HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

If you are un­der­go­ing Chemother­a­py and ex­pe­ri­ence episodes of mem­o­ry loss, or dif­fi­cul­ty in fo­cus­ing or sim­ply feel your brain is all fogged up, you are not imag­in­ing these symp­toms. Some­times peo­ple with can­cer wor­ry about, joke about, or be­come frus­trat­ed by what they de­scribe as men­tal cloudi­ness or changes they might no­tice dur­ing and af­ter can­cer treat­ment. This cloudi­ness or men­tal change is com­mon­ly re­ferred to as “chemo brain”.

Mayo Clin­ic de­fines this phe­nom­e­non as “a com­mon term used to de­scribe think­ing and mem­o­ry prob­lems that can oc­cur dur­ing and af­ter can­cer treat­ment.”

What is chemo brain?

Chemo brain can al­so be called chemo fog, can­cer-re­lat­ed cog­ni­tive im­pair­ment or cog­ni­tive dys­func­tion. Even though its ex­act cause is not known, it can hap­pen at any time when you have can­cer and is not lim­it­ed to chemother­a­py for breast can­cer.

Chemo brain is most com­mon­ly con­nect­ed with chemother­a­py, but oth­er treat­ments, such as hor­mone ther­a­py, ra­di­a­tion and surgery may al­so be as­so­ci­at­ed with it.

Here are some ex­am­ples of what pa­tients with chemo brain may ex­pe­ri­ence:

- For­get­ting things that they usu­al­ly have no trou­ble re­mem­ber­ing (mem­o­ry laps­es)

- Trou­ble con­cen­trat­ing (can’t fo­cus on what one is do­ing, have a short at­ten­tion span, may eas­i­ly “space out”)

- Trou­ble re­mem­ber­ing de­tails like names, dates and some­times larg­er events

- Trou­ble learn­ing new things

- Tak­ing longer to fin­ish things (dis­or­gan­ised, slow­er think­ing and pro­cess­ing)

- Trou­ble re­mem­ber­ing com­mon words (un­able to find the right words to fin­ish a sen­tence)

For most peo­ple, these men­tal changes on­ly last a short time. Oth­ers can have long-term or de­layed men­tal changes.

Cer­tain cir­cum­stances can in­crease the risk of de­vel­op­ing chemo brain or wors­en­ing brain func­tion prob­lems.

These in­clude:

- The can­cer it­self, for ex­am­ple brain tu­mors

- Oth­er con­di­tions or ill­ness­es, such as di­a­betes or high blood pres­sure

- Emo­tion­al dis­tress such as de­pres­sion or anx­i­ety

- In­fec­tion

- Hor­mone changes or hor­mone treat­ments

- Nu­tri­tion­al de­fi­cien­cies

- Us­ing al­co­hol or oth­er sub­stances that can change your men­tal state

Most of these cause short-term prob­lems and get bet­ter as the un­der­ly­ing prob­lem is treat­ed or goes away. Oth­ers can lead to long-last­ing brain prob­lems un­less the cause is treat­ed.

Treat­ment of chemo brain

Treat­ments for chemo brain may in­clude:

Cog­ni­tive re­ha­bil­i­ta­tion: This might be part of a can­cer re­ha­bil­i­ta­tion pro­gramme. It in­cludes ac­tiv­i­ties to im­prove brain func­tion such as learn­ing how the brain works and ways to take in new in­for­ma­tion and per­form­ing new tasks; do­ing some ac­tiv­i­ties over and over that be­come hard­er with time; and us­ing tools to help stay or­gan­ised such as plan­ners or di­aries.

Ex­er­cise: Ex­er­cise can im­prove your think­ing and abil­i­ty to fo­cus. Ac­tiv­i­ties such as gar­den­ing, car­ing for pets or walk­ing, can help im­prove your at­ten­tion and con­cen­tra­tion lev­els.

Med­i­ta­tion: Med­i­ta­tion and mind­ful­ness ex­er­cis­es can help im­prove brain func­tion by in­creas­ing your fo­cus and aware­ness.

Con­sult with your can­cer care team about these treat­ment sug­ges­tions and oth­er op­tions they may rec­om­mend to help you cope with any cog­ni­tive prob­lems.

Day-to-day cop­ing with chemo brain

Track your mem­o­ry prob­lems.

Keep a di­ary of when you no­tice prob­lems and what’s go­ing on at the time. Mon­i­tor­ing med­ica­tions tak­en, time of day and the sit­u­a­tion you’re in might help you fig­ure out what af­fects your mem­o­ry. Keep­ing track of when the prob­lems are most no­tice­able can al­so help you cope. You will know to avoid plan­ning im­por­tant con­ver­sa­tions or ap­point­ments dur­ing those times. This record will al­so be use­ful when you talk with your doc­tor about these prob­lems.

Try not to fo­cus on how much these symp­toms both­er you.

Ac­cept­ing the prob­lem will help you deal with it. As many pa­tients have not­ed, be­ing able to laugh about things you can’t con­trol can help you cope. And re­mem­ber, you prob­a­bly no­tice your prob­lems more than oth­ers do.

Ask for help when you need it. Friends and loved ones can help with dai­ly tasks to cut down on dis­trac­tions and help you save men­tal en­er­gy. Find­ing and get­ting sup­port is im­por­tant. Let them know what you are go­ing through. You may feel re­lieved once you tell peo­ple about the prob­lems you some­times have with your mem­o­ry or think­ing.

Talk with your doc­tor or can­cer care team

If this men­tal fog­gi­ness caus­es anx­i­ety at work or school, or in­ter­feres with your usu­al ac­tiv­i­ties, talk with your doc­tor to try and pin­point what is caus­ing your brain fog and what can be done about it.

- For in­stance, are they worse in the morn­ing or evening?

- Do you have more trou­ble when you are hun­gry or tired?

- Does it help to nap, walk or have a snack?

Your doc­tor will want to know when the prob­lems start­ed and how they af­fect your dai­ly life and may re­fer you to an oc­cu­pa­tion­al ther­a­pist or a neu­ropsy­chol­o­gist.

Can chemo brain be pre­vent­ed?

Even though this might be a change that is not easy to see, like oth­er changes such as hair loss or skin changes, chemo brain is a side ef­fect you can learn to man­age with the right sup­port and aware­ness.

Most im­por­tant­ly, do not judge your­self harsh­ly when this hap­pens and recog­nise, this is not en­tire­ly with­in your con­trol.