Dear OncoLink "Ask The Experts,"
What treatments are available for chemo-brain? My doctor does not believe it is real, and I don’t know where to turn for help.
Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
Many survivors who have previously received or are currently undergoing chemotherapy report experiencing cognitive changes, often referred to collectively as "chemo-brain." These changes include difficulty with short term memory, multi-tasking, new learning, reading comprehension, working with numbers, and concentration. For many years, this was attributed by both physicians and researchers to be caused by the depression or anxiety over the diagnosis and the treatment of cancer. More recently, researchers have begun to study and document what survivors have been saying all along: cognitive changes after chemotherapy are real. Although we are not yet able to pinpoint whether only certain chemotherapy agents are responsible, it seems certain that the effects are cumulative. That is, those who receive more chemotherapy tend to experience greater deficits. Studies have found that cognitive ability can improve over time in some survivors, but deficits are still present in many long-term survivors, even years after treatment.
Some medications are being studied as potential treatments for cognitive changes, but there are not yet enough data to support their use. Some of the agents being studied include: methylphenidate (Ritalin), modafinil (a medication approved to treat narcolepsy), various antidepressants, herbal therapies such as ginkgo biloba and ginseng, and certain amino acids. Cognitive rehabilitation programs are structured programs utilizing “mental exercise”, tasks that use memory and puzzles to "rehabilitate" one's mind. These programs are typically used for people with brain injuries, but therapists have tailored programs for cancer survivors. Bookstores and websites offer memory training, which may be helpful to survivors. Puzzles using numbers, like Sudoku, may help "exercise" your brain. Fatigue can enhance cognitive problems, so avoiding fatigue by getting enough sleep, incorporating exercise into your life, and eating a healthy diet may be helpful.
It is important to remember that some very treatable problems can result in cognitive difficulties, such as thyroid dysfunction, depression and anxiety, so it is important to exclude or treat these diagnoses. Hypothyroidism (low thyroid hormone levels) is a common issue for survivors and can make you feel "fuzzy" or "out of it." This is easily treatable with supplemental thyroid hormone. Survivors who may be depressed or experiencing anxiety would benefit from consulting with a psychiatrist or psychologist experienced in working with cancer patients or survivors.
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