The symptoms of chemo brain can be very frustrating both for those who are going through cancer treatment, as well as for their loved ones, who are trying to provide support.
Despite the many questions, it’s clear that the memory problems commonly called chemo brain can be a frustrating and debilitating side effect of cancer and its treatment. Researchers are working to understand the memory changes that people with cancer experience.
How Does Chemo Brain Happen?
Oncologists and other physicians have known for years that radiation can contribute to patients experiencing memory problems, but more recent information now suggests that chemotherapy is also linked to some of the cognitive problems patients experience. These sometimes vague yet distressing mental changes cancer patients notice generally last a short period of time, but they also may go on for years.
The good news is that there is now more information available to patients to verify that chemo brain symptoms are real. Unfortunately, more research is still needed to help patients cope with this symptom, as well as with preventing it altogether. How much these chemo brain symptoms are attributable to being a side effect of the patient’s chemotherapy treatment or the rigors of cancer treatment still remains to be identified.
Chemo Brain Symptoms
Signs and symptoms of chemo brain may include the following:
- Memory Lapses – Difficulty Recalling
- Trouble Concentrating or Finishing Tasks
- Difficulty Remembering Details
- Forgetting Common Words
- Shortened Attention Span
- Feeling Foggy
- Being unusually disorganized
- Difficulty concentrating
- Difficulty finding the right word
- Difficulty learning new skills
- Difficulty multitasking
- Feeling of mental fogginess
- Short-term memory problems
- Taking longer than usual to complete routine tasks
- Trouble with verbal memory, such as remembering a conversation
- Trouble with visual memory, such as recalling an image or list of words
How Long Does Chemo Brain Last?
When the symptoms of chemo brain begin, how long these symptoms last and how much trouble or difficulty they cause may vary quite a bit. While the term “chemo brain” is not commonly accurate, it’s still what most people refer to in regards to addressing possible memory issues from cancer treatment.
When to see a doctor
If you experience troubling memory or thinking problems, make an appointment with your doctor. Keep a journal of your signs and symptoms so that your doctor can better understand how your memory problems are affecting your everyday life.
What Causes Chemo Brain?
The causes of brain problems related to cancer and its treatment are still being studied. While there is currently no known way to prevent chemo brain, it does seem to occur more often with high doses of chemotherapy and is also more likely if the brain is also treated with radiation.
For the short term symptoms, studies suggest that there may be more than one possible cause for chemo brain. Some cancer patients experience chemo brain symptoms even without having had chemotherapy. Other patients notice symptoms when getting hormone treatments, such as estrogen blockers.
For other patients, cognitive problems may begin after their surgery. Besides chemotherapy, there are many different elements associated with a patient’s cancer that can worsen brain function.
- The Cancer
- Other drugs associated with the cancer treatment such as steroids, anti-nausea or pain medications. Low blood counts
- Sleeping problems
- Hormone changes
- Anxiety or stress
- Patient age.
It’s not clear what causes signs and symptoms of memory problems in cancer survivors. it can be any number of reasons.
Cancer-related causes could include:
- A cancer diagnosis can be quite stressful in itself and this can cause memory problems
- Certain cancers can produce chemicals that affect memory
Cancer treatments (Traditional)
- Hormone therapy
- Radiation therapy
- Stem cell transplant
Complications of cancer Traditional treatment
- Menopause or other hormonal changes (caused by cancer treatment)
- Nutritional deficiencies
- Sleep problems, such as insomnia
- Pain due to cancer treatments
Emotional reactions to cancer diagnosis and treatment
- Inherited susceptibility to chemo brain
- Medications for other cancer-related signs and symptoms, such as pain medications
- Recurrent cancer that has spread to the brain
Factors that may increase the risk of memory problems in cancer survivors include:
- Brain cancer
- 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
- Increasing age
The severity and duration of the symptoms sometimes described as chemo brain differ from person to person. Some cancer survivors may return to work, but find tasks take extra concentration or time. Others will be unable to return to work.
If you experience severe memory or concentration problems that make it difficult to do your job, tell your doctor. You may be referred to an occupational therapist, who can help you adjust to your current job or identify your strengths so that you may find a new job.
In rare cases, people with memory and concentration problems are unable to work and must apply for disability benefits. Ask your health care team for a referral to an oncology social worker or a similar professional who can help you understand your options.
There’s no clear definition of chemo brain, so no tests exist to diagnose this condition. Cancer survivors who experience these symptoms often score in normal ranges on memory tests.
Your doctor may recommend blood tests, brain scans or other tests to rule out other causes of memory problems. But if no apparent cause can be found for your symptoms, your doctor may refer you to a specialist who can help you cope with memory changes.
It’s not clear what causes chemo brain, and no cure has been identified. In most cases, cancer-related memory problems are temporary, so treatment focuses on coping with symptoms.
No standard treatment has been developed for cancer-related memory problems. Because symptoms and severity differ from person to person, your doctor can work with you to develop an individualized approach to coping.
Controlling other causes of memory problems
Cancer and cancer treatment can lead to other conditions, such as anemia, depression, sleep problems and early menopause, which can contribute to memory problems. Controlling these other factors may make it easier to cope with these symptoms.
Learning to adapt and cope with memory changes
A neuropsychologist, who specializes in diagnosing and treating conditions that affect memory and thinking, can create a plan to help you cope with chemo brain symptoms. Doctors sometimes refer to this as cognitive rehabilitation or cognitive remediation.
Learning to adapt and cope with memory changes may involve:
- Repetitive exercises to train your brain. Memory and thinking exercises may help your brain
repair broken circuits that may contribute to chemo brain.
- Tracking and understanding what influences memory problems. Carefully tracking your memory problems may reveal ways to cope. For instance, if you become more easily distracted when you’re hungry or tired, you could schedule difficult tasks that require extra concentration for the time of day when you feel your best.
- Learning coping strategies. You may learn new ways of doing everyday tasks to help you concentrate. For instance, you may learn to take notes or make an outline of written material as you read. Or a therapist may help you learn ways of speaking that help you commit conversations to memory and then retrieve those memories later.
- Stress-relief techniques. Stressful situations can make memory problems more likely. And having memory problems can be stressful. To end the cycle, you may learn relaxation techniques. These techniques, such as progressive muscle relaxation, may help you identify stress and help you cope.
Experiencing Symptoms? Don’t Keep it to Yourself
Unlike other chemotherapy side effects like hair loss, which is easy to see, many of those around you may not be aware of any the chemo brain symptoms you are experiencing, unless you tell them.
Tell your family, friends, co-workers and your health care team about any chemo brain symptoms you experience. Let others know that you are going through a side effect of your cancer treatment.
If you experience chemo brain symptoms during your cancer treatment, please tell your oncologist. They will want to check for any other conditions that may be causing or contributing to your symptoms, as well as review your treatment plan. If your symptoms are significantly interfering with your day-to-day life, your doctor may recommend that you see a specialists to conduct a more in-depth evaluation.
While there is now more awareness about chemo brain and the symptoms, we still need much more research and information to better understand it and hopefully prevent it. Thankfully most of the people who do witness this particular side-effect experience it for a short time.
Please visit our chemotherapy side effects page to learn more about other possible side effects during cancer treatment.
More study is needed to understand how or if these drugs may be helpful for people with these types of memory problems.
No alternative treatments have been found to prevent or cure chemo brain. If you’re interested in trying alternative treatments for your symptoms, discuss the risks and benefits with your doctor.
Alternative treatments for other types of memory problems are also touted as helpful for chemo brain, such as:
- Ginkgo. Supplements containing ginkgo leaves have shown some promise in treating age-related memory changes in older adults, but more study is needed. Ginkgo supplements are generally safe, but they can interfere with some common medications, including blood thinners. Talk to your doctor before beginning ginkgo supplements.
- Vitamin E. Vitamin E may be beneficial for brain cells, but more study is needed. Vitamin E supplements are generally safe when taken in recommended doses, but they can interfere with common medications, including blood thinners and chemotherapy drugs. It may be easier and safer to choose foods that are high in vitamin E, such as vegetable oils and eggs.
Preparing for Your Appointment
If you’re currently undergoing cancer treatment, talk to your oncologist about your signs and symptoms. If you’ve completed treatment, you might start by making an appointment with your family doctor. In some cases, you may be referred to a professional who specializes in helping people cope with memory difficulties (neuropsychologist).
Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be well-prepared. Here’s some information to help you get ready and what to expect from your doctor.
What you can do
- Keep a journal of your memory lapses. Describe the situations in which you experience memory problems. Note what you were doing and what type of difficulty you experienced.
- Make a list of all medications, as well as any vitamins or supplements that you’re taking.
- Take a family member or friend along or bring a recorder. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot. Record the conversation with your doctor so you can listen to it later.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your visit. List your questions from most important to least important in case time runs out. For chemo brain, some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- How long do symptoms typically last?
- What kinds of tests can help determine whether my symptoms are caused by cancer treatment?
- Should I see a neuropsychologist? What will that cost, and will my insurance cover it?
- What is the best treatment for my symptoms?
- Are there things I can do on my own, in addition to the treatment you’re suggesting, to help improve my memory problems?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- Should I plan for a follow-up visit?
- If I need brain radiation, can you do hippocampal-sparing radiation?
- Should I take memantine (Namenda) during brain radiation?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask any other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover points you want to address. Your doctor may ask:
- When did you first begin experiencing these symptoms?
- Have your symptoms been continuous or occasional?
- How do your symptoms affect your everyday life?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Track your symptoms in a journal. Note the time of day and the situations when memory problems occur. Patterns in your symptoms may help your doctor better understand what could be causing your symptoms and the best way to help you cope.
You can take steps to ease chemo brain symptoms on your own. For instance, try to:
- Control what you can about your working environment. If noise and commotion are contributing to your distraction, try to find a quiet corner where you can concentrate. Soft music may help drown out other noises.
- Prepare yourself for success. Before tackling a complicated task that requires concentration, take steps to ensure that you will have the best chance for success. Eat so you won’t be distracted by hunger. Pick a time of day when you’ll be the most alert. Get a good night’s sleep. Have a plan so you know exactly what you’ll need to do in order to complete your task.
- Stay organized. Use calendars or planners to keep on task. That way you won’t spend time wondering if you’re forgetting an appointment or an item on your to-do list. Write everything down in your planner. Make organization a priority at home and at work, too. Having an organized work space means you can spend more time on tasks that you need to accomplish.
- Clear your mind of distractions. When distracting thoughts pop up, write them down in your planner. Recording your thoughts will help to quickly clear them and ensure that you remember them later.
- Take frequent breaks. Divide your tasks into manageable portions and take a break each time you complete one part. Give yourself a short rest so that you’ll be able to continue later.
- Exercise your brain. Try crossword puzzles or number games to exercise your brain. Take up a new hobby or master a new skill, such as learning to play a musical instrument or learning a language.
- Exercise your body. Moderate exercise, such as brisk walking, can help you cope with stress, fatigue and depression. All can contribute to memory problems. If you haven’t been active lately, get the OK from your doctor first.
Chemo brain symptoms can be frustrating and debilitating. With time, you’ll find ways to adapt so that concentrati on will become easier and memory p
roblems may fade. Until then, there are ways to cope. Try to:
- Understand that memory problems happen to everyone. Despite your best strategies for dealing with your memory changes, you’ll still have the occasional lapse. It happens to everyone. While you may have little control over the cancer-treatment-related memory changes, you can control other causes of memory lapses that are common to everyone, such as being overly tired, distracted or disorganized.
- Take time each day to relax. Stress can contribute to memory and concentration problems. Devote time each day to stress-relief activities, such as exercise, listening to music, meditation or writing in a journal.
- Be honest with others about your symptoms. Be open and honest with the people who are close to you about your chemo brain symptoms. Explain your symptoms and also suggest ways friends and family can help. For instance, you might ask a friend to remind you of plans by both phone and email.
Strategies for coping with cognitive problems
The following strategies may help you better cope with attention, thinking, and memory difficulties and help you stay mentally sharp:
- Keep a checklist of daily reminders. Put it in a convenient location, where you can look at it frequently. If necessary, keep another copy at work.
- Do one task at a time and avoid distractions.
- Carry around a small pad and a pen or pencil to easily write down notes and reminders. Or, download a note-making app on your smartphone and tablet.
- Use a calendar or daily organizer to keep track of upcoming appointments, activities, and important dates.
- Place sticky notes around the house and workplace to remind you of important tasks. You can also set reminders using your phone or email calendar.
- Use word play, such as rhyming, to help you remember things.
- Get plenty of rest.
- Make time for physical activity to increase mental alertness. Try walking, swimming, or gardening. Yoga or meditation can also help you relax and clear your mind.
- Conduct brain-strengthening mental activities, such as solving crosswords or puzzles, painting, playing a musical instrument, or learning a new hobby.
- Don’t be afraid to ask your doctor questions, even if you feel like you are repeating yourself. Then keep track of the important facts you discuss with your doctor. You can use a special notebook, or a voice recorder. If it is too overwhelming, ask a friend or family member to go to the appointment with you. He or she can take notes and review them with you afterward.
- Talk with your employer if you are having problems at work. Discuss ways your employer could support you, such as changing your workload or deadlines. Read more about going back to work after cancer.
- Prepare for the next day
by setting out the things you will need the night before.
- Color code or label certain cabinets or drawers where you store things around your home.
- Put things, such as car keys, back in the same place every time so you can easily find them.
- Eliminate clutter.
- Store important phone numbers in your cell phone or display them next to your home phone. You can also carry an address book in case you forget to bring your cell phone when you go out.
Also, don’t be afraid to ask your family and friends for help. And, talk with your doctor or other health care team members about counseling
and other resources.
Young children (age 5 and younger) are more likely to have long-term cognitive problems. These cognitive problems can occur months or years after treatment ends and can continue into adulthood. The following treatments are more likely to cause cognitive problems:
- Radiation therapy directed at the head, neck, or spinal cord
- Total body radiation
- Chemotherapy delivered directly into the spine or the brain.
Some of the possible cognitive problems include:
- Decreased overall intelligence
- Learning disabilities
- Decreased attention span and attention deficit disorders
- Delayed development, including delayed social, emotional, and behavioral development
- Lower academic achievement, especially in reading, language, and math
- Decreased ability to understand language or to put thoughts together in a way that makes sense
- Decreased nonverbal and verbal memory skills
Your child may receive occupational therapy, speech therapy, behavior therapy, social skills training, cognitive rehabilitation, and/or medications for attention deficit disorders to help treat cognitive problems. Some children may need to learn new ways of learning in school or paying attention.
Additional in-school options such as specialized reading and mathematics instruction and special education programs are also helpful. Because early intervention seems to offer the most benefit, parents must be aware of possible cognitive problems. They should talk with their child’s doctor, oncologist, or another member of the health care team as soon as they suspect a problem.
Coping with Chemo Brain
The symptoms associated with chemo brain are generally for a short term, usually diminishing shortly after the patient’s cancer treatments are complete. But sometimes the symptoms may linger longer.
The first step in coping with chemo brain is to understand that the memory symptoms the patient may experience are not imagined, but valid. Once the experience of chemo brain is accepted there are some things the patient can do to help them manage their chemo brain symptoms.
- Use day planners – keeping all the patient’s information in one place will help patients find the reminders they need, such as “to do” lists, appointments, phone numbers, important dates, notes, etc.
- Give your brain a work out – stimulate your mind with word puzzles, taking a class or even trying a new language.
- Get plenty of sleep and rest.
- Eat more vegetables – studies confirm that eating more vegetables better maintain brain power as people age.
- Set up and follow routines.
- Take it easy on the multitasking – slow down and focus on one thing at a time.
- Work out – it’s not only good for your body but it also helps improve your mood, increases alertness and decreases fatigue.
- Ask for help when you need it.
- Keep track of your memory problems -jot down in your day planner when you notice problems.