Many people experience mental cloudiness when they have cancer, also known as chemo brain or treatment-related cognitive impairment. Here’s what you can do.
It’s not just a joke — many people experience mental cloudiness when they have cancer. “Chemo brain,” technically called “treatment-related cognitive impairment,” can happen before, during, and after treatment. You might become more distractible, forgetful, or slower with chores. You might forget names or be unable to talk even briefly on the phone while monitoring a child.
The Oncology Nursing Society reports that most patients with brain tumors or lung or breast cancer experience some mental impairment. The problem is also common in patients treated with bone marrow transplantation after high-dose chemotherapy. But cancer patients who don’t have chemo may notice symptoms, which might show up when you receive hormones, or after surgery. Usually the cloudiness is subtle, and may not even be noticeable to other people. It can also pass quickly, or last years.
The triggers can include the cancer, any of the treatments, low blood counts, loss of sleep, stress, or something else.
Of many possible remedies for chemo brain, a 2014 review of the research concluded that they were unproven or useless — including several drugs, gingko biloba, and biofeedback, when patients see a real-time record of their brain activity. These researchers were most enthusiastic about brain training exercises, typically in the form of computer games.
For example, one small study reported that a group of breast cancer survivors with brain fog said they felt much sharper and happier after playing a specific set of brain training games for 15 weeks — and were also upbeat six months later. The evidence wasn’t strong — the game-players didn’t do any better than a control group in other measures of their mood and mental abilities. So these good results could easily be a matter of perception. Behold the placebo effect!
The remedies that help everyone stay sharper also apply to cancer patients. You may need memory aids to get organized, keeping detailed calendars and lists in a book, on your computer, or on your phone. You’ll be sharper if you exercise, eat veggies, and get enough sleep and down-time. Don’t try to multi-task, and try to keep your home tidy.
Be sure you’ve addressed other issues that can interfere with your alertness, including depression, insomnia, sleep apnea, hormone or vitamin deficiencies, or hearing loss.
You might keep a log for a week, recording when you are more clear-headed and less so. That way, you may be able to schedule important activities for your best times. You’ll also have information to help your doctor pin down the problem. Do you have more trouble in the morning, even after a good night’s rest? Do you get especially befuddled when you’re hungry or tired? When you discuss the issue with your doctors, bring along your medicines and any herbs, vitamins, or other supplements you use, even if you don’t take them every day. It’s best to bring a friend or family member along to take notes or give your doctor another perspective and set of eyes.
If problems persist, you may ask to see a specialist — a speech language pathologist, for example, if you’re forgetting words.
Try not to obsess, give in to embarrassment, or get defensive when things take longer or go wrong. Your friends and family may have helpful suggestions. Maybe it’s not like you to leave your credit card behind at the coffee shop, or forget to bring your referral form or insurance card to a medical appointment. But people do these things all the time. Ask anyone who works in retail or a doctor’s office!
March 30, 2020
Christopher Nystuen, MD, MBA