • Learning: Difficulty learning new skills

  • Memory: Trouble remembering names, events or familiar details

  • Multitasking: Trouble doing two things at once

  • Word recall: Inability to find the word you want to say

It may also cause:

  • Confusion

  • Fatigue

  • Metal fogginess

What causes chemo brain?

Dr. Dunbar references a study that uses a soil, seed and pesticide analogy to explain chemo brain:

  • The "soil" is your brain health, age and any pre-existing conditions that can affect brain health.

  • The "seed" is the type of tumor or cancer you have.

  • The "pesticide" is the type of cancer treatment (such as chemotherapy, radiation therapy, surgery, hormone therapy or immunotherapy) used to fight your cancer. While the "pesticide" works to kill cancer cells, it can cause unintended damage to healthy cells as well as inflammation of the brain.

"It doesn't matter if your cancer treatment is a pill, intravenous chemotherapy or radiation," she says. "What matters is that the treatment can function as a toxin in the body and injure the brain unintentionally. Treatment can damage blood vessels and nerve connections, and affect the brain's chemical production."

Dr. Dunbar adds, "The main mechanism of injury is inflammation. Inflammation in the brain is similar to sunburn on the skin. It is important to understand it is not just chemotherapy causing chemo brain or treatment brain. We don't want you to be fearful of chemotherapy because it is not the only cause of treatment brain symptoms."

In addition to cancer treatment, the following can contribute to treatment brain symptoms:

  • Cancer itself, particularly if it has spread to the brain or started in the brain

  • Complications from treatment, including infection, pain, insomnia, vitamin and mineral deficiencies, anemia, menopause or hormonal changes

  • Other medications, such as pain medicine

  • Stress, depression and/or anxiety related to your diagnosis

When does chemo brain occur?

Depending on the type of treatment, some of the effects on the brain occur in real time and others are delayed or cumulative.

"Someone may have fatigue, nausea or ear ringing during treatment, and a few months later, may experience hearing loss or memory loss," says Dr. Dunbar. "Symptoms can come in waves or stages."

Chemo brain: What you can do

"Chemo brain or treatment brain is real and there is evidence-based hope that we can successfully treat it," says Dr. Dunbar. "We pick the best treatment plan and optimize it for the patient. We do everything we can to prevent the effects of treatment brain. We want to be aware, acknowledge that it exists and prevent it."

She says there are several lifestyle modifications you can make to prevent or minimize the effects of treatment brain, including:

  • Ask your family and friends for support.

  • Eating a healthy, well-balanced diet.

  • Getting adequate rest.

  • Getting good exercise.

  • Practicing relaxation or mindfulness techniques. "There is a phenomenal amount of literature on the positive impact of mindfulness, yoga and stress-relieving techniques," says Dr. Dunbar.

  • Staying hydrated.

  • Staying organized with a planner or journal.

  • Talk to your employer about minimizing distractions at work. Most employers are required by the Americans with Disabilities Act to help you make reasonable accommodations to perform the essential functions of your job.

  • Track your symptoms so you can share them with your physician.

Chemo brain: How your physician can help

"It doesn't matter when the patient comes to see me," says Dr. Dunbar. "There is always something we can do to help treat their symptoms. We use evidence-based hope. At Piedmont, our treatment plans are personalized to the patient's unique cancer journey and are precise, using the best available evidence to optimize their situation."

Your physician may recommend one or more of the following:

  • Hyperbaric oxygen treatment

  • Managing other identified causes of cognitive impairment, such as anemia, depression or early menopause

  • Medications, such as those traditionally used for memory disorders, fatigue, depression, and anxiety, can improve cognitive function and quality of life

  • Occupational therapy, which helps you master your environment.

  • Surgery to reduce swelling or pressure in the brain

Is chemo brain permanent?

It depends on your individual circumstance, but in general, treatment brain or chemo brain responds well to treatment and it is not dangerous.

"Many patients have meaningful improvements with treatment and in many cases, chemo brain or treatment brain goes away. You are not necessarily stuck with it. There is a real possibility it will go away."

When to see a physician for chemo brain

If you experience any of the above symptoms during or after cancer treatment, contact your doctor.

"Call your specialist at the earliest symptom that causes you worry," says Dr. Dunbar. "The earlier we know, the easier it can be to fix."

See 11 things your doctor wants you to know.


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