Chemo Brain

Chemo brain refers to impairment of brain functions that include a wide range of cognitive problems experienced by cancer survivors, such as problems with memory, concentration, multitasking, organization and learning.

These symptoms appear after cancer therapy. It is also called chemo fog, chemotherapy-related cognitive impairment or cognitive dysfunction.

The term “Chemo brain” does not really indicate that all these symptoms are caused solely by chemotherapy, however it might be misunderstood that way.

Though it’s not clear what exactly causes Chemo brain, it is well understood that it is an exhausting experience that can interfere with normal life of cancer survivors. Further investigations are expected to unveil more insights on the condition.

The common signs and symptoms of chemo brain are:

• Difficulty remembering things like date, name, number
• Problems with verbal and visual memory like finding the right word or remembering a picture
• Confusion
• Inability to focus
• Learning problems like difficulty learning new skills
• Difficulty doing more than one task at a time
• Tiredness
• Lack of mental clarity often feels like foggy thought processing

When to see a Doctor

Consult your doctor if you experience any of these symptoms. You may note down the signs and symptoms regularly so that your doctor can have a clear understanding of what you are going through.

The exact cause behind signs and symptoms of chemo brain has not yet been figured out.

Some probable causes are:

Cancer-related causes

• Cancer: The psychological impact of a cancer diagnosis could cause memory problems
• Certain cancers can produce memory altering chemicals in the body
• Cancer treatments: Chemotherapy, Hormone therapy, Immunotherapy, Radiation therapy, Stem cell transplant, Surgery

Side effects of cancer treatment

• Anemia
• Fatigue
• Infection
• Menopause or other hormonal changes (caused by cancer treatment)
• Nutritional deficiencies
• Sleep problems, such as insomnia
• Pain due to cancer treatments

Psychological trauma caused by cancer diagnosis and treatment

• Anxiety
• Depression
• Stress

Other causes

• Hereditary characteristics that make you prone to chemo brain
• Certain cancer pain medications
• Cancer that has spread to brain

As Chemo brain in itself is not well defined and elaborated, no diagnostic tests have yet been developed. Often memory scores of cancer survivors experiencing these symptoms are in normal ranges.

You may need blood tests, brain scans or other tests to ensure that other factors are not causing your memory problems.

If these tests indicate no underlying causes, you may be referred a specialist who can design certain coping skills for you.

Simply, there is no cure for Chemo brain as there is no identifiable cause and the treatment is aimed at developing coping skills in the cancer survivors.

Often the treatment is customized according to the individual needs.

The treatment approaches include:

Controlling other causes of memory problem

Health impacts of cancer and cancer treatment such as anemia, depression, sleep problems and early menopause may contribute to chemo brain. These factors may be targeted to minimize symptoms of chemo brain.

Medications

Till now, no medication that has been approved for treating chemo brain. Talk to you doctor if certain medications are useful.

Some doctors prescribe these medications for patients with chemo brain:

• Methylphenidate, a drug used to treat attention-deficit/hyperactivity disorder (ADHD)
• Donepezil, a drug used in Alzheimer's
• Modafinil, a drug used in sleep disorder like excessive day time sleeping
• Memantine, a memory enhancing drug used in Alzheimer’s

It is not possible to describe how these medication may help chemo brain, even if they could.

Alternative and Homeopathic Remedies

There is no evidence that suggests alternative treatment could prevent or cure chemo brain. However, you may consider following treatments after assessing the risks and benefits. Alternative treatments that are said to have memory enhancing properties may also be helpful for chemo brain.

You may try:

• Ginkgo: Initial studies suggest ginkgo may help improve memory in older adults with age-related memory changes. Consult your doctor if ginkgo is safe for you. Ginkgo may interact with blood thinners.
• Vitamin E: Instead if popping in vitamin pills, focus on Vitamin E rich foods such as eggs and vegetable oils. Remember that Vitamin E supplements can interact with blood thinners and chemotherapy drugs.

Lifestyle modifications are necessary in order to cope with Chemo brain.

Cognitive rehabilitation forms the mainstream therapy for people with chemo brain. Your doctor may recommend you to a specialist in managing memory and thinking problems, neuropsychologist.

Some usual approaches in learning coping skills are:

• Repetitive brain exercises: Brain training exercises may rewire brain circuits and improve chemo brain signs.
• Locating the simple and modifiable cause of memory problems: You may keep a track of what seems to cause your memory problems. For instance, if you become more easily distracted when you're hungry or tired, start your work when your tummy is full or you are properly relaxed.
• Learning coping strategies: Finding an alternative and most probably easier way to do everyday tasks might help you cope better with the signs of chemo brain. For instance, you note down briefs of your daily activity or strictly follow your schedule.
• Stress-relief techniques: Stress can worsen your memory and memory problems can increase your stress level. You may learn relaxation techniques such as progressive muscle relaxation or deep breathing techniques to cope better with the situation.

There are several risks and complications associated with Chemo brain.

Risks

Following factors may increase your risk of memory problems:

• Brain cancer
• Increasing age
• Chemotherapy given directly to the central nervous system
• Chemotherapy combined with whole-brain radiation
• Higher doses of chemotherapy or radiation
• Radiation therapy to the brain
• Younger age at time of cancer diagnosis and treatment

Complications

There is a huge inter-individual difference on how long your symptoms last or how severe they are. Talk to your doctor if any symptom of chemo brain bothers you and interferes with your daily life. Your doctor may refer you to an occupational therapist, who can design a better coping technique for you.
Rarely, the symptoms are so severe that people with chemo brain become unable to work and must apply for disability benefits.

Request your health care team to refer you to an oncology social worker who can suggest you better options.