Chemo Brain: Understanding Brain Fog and How to Treat It
If you’ve felt forgetful or out of sorts since beginning breast cancer treatment, you’re not alone. Most people in treatment for cancer report problems with their focus, memory, and ability to make decisions — a batch of symptoms commonly called chemo brain, chemo fog, or brain fog. Doctors sometimes call this cancer-related cognitive impairment (CRCI).
Chemo brain is a side effect of chemotherapy that affects up to 75% of people with breast cancer. You may also experience it when you receive a cancer diagnosis, following surgery, or during or after radiation, immunotherapy, or hormonal therapy.
What is chemo brain?
Chemo brain affects how your brain functions and can vary from person to person. For some people there's a feeling of disassociation. Nanette, a member of the Breastcancer.org Community, writes that brain fog “makes me feel like my mind is in outer space and the rest of me is down here on earth. And the mental thoughts are like being beamed to my body.”
Others, like member Hazel-Nut, notice it more in their day-to-day tasks: "My whole life is a series of half done tasks,” they write. “Laundry in the wash that doesn't make it to the dryer, filled a trash bag of junk in my car but keep forgetting to run it to the dumpster.”
People who experience chemo brain or brain fog also report:
difficulty remembering dates or names
taking longer than usual to finish tasks
having problems concentrating
having a hard time grasping new ideas
difficulty finding the right words to say
Does chemo brain ever go away?
“For the majority of breast cancer survivors, these issues don’t last long, gradually improve, and there are no long-term or permanent effects,” said Timothy Ahles, PhD, a behavioral psychologist and director of the Neurocognitive Research Lab at Memorial Sloan Kettering Cancer Center. But chemo brain can last longer for some people: 20-30% of women experience prolonged cognitive deficits after treatment, according to one estimate.
Chemo brain has stuck around for member Marcia1111, who writes, “I still feel like I have chemo brain and I’m seven years out. I hate it.” The same was true for member fairchild, who has struggled with chemo brain three years after their treatment ended. “I still struggle with many aspects of my job, especially those that involve multitasking and concentration,” they write. “My oncologist has put me on ADHD meds, which have helped.”
What causes chemo brain?
While chemo brain is most often associated with chemotherapy or other treatments, just the mere experience of being diagnosed with cancer can cause brain fog and memory and concentration problems. Some people also develop anxiety or depression after being diagnosed or while going through treatment, which can also affect brain function.
Other side effects of treatment can also affect how well the brain works, like anemia, pain (and medicines used to treat pain), fatigue, sleep problems, and appetite changes.
You may be at greater risk of getting chemo brain if you:
have diabetes, hyperglycemia, or high blood pressure (high blood sugar levels and high blood pressure can damage blood vessels in the brain)
have obesity or an autoimmune disorder like lupus or rheumatoid arthritis (these can lead to chronic inflammation, which causes structural changes in the brain)
are post-menopausal
don’t exercise
use substances like alcohol or cannabis that may cause thinking or memory problems
The gut microbiome may play a role in chemo brain: Early research found that people who reported chemo brain symptoms also had a less diverse gut microbiome after chemo.
Treating chemo brain
While chemo brain has likely been around since the start of chemotherapy in the 1940s, it’s taken a while for healthcare professionals to take it seriously. That has started to change in recent years though, leading to more research on interventions. There’s still no FDA-approved medication for CRCI, but there are science-backed interventions.
Exercise
A growing amount of research has pointed to exercise as a useful tool to help reduce the risk of chemo brain and improve thinking and memory function for people with breast cancer.
In one study, people with breast cancer who exercised for 2.5 hours a week — about 20 minutes each day — before starting and during chemotherapy had better brain function immediately after chemo than people who didn’t exercise. The exercise included moderate to vigorous physical activity like brisk walking. “Even if they stopped being as physically active during chemotherapy, this effect on their cognition remained,” said study author Michele Janelsins, PhD, MPH, of the University of Rochester.
A more recent study found similar results: Women who started an aerobic exercise program at the same time as starting chemotherapy had greater improvements in cognitive function and quality of life compared with those receiving only chemotherapy.
“The bottom line,” said Janelsins, “is that the data so far suggests that being as physically active as possible can help maintain cognitive functioning throughout treatment.”
Acupuncture
Acupuncture has been shown to ease several common symptoms of breast cancer treatments, including chemo brain: A study showed that a 10-week program of weekly acupuncture improved chemo brain in people with breast cancer. The people who got acupuncture reported better cognitive function and performed better on cognitive tests than those who didn’t get acupuncture.
Listening to music
Just 12 minutes a day of listening to classical music improved cognitive function, stress, and fatigue in a small study of people with breast cancer who went through chemotherapy treatment. The other group of participants, who did a 12-minute guided meditation called Kirtan Kriya, also reported cognitive improvements, including a better ability to recall words, focus, prioritize, and solve problems.
“It’s possible that regular music listening serves as a form of attention training, and improving one’s attention can be beneficial for other cognitive processes like remembering, multitasking, and processing information,” said study author Ashley Henneghan, PhD, RN, FAAN, of the University of Texas at Austin.
Chemo brain tips from the Breastcancer.org Community
The Breastcancer.org community has great tips for keeping chemo brain at bay during treatment and doing small daily things to manage your brain fog. If you’re struggling with chemo brain, it’s important to talk with your care team about your symptoms. They may be able to help.
Keep your brain learning new things, especially during treatment
Member Mncteach had a nurse practitioner advise her to keep her brain active during treatment by learning something new to avoid chemo brain. “I learned a new card game and did word games on my tablets, and I also worked as much as possible during chemo,” wrote mncteach. “I have had no real big issues.”
Break up complicated tasks into smaller tasks
One thing that’s helped Aterry is breaking things down into smaller pieces. “If I’m booking a flight I’ll go to a booking site and just spend five minutes looking at how to navigate the site — then I exit. Later I’ll open the site again, maybe look at one option, take notes — then I exit; and so on. It can take me a long time to book a flight or do most things with options.”
Leave yourself lots of notes
It took slv58 more than a decade for her chemo brain to subside, but she writes “while in the thick of it, I would make out loud verbal notes to remember things — ‘Shari, you’re putting your phone in your bag’ — which I found helped me. I also wrote notes. Finding the right word was frequently a challenge but did improve with time.”
Keep a routine
Debal noticed she was able to stay focused at her job as a nurse and her critical thinking skills were strong. But at home it was a different story. “I mentioned all this to my breast surgeon. She said it makes sense to be more comfortable at work because it is routine,” debal writes.
Switch to a tactile activity if you feel your brain fog coming on
“When I feel the brain numbness coming on, I stop what I’m doing and switch to something physical or tactile, like folding laundry,” writes Aterry. “At least I can still remember where to put the laundry!”
This content is made possible, in part, by AstraZeneca.