Chemo Brain and Cognitive Side Effects

What is chemo brain?

Some cancer patients have changes in cognitive function during cancer treatment. Patients and families may notice changes in thinking, attention, or memory. Cancer patients often call this “chemo brain” or “brain fog.” Cognitive side effects during cancer are not fully understood, and there may be different causes including chemotherapy, radiation therapy, surgery, or hydrocephalus. Some cognitive changes are temporary, while others may be long lasting.

Chemo brain symptoms and cognitive side effects in children and teens

Signs and symptoms of cognitive changes during cancer often depend on the age of the patient. Patients may feel like their thoughts are slow or that their mind is foggy. Symptoms of cognitive problems or chemo brain may include:

• Poor memory
• Short attention span
• Losing focus or being easily distracted
• Slow speech
• Trouble finding the right word
• Confusion
• Taking longer than normal to complete tasks
• Problems organizing ideas
• Anxiety or frustration with school
• Change in school or work performance
• Loss of interest in reading, games, or other activities requiring mental focus

Causes of chemo brain and cognitive side effects

Cognitive side effects of chemotherapy and radiation therapy likely have multiple causes. Cancer treatments can impact the brain directly through effects on cell growth, inflammation, and blood supply.

Other factors may also affect thinking, attention, and memory in patients with cancer. These include:

• Medicines such as anti-nausea medicines, pain medicines, and corticosteroids
• Surgery and anesthesia
• Infection
• Low blood counts
• Changes in hormones
• Stress, anxiety, or depression
• Changes in routine and environment
• Sleep problems and fatigue
• Poor nutrition
• Problems with hearing or vision

It is important for families to keep in mind that the development of cognitive problems may not be related to the cancer experience. Symptoms may instead reflect familial risk or developmental problems unrelated to treatment (e.g., dyslexia or ADHD). A neuropsychological assessment can help detect specific problems, identify possible causes, and allow for interventions that best meet patient needs.

Coping with chemo brain and cognitive side effects: tips for families

Cancer treatments may cause some cognitive changes that may or may not be long lasting. However, there are things families can do to help manage cognitive side effects and promote cognitive health.

• Be aware of cognitive changes. Talk to your care team about the risk of side effects and late effects related to cancer treatments. Watch for signs of cognitive problems. Explain symptoms to children so that they can understand. Cognitive changes can be scary, especially if you don’t know what to expect.
• Seek help for cognitive problems. Neuropsychologists, psychologists and learning specialists can help evaluate problems and offer help in navigating school or work. Early intervention is especially important for patients at higher risk for cognitive late effects. Some patients benefit from medications, especially to help with attention and concentration. Medicines being studied for improving cognitive function in cancer patients include methylphenidate (Ritalin®) and modafinil (Provigil®).
• Practice good health habits. Many health habits that are good for physical health are good for mental health and cognitive function:
  • Exercise, and be active.
  • Eat healthy.
  • Have good sleep habits.
  • Control stress.
• Plan for school support. Children and teens face many challenges when going back to school after cancer. Talk to teachers and school administrators about resources and academic accommodations, and develop a plan to meet the student’s individual needs.

Practical ways to manage chemo brain and cognitive side effects

For many patients, cognitive function will improve over time. However, there are some practical ways to cope with chemo brain and cognitive problems day to day. Patients and families can work together to develop strategies that best fit their needs. Make sure strategies are age-appropriate and give patients a say in planning.

Use memory aids and tools. Memory problems are very common with chemo brain and cognitive side effects. Calendars, notes, to-do lists, and reminders can help patients organize their day and accomplish tasks.

• Make a to-do list with tasks that can be checked off.
• Set an alarm as a reminder to take medicine or do tasks.
• Keep a detailed planner or calendar. It can also help to have a family calendar with a designated space for each person.
• Work with teachers to get all notes for lessons and homework.
• Use text reminders for schedule updates and other important information.

Keep to a routine. Many families find that consistency is key to help with memory and focus. A stable routine can also help reduce stress and anxiety because children know what to expect.

• Wake up and go to bed at the same time every day.
• Set specific times for homework, play, meals, and sleep.
• Use the same route to get places when walking, biking, or driving.
• Take medicines and perform medical care tasks at the same time every day.
• Keep items in the same place, and have back-ups of things that are often misplaced (shoes, coats, textbooks, keys).

Focus on one thing at a time. Multi-tasking can be difficult for patients struggling with chemo brain or cognitive side effects. Limit distractions during activities. Help patients break down tasks into simple steps, and do one step at a time.

• Set up a quiet place for homework, reading, or projects.
• Turn off TV and music when getting ready for school or bedtime.
• Write down directions for complex tasks.
• Work with teachers for classroom accommodations such as sitting in the front row, extra time, or privacy during tests or independent work.

Practice mental skills. Chemo brain or cognitive side effects can affect each person differently. Some patients might have more trouble with memory while another might struggle with focus. Find fun ways to work on skills and exercise the mind through games, puzzles, and activities. Make sure to choose age- and ability-appropriate activities.

• Try different games that use memory, strategy, or logic.
• Do physical activities that use both physical and mental coordination.
• Include word games to help with word finding and vocabulary.
• Make sure that activities are fun, not stressful. Watch for anxiety, fatigue, or frustration.