Chemobrain
One of the most common complaints and side effects that patients report after receiving chemotherapy is forgetfulness. This forgetfulness has been termed chemobrain. This forgetfulness can be relatively minor to very significant. Sometimes the patient may have simple short-term memory problems where they forget very minor things, other times the memory loss can be quite significant. Recently, research has begun to unravel this side effect.That research has shown that some cancer drugs can indeed cause changes in the brain. Using PET scanning, which shows metabolic activity of the brain,these changes are being observed. These PET scans show that after chemotherapy, some patients have smaller areas of metabolism in parts of the brain that deal with memory, planning, putting thoughts into action, monitoring thought process and behavioral inhibition. One of the areas that we see chemobrain quite readily and acutely is in young women who are receiving therapy for breast cancer. It appears that hormonal treatment and putting a young woman into menopause causes a significant amount of problems with memory. What is chemobrain? An article by American Cancer Society gives some examples of what the patients call chemobrain.
- forgetting things that they usually have no trouble recalling-- memory lapses
- trouble concentrating--they can't focus on the task at hand
- trouble remembering details like names, dates, and sometimes larger events
- trouble multi-tasking, like answering the phone while cooking, without losing track of one of them-- less ability to do more than one thing at a time
- taking longer to finish things --slower thinking and processing.
- trouble remembering common words--can't finish a sentence because you can't find the right words
I have a patient who has had chemotherapy for both breast cancer, five or six years ago and then most recently she received chemotherapy for colorectal cancer. She noticed a much more significant change in her memory with the drugs that were used for her breast cancer than with the drugs that were given for her colorectal cancer. As this shows there are likely significant differences in the effects that different types of chemotherapy have on the brain. There are likely other causes. Below are listed some of the other causes:
- the cancer itself
- chemotherapy drugs
- other drugs used as part of treatment (such as anti-nausea or pain medicines)
- patient age
- stress
- low blood counts
- depression
- fatigue
- hormone changes
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Changes that we see in PET scans can show up on scans 5-10 years after treatment has stopped. There are probably multiple factors that cause this symptom. As mentioned above, the cancer itself can cause the side effect, chemotherapy drugs, other drugs used as part of the treatment , the patient's age, stress, low blood counts, depression, fatigue, hormone changes can contibute to this problem. It is estimated that at least 20-30% of patients who receive chemotherapy will develop chemobrain. The American Cancer Society makes several recommendations that are listed below on managing chemobrain.
- Use a detailed daily planner. Keeping everything in one place makes it easier to find the reminders you may need. Serious planner users keep track of their appointments and schedules, "to do" lists, important birthdays and anniversaries, phone numbers and addresses, meeting notes, and even movies they'd like to see or books they'd like to read.
- Exercise your brain. Take a class, do word puzzles, or learn a new language.
- Get enough rest and sleep.
- Exercise your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert, and decreases fatigue.
- Eat your veggies. Studies have shown that eating more vegetables can help you maintain brain power.
- Set up and follow routines. Pick a certain place for commonly lost objects and put them there each time. Try to keep the same daily schedule.
- Don't try to multi-task. Focus on one thing at a time.
- Track your memory problems. Keep a diary of when you notice problems and the events that are going on at the time. (You might track this in your planner.) Medicines taken, time of day, and the situation you are in may help you figure out what affects your memory. Keeping track of when the problems are most noticeable can also help you prepare by not planning important conversations or appointments during those times.
- Try not to focus so much on how much these symptoms are bothering 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 notice your problems much more than others do. Sometimes we all have to laugh about forgetting to take the carefully composed grocery list with us to the store.
I believe these recomendations can help patients get though the acute effects of this common side effect. The good news is that most patients in my experience have improvement of thier symptoms over time.
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