Call it "chemo brain," call it "brain fog," call it anything you like — but for some people with cancer, in treatment and often long after it ends, memory and other intellect-driven skills are not what they once were, before cancer. Some cancer survivors report feeling that they have recovered their full mental powers, but others say that the treatments they took have left them impaired even years after treatment ends.

For many years, cancer patients were always reassured by health care providers that "this will go away after your treatment." But new, credible research is now showing that this is not necessarily the case.

For many people with cancer, the risk of some measure of cognitive impairment versus taking potentially-life-saving treatment is no real contest. However, for people whose treatment options are broader, such as those with early stage cancer weighing whether to undergo the most aggressive treatment available, cognitive issues may be factored into the decision-making. Of course, this issue must and should be discussed thoroughly with one's family and health care team before decisions are made.

The primary causes of cognitive problems in people with cancer can range from the cancer itself to the treatments involved in working to cure it. Other aspects of coping with cancer can also contribute. Some of these are:

• Low red blood cell counts (anemia)
  
  
• Poor nutrition. Low levels of iron, vitamin B and folic acid can cause reduced ability to pay attention, memory and speaking ability.
  
  
• Medicine. Some of the medications used to manage side effects, such as nausea, can make people sleepy and less alert. Others, like cortisone, can make it difficult for people to concentrate and spark feelings of anxiety.
  
  
  • Hormone blockers like tamoxifen (Novaldex) and anastrazole (Arimidex) can contribute to memory loss in women. In men, medications causing memory problems, including leuprolide (Lupron), bicalutomide (Casodex) and flutamide (Eulexin).
  
  
• Discomfort from other side effects, such as constipation and diarrhea, can contribute to a poor quality of life and forgetfulness.
  
  
• Rapid change in hormone levels, such as the kind women experience from some chemotherapies that create "instant menopause," can contribute to forgetfulness.
  
  
• Stress can contribute to distraction and forgetfulness.
  
  
• The spread of cancer to the brain, a relatively rare occurrence, may cause initial symptoms like forgetfulness.

However, people with cancer who detect "chemo brain" should not assume that this must just be tolerated, and attempt to ignore it. There are approaches and treatments that can hel — pso talk with your health care team and make certain that your situation is properly evaluated and treated. (Can you remember that?)

Symptoms

The symptoms of possible cognitive loss will vary from individual to individual. Here are the ones most commonly reported by survivors:

• Reduced ability to concentrate
• Short-term memory loss
• Difficulty in performing multiple tasks at the same time
• A decline in language or mathematical skill

Significant problems in any of these areas can impact one's relationships, ability to work, receive education and other aspects of daily life.

Prevention

While there is no guaranteed way to ensure that no cognitive impairment will occur while you are being treated for cancer, there are some logical steps you can take:

• Manage other side effects like pain, depression, and infection. The presence of these side effects and others can impair quality of life, and with it, reduce a person's interest in and engagement with the world around him or her. Excellent symptom management is very important, and patients and their caregivers must insist that symptoms are listened to and promptly treated.
  
  
• Maintain good nutrition. Poor nutrition may produce an impaired mental capability. This is very treatable, and patients must make certain that their nutrition levels are closely monitored by the health care team.
  
  
• Combat fatigue. Unrelenting fatigue is very distressing and can have an impact on cognitive function. Fatigue is a treatable side effect and can be managed, restoring quality of life for you. Physical therapy can be helpful, as well.
  
  
• Get enough sleep. If you aren't able to sleep normally, your fatigue will increase and with it, forgetfulness and difficulty concentrating. Check with your health care team about medications that can help.
  
  
• Keep an active mind. Make a plan to keep yourself mentally stimulated. Make sure you read, listen actively to music that you love, get involved as much as possible in the activities of normal life, even work if possible — staying "in the world" instead of only in the "world of cancer." Some people keep a journal about their cancer journey, and find this stimulating, as well. If you need memory support, try keeping notes of reminder, and a daily calendar.
  
  
• Seek support. Cancer support groups can offer a wonderful opportunity to speak with others likely to be experiencing side effects like yours. Here, you can speak your mind and learn from the coping skills of others. If cancer support groups aren't right for you, seek out other communities of people with whom you feel comfortable.

Treatment

The treatments for symptoms of cognitive impairment will depend on each individual's particular symptoms and physical condition. Some techniques and approaches to treat cognitive problems that your health care team might consider include:

• Counseling. Working with a therapist can be helpful in treating this side effect. Often counseling can be combined with medications, as needed.
  
  
• Stimulant and anti-depressant medications. There are a number of medications used for cancer-related cognitive problems. Some include Ritalin (methylphenidate), various antidepressants and stimulants. Your health care team will determine what might be useful for you.
  
  
• Nutrition evaluation and treatment. Nutrition can play a very important role in the mind's functioning, and people in cancer treatment have exceptional nutrition needs. Ask your health care team for a referral to a registered dietician for advice and assistance in nutrition.
  
  
• Physical therapy. This can improve your overall physical strength and sense of well-being. The better you feel, the more likely you will be active and have sufficient energy.
  
  
• Sleep medications can help with getting enough rest. Talk with your health care team about what is recommended for you. Do not begin taking over-the-counter sleep medications without talking with your health care team.

Questions for Your Doctor

In treating cognitive concerns, your health care team may include an internist, oncologist, counselor, dietician, and physical therapist.

1. Is it likely that my cancer treatment will cause cognitive problems?
   
   
2. What do you believe has caused my cognitive problems?
   
   
3. Can we assess my degree of impairment?
   
   
4. Are there medications that can help?
   
   
5. How long to you believe my problems will continue? What has been your experience with other patients taking similar treatment?
   
   
6. What is our plan to help me increase and improve my level of cognitive function?
   
   
7. Are my problems like to worsen as treatment continues?
   
   
8. Can we assess my nutrition levels? And can these be monitored regularly?
   
   
9. Do I have any other health conditions that might be contributing to my cognitive problems? Is it appropriate to consider possible brain involvement of my cancer?

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