Chemo Brain: What Helps and What to Ask

The single most useful step is telling your team. The National Cancer Institute's guidance is direct. Talk with your doctor about memory loss or problems with thinking. Do that whether it is happening during treatment or afterwards.

That conversation is not just for the record. Your doctor will ask about your health history. They will ask about your usual daily activities, to find a cause for the cognitive problems. And they will do an exam to check for signs of disease. NCI also notes something you cannot work out on your own. Testing can help sort out whether the problem comes from the cancer coming back, or from the treatment itself.

Some of what feels like chemo brain is driven by something fixable. NCI lists five conditions that may be contributing: poor nutrition, anxiety, depression, fatigue, and insomnia. It says treating them may help.

NCI names other contributors too. They include pain, sleep problems, and alcohol or drug use. They also include other medical conditions unrelated to cancer, older age, being postmenopausal, frailty, and the stage of the cancer. Certain medicines count as well, such as endocrine therapies like tamoxifen.

None of these are things to sort out alone. Bring your full medicine list. Include anything you take for sleep, pain, or mood. Then your team can look at the whole picture.

This is the specific service to ask for by name. NCI describes the goal of cognitive rehabilitation. It is to improve your memory, and the way you think, organize, and make decisions.

Here is what it involves, according to NCI:

• Learning ways to take in new information and perform new tasks
• Staying organized by using tools such as calendars or electronic diaries
• Doing activities over and over, usually on a computer, that become more challenging over time

Ask whether your cancer center offers it. If not, ask who they refer to.

NCI suggests asking your health care team directly whether there are specialists you can see. It names three: a neuropsychologist, an occupational therapist, and a vocational therapist. It also suggests asking to meet with a social worker, who can tell you about support resources.

Occupational therapy is worth pushing on. NCI's late effects guidance notes that doctors may refer people with cognitive changes to physical, occupational, or speech therapists. Those therapists help manage symptoms. An occupational therapist works on the actual tasks that have become hard.

A vocational therapist is the person to ask about work. NCI names the role. But it does not spell out what workplace adjustments to seek. So treat this as a question for your team, not a checklist. Ask what a vocational therapist in your area can help with. Ask what documentation your employer would need from your clinic.

Plan your day. Do things that need the most concentration at the time of day when you feel best. Try to get enough sleep at night. Keep daytime naps to under an hour. And keep a consistent daily routine.

Exercise your body and mind. Exercise releases endorphins, also known as feel-good chemicals. They give people a feeling of well-being. NCI adds that exercise, physical activity, and mind-body practices may improve the way you think and focus. Tai chi, qigong, and yoga are examples.

Restore your attention. NCI describes activities that restore attention. They may help you stay focused on what is around you: walking, gardening, bird-watching, and caring for pets.

Try meditation. Mindfulness-based stress reduction is a type of meditation. It focuses on bringing attention and awareness to each moment. Meditation may help improve cognitive function.

Use memory aids without apology. Write down important information and keep the list handy. Use a daily planner, recorder, or other electronic device to help you remember important activities. Keep a list of important names and phone numbers in one place.

Ask, but keep expectations realistic. NCI reports that several drugs have been studied to treat cognitive problems. They include psychostimulants and erythropoietin-stimulating agents. The results are mixed.

NCI suggests asking your health care team:

• Am I at increased risk of cognitive problems based on my treatment?
• When might these problems start, and how long could they last?
• What steps can I take to prevent them?
• Which symptoms should I contact you about?
• Can I meet with a social worker about support resources?
• Are there specialists I can see, such as a neuropsychologist, occupational therapist, or vocational therapist?

• Call 911 or go to an emergency department if the confusion begins abruptly alongside a fever, a severe headache, a racing pulse, clammy skin or a faint, or if the person cannot be kept awake. MedlinePlus puts sudden confusion of that kind in the emergency category, not the waiting-room one.
• Call your care team the same day if thinking, awareness or behaviour shifts suddenly, over hours or a couple of days, rather than drifting slowly. NCI describes that pattern as delirium: a confused mental state with changes in awareness, judgment, sleeping patterns and behaviour, sometimes with restlessness, anxiety or sudden agitation. It has causes that can be found and treated, so it is worth a call rather than a wait.
• Call your care team within a day or two if the fog has clearly deepened, or it is now getting in the way of taking your medicines correctly, driving safely or holding onto work.

• National Cancer Institute: Delirium (PDQ) - Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/memory/delirium-pdq
• National Cancer Institute: Cognitive Impairment in Adults with Cancer (PDQ) - Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/memory/cognitive-impairment-pdq
• National Cancer Institute: Memory or Concentration Problems and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/memory
• MedlinePlus: Confusion. https://medlineplus.gov/ency/article/003205.htm
• National Cancer Institute: Late Effects of Cancer Treatment. https://www.cancer.gov/about-cancer/coping/survivorship/late-effects

Helpful next pages include Side Effects of Cancer Treatment, Immune-Related Side Effects, Low White Blood Cells During Chemotherapy, and Supportive Care.