What to know about chemo brain and helpful coping strategies


by Asha Karippot, MD

Mar 30, 2022

Chemo brain is a common term cancer survivors use to describe thinking and memory problems that can happen during and after cancer treatment. You may also hear chemo brain referred to as:

  • Chemo fog
  • Cancer-related cognitive impairment
  • Cognitive dysfunction

Most define chemo brain as a decrease in mental “sharpness” and cloudy mind. Its exact cause isn’t known, and symptoms can crop up any time when you have cancer. These cognitive changes can cause you to struggle with your usual everyday activities at school, work or socially. Or it may feel like it takes a lot of mental effort to do them.

Signs and symptoms of chemo brain

Some examples of someone experiencing chemo brain include:

  • Being unusually disorganized
  • Confusion
  • Difficulty concentrating or finding the right word
  • Trouble learning new skills or multitasking
  • Feeling of mental fogginess
  • Short-term memory problems
  • Taking longer than usual to perform routine tasks
  • Trouble with verbal memory, such as remembering a conversation
  • Visual memory struggles, such as recalling an image or list of words

How chemotherapy affects cognitive abilities

Chemo brain is most commonly connected with chemotherapy, but other treatments, such as hormone therapy, radiation and surgery may play a role.

Beyond symptoms that begin during and just after treatment, there are some cases where chemo brain symptoms start and continue after treatment is over. Some people with cancer have real brain problems even though they haven’t had chemo.

Certain things can increase the risk of developing chemo brain or worsening brain function problems. These include:

  • The cancer itself, for example, brain tumors
  • Other drugs used as part of treatment, such as steroids, anti-nausea or pain medicines
  • Conditions or illnesses, such as diabetes or high blood pressure
  • Other symptoms like tiredness, pain, or sleep problems
  • Emotional distress, such as depression, anxiety or weakness that comes with aging
  • Surgery and the drugs used during surgery (anesthesia)
  • An infection
  • Hormone changes or hormone treatments
  • Being postmenopausal, nutritional deficiencies, using alcohol or other substances that can change your mental state

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

How do doctors treat chemo brain?

If chemo brain is disrupting your daily life,  talk to your doctor. They may recommend a counselor or psychologist. Other treatments that can help ease your symptoms may include:

  • Some stimulants and antidepressants
  • Physical exercise, even five minutes a day
  • Mental activities like puzzles, playing an instrument or learning a new hobby
  • Plenty of sleep and rest
  • Memory aids, such as a daily to-do list of reminders

Coping with chemo brain

Simple lifestyle strategies can help with memory loss and confusion. Try the following tips to prepare yourself for success:

  • Carry a daily to-do list with reminders. Put sticky notes around your home and office. Set reminders on your smartphone, too.
  • Don’t multitask. Do one thing at a time, so you’re not distracted.
  • Prepare yourself for success. If noise and commotion contribute to your distraction at work, try to find a quiet place to concentrate. Consider earplugs or noise-canceling headphones. Soft music may help drown out other noise.
  • Have a plan, so you know what you’ll need to do in the exact order to complete your task. Pick a time of day to get things done when you’ll be the most alert.
  • Make organization a priority at home and work, too. Use calendars or planners to stay on task and avoid worrying if you’ve forgotten an appointment or an item on your to-do list. Write everything down in your planner.
  • Clear your mind of distractions. When distracting thoughts pop up, write them down in your planner. Recording your thoughts will help you quickly clear them and ensure that you remember them later.
  • Take frequent breaks. Divide your tasks into manageable portions and take a break each time you complete one part. Give yourself a short rest so that you’ll be able to continue later.

Focus on caring for your physical and emotional well-being too.

  • Eat so hunger won’t distract you.
  • Get a good night’s sleep.
  • Exercise your brain. Try crossword puzzles or number games to exercise your brain. Take up a new hobby or master a new skill, such as discovering how to play a musical instrument or learning a new language.
  • Exercise your body. Moderate exercise, such as brisk walking, can help you cope with stress, fatigue and depression. All can contribute to memory problems. If you haven’t been active lately, get the okay from your doctor first.

It’s essential to reduce stress, which can contribute to the mind and body fatigue commonly experienced with cancer treatment. Take time to relax with music, art therapy, meditation, yoga or any stress-relieving activity that works for you.

If brain fogginess interferes with your usual day-to-day activities, talk with your doctor to try and pinpoint the cause of your brain fog and come up with solutions to combat it. This is especially important for people whose chemo brain symptoms last longer than the treatment period and disrupts their daily lives.

Talking to your doctor about chemo brain

It helps to keep a diary or log to track your symptoms and let your doctor know what things make the problems better or worse. For instance, are your memory problems worse in the morning or evening? When you’re hungry or tired? Does it help to nap, walk or have a snack?

Your oncologist will want to know when the problems started and how they affect your daily life.

Write down questions about the problems you have. Take them to your appointment along with your memory tracking log to talk over with your doctor.

Bring a list of all the medicines you take, including herbs, vitamins, supplements and those you take on an “as needed” basis. Take a friend or family member with you to help you take notes during the visit. They can also describe the changes they’ve seen in you if the doctor wants a different viewpoint.

If your memory and thinking problems persist, ask your doctor if you might need the help of a specialist such as a neuropsychologist, speech-language pathologist, or occupational or vocational therapist. Through testing, these professionals may recommend ways to help you better handle the cognitive problems or changes you are experiencing (You may hear this called cognitive rehabilitation).

You may also need to visit a larger hospital or cancer care center to find experts on testing brain function, including chemo brain. Ask if you can get a referral to one of these specialists who can help you learn the scope of your problem and work with you on ways to manage it. You’ll want to find out what your insurance will cover before starting.

Can chemo brain be prevented?

So far, there is no known way to prevent the cognitive changes that cause chemo brain, and scientists are still studying the suspected causes. Chemo brain seems to happen more often in people who get high doses of chemo and is more likely to occur if the brain is also treated with radiation therapy.

In most cases, chemo brain is temporary, and the signs usually improve nine to 12 months after completing chemotherapy.

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About the Author

Asha Karippot, MD, is a hematologist and medical oncologist on the medical staff at Baylor Scott & White Medical Center – Plano.

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