When cancer patients undergo treatment to shrink tumors, they may feel fatigued, forgetful, absent-minded, stressed and anxious. They may chalk this up to chemotherapy, saying they have “chemo brain.” But is chemo brain a real issue? And if so, what is it, really?
“Chemo brain is real, in some people,” says Lisa Rogers, D.O., a neuro-oncologist with Henry Ford Cancer. “Certain chemotherapies can result in microscopic brain inflammation or affect certain cells in the brain that control memory and attention and cause the symptoms described.”
“A variety of side effects have accompanied cancer therapy from its early days in the 20th century, and chemo brain is one that has especially been recognized in recent years,” adds Haythem Ali, M.D., a medical oncologist with Henry Ford Cancer. “Research in this area is ongoing. I encourage patients to talk with their oncologist, as there are ways to determine whether chemo brain is the cause of their symptoms and identify the proper treatment.”
Identifying Symptoms of Chemo Brain
Although in most patients chemo brain goes away over time (it lasts a year, on average, says Dr. Rogers) it can be very frustrating while it is occurring. “It can be intrusive while you’re trying to live your daily life, as it can interfere with work, raising a family, and social engagements,” says Dr. Rogers. Symptoms of chemo brain include:
- Lapses in memory, difficulty remembering names, dates or words.
- Inability to focus or concentrate.
- Difficulty multitasking.
- Slow or disorganized thinking.
Other Culprits Aside From Chemo Brain
Some people use the term chemo brain as a catchall phrase, but not all cancer patients experience chemo brain. Many other factors can cause the same symptoms, such as:
- Stress, due to a cancer diagnosis and lifestyle interruptions caused by schedule of treatments, which can interfere with mental focus and concentration.
- Pain, which can inhibit thinking abilities and lead to insomnia.
- Fatigue caused by radiation treatment, lack of sleep caused by stress or pain, or side effects of pain medication.
- Hormone therapy.
- Depression and anxiety from dealing with cancer, both of which can be mentally and physically debilitating.
How To Test For Chemo Brain
Before calling it chemo brain, a careful assessment to identify all potential causes of memory impairment is essential.
“A thorough evaluation, including a neurological history and physical examination, is necessary to determine that chemotherapy is the root cause of the symptoms,” Dr. Rogers says. “I often order lab tests to search for nutrient or hormonal abnormalities that may be contributing to problems with cognition, and I often order a brain MRI scan."
If these tests do not reveal a cause for the symptoms, she says, neuropsychology testing can be useful. It analyzes cognitive functions such as learning, reasoning, remembering, decision-making and problem-solving skills. It can also identify whether an undiagnosed mood disorder, such as anxiety or depression, is a contributing factor.
How To Treat Chemo Brain (And Other Cognitive Issues)
The test results are used to tailor a treatment program, and a multidisciplinary approach to treatment is often the most effective. Identifying and addressing reversible causes such as sleep deprivation, pain, or side effects of medication can be useful. Medications can also target specific types of thinking or memory problems associated with chemo brain. And neuropsychologists will often recommend specific aids for organizing tasks and schedules. Treatment may also include a psycho-oncologist to help manage depression or anxiety.
“A former patient had recently completed chemotherapy for breast cancer and was starting a new job,” says Dr. Rogers. “She was having trouble using the computer keyboard and said she couldn’t think straight when trying to do computer tasks. She attributed her symptoms to chemo brain and was certain she would lose her job.
“Her neurological examination, laboratory tests, and brain MRI were normal, so I proceeded with neuropsychological testing. The testing showed that all of her thinking skills were within the normal range, but her depression score was very high. What she had attributed to chemo brain was actually depression, which was debilitating. She was very reassured to discover this was the cause, and the good news was that it was treatable by a psych-oncologist. Each person should be evaluated and treated based upon their individual symptoms and issues.”
Just as with other conditions in patients without cancer who experience memory problems, lifestyle changes can also help, such as maintaining a balanced diet, incorporating regular exercise into your daily routine, meditating, and improving sleep patterns.
Chemo brain testing, along with education about improving lifestyle patterns (such as diet, sleep, exercise and meditation), is offered by the cancer specialists at Henry Ford Health. If you have undergone cancer treatment and think you have chemo brain, call 313-916-2723 to schedule an appointment.
Dr. Lisa Rogers is a neuro-oncologist with Henry Ford Cancer and a member of the Hermelin Brain Tumor Center. She sees patients at Henry Ford Cancer in Brownstown, Henry Ford Wyandotte Hospital, and the Brigitte Harris Cancer Pavilion in Detroit.
Dr. Haythem Ali is a medical oncologist with Henry Ford Cancer. He sees patients at Henry Ford Cancer in Brownstown and the Brigitte Harris Cancer Pavilion in Detroit.
