Thursday, September 20, 2012

Navigating Through 'Chemo Brain'*

Idelle Davidson

Does any of this sound familiar? You’re halfway through what will be six rounds of chemotherapy when you notice a dense fog rolling over your brain. You grow forgetful. The responsibility of making even small decisions overwhelms you. You find multitasking impossible; good luck completing any task at all. Driving shatters your nerves; you’re disoriented, no longer sure which direction is home.
You lose your keys, your glasses, your cell phone, and realize with a panic that the kids are waiting for you at school. You haven’t a clue where you parked your car. You leave water running in the sink and food burning on the stove. You struggle to retrieve words (you know it begins with a “ka” or “ch” sound and it’s oh so close, right there on the tip of your tongue). Ditto for numbers. You pick up a book and put it down because after the first paragraph, you have no idea what you just read. You avoid social situations because you can’t follow the thread of a conversation. And you wonder, what is happening to me?

If you can relate, then chances are you’re experiencing what researchers refer to as “cancer or cancer-treatment-related cognitive impairment,” also known as, “chemo brain,” or as I like to say, “Where the hell is my memory?” You’re not alone. In fact, among lymphoma and breast cancer survivors where there’s the most data, up to 80 percent of people who undergo chemotherapy report some amount of cognitive impairment. For some, the condition is fleeting. For others, it may last for years.

Undoubtedly you’re concerned. So talk to your oncologist and gather as much information as you can. In the meantime, although there is no cure or prevention as yet for chemo brain, here are some strategies that may help:

1) Ask for a referral to a neuropsychologist who should be able to evaluate your language, motor, and sensory and visual-spatial skills as well as how you reason and process information. This is an especially good idea for people who have not yet begun treatment but are worried about the cognitive fallout and want to establish a baseline. Whether you’re newly diagnosed or not, a neuropsychologist can monitor you over time and work with you to strengthen any areas of weakness.

2) Seek out emotional support. It’s well-established that depression and stress also can cloud memory (neuropsychologists screen for that too), not to mention that they wreck havoc on your sense of well-being. So do what you can to lighten your emotional load, whether that means joining a support group, practicing meditation or yoga (both fabulous stress-reducers) or consulting with your doctor about the pros and cons of antidepressants.

3) Other prescription drugs may help with focus. Talk to your doctor about Provigil, Ritalin and other stimulant pharmaceuticals.

4) Exercise your body. Swim, walk, join a gym. Physical exercise increases cerebral blood flow and promotes the growth of brain cells. It is probably the number-one best natural stress reducer as well.

5) Exercise your mind. Work at reading that book (even if it takes you three times as long as anyone else), learn a dance routine (in small chunks if that's what works), try your newspaper’s daily crossword puzzle, take up piano, look into some of the commercial cognitive rehabilitation games. The “no-pain, no-gain” adage applies to the mind as well.

6) Eat healthfully. Cut out the junk. Focus on lean proteins and a colorful assortment of vegetables (especially dark leafy greens) and fruits that nourish the brain. Avoid saturated fats (cheese, whole milk, lard, butter, fatty animal products) and trans-fats (in some fast foods and baked goods such as pie crusts, donuts, crackers, etc.) that can clog arteries and cause poor blood flow to the brain (there’s a reason trans-fats are banned in a few states). Omega-3 fats are the good guys (wild salmon, fish oil supplements, herring, flaxseeds, chia seeds, walnuts, etc.). Researchers believe they improve mood and protect against inflammation and cognitive decline. 

7) Laugh.  Laugh a lot.  Humor really does help bring the world into focus and that's an especially good thing for people with chemo brain.

* [Note: A version of my post appears on the Navigating Cancer Survivorship blog. NCS is a national nonprofit organization connecting people to cancer survivorship resources.]


  1. Thanks for the wonderful tips. More importantly, thanks for the work you do regarding this under-acknowledged side effect of treatment. I need to get my hands on your book soon.

  2. I noticed the effects when I returned to work after a 6 month battle with leukemia. I went into training for new responsibilities and felt like I didn't grasp much of the program. I would see co-workers I've known for years and have to wrack my brain to remember their name. Things that always came easily to me no longer did. I couldn't focus and the most simple task seemed like a huge effort. It was scary and frustrating and I didn't know what was going on until I happened to see a news article about "chemo brain". I was surprised none of my care givers ever addressed this issue. It took about 2 years but I now feel like I am back to what I used to be. I still struggle sometimes, mostly with math calculations, but I've learned to use the calculator and Excel formulas to compensate ! Hang in there if you are struggling, as it will get better. Livestrong !

  3. Thanks, Nancy and Wendy.

    Wendy, I'm glad you're mostly back to your old self and that you've found easy ways to compensate. It was so nice to read your positive message.