Over the past few years, scientists and doctors have confirmed what we have known for a long time: that some of us do experience some degree of cognitive blunting during and after chemotherapy. For most people, the sense of feeling less sharp improves quite quickly, but some do struggle with it for longer. One of the complications is that it is impossible to tease out what is due to drugs (chemo and the accompanying medications) and what is due to stress, natural aging, loss of estrogen, etc. Certainly it is frustrating when your friends who have not had cancer treatment minimize your trouble with word-finding or memory--when we absolutely know it is something a bit different.
Here is an excellent article from the New York Times:
New York Times
August 11, 2009
By Tara Parker-Pope
Last week, my colleague Jane Brody explored the new scientific thinking about "chemo brain," the foggy thinking and forgetfulness that afflicts many cancer patients after treatment. This week, Jane offers advice for patients in "Taking Steps to Cope With Chemo Brain."
For years, patient complaints about the cognitive losses that seemed to follow cancer treatment were dismissed by doctors, who blamed memory problems on aging or the fatigue of illness. But more recently, many doctors are finally acknowledging chemo brain as a legitimate and vexing after-effect of chemotherapy.
If you have a question about chemo brain, be sure to check out the Consults blog, "When Cancer Treatment Affects Memory," where Dr. Daniel Silverman, a leading researcher in the field and co-author with Idelle Davidson of "Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus," is answering questions.
Have you experienced chemo brain? Do you have advice for coping? Please share your experiences below.
Taking Steps to Cope With Chemo Brain
New York Times
August 11, 2009
By JANE E. BRODY
Cancer can be a life-changing experience, both physically and mentally. And when cancer treatment delivers a knockout punch to cognitive abilities, patients with the resulting "chemo brain" often face major challenges trying to get their lives back on track. But those who recognize the cognitive effects of toxic cancer drugs, adjust their schedules and learn to compensate for what are usually temporary limitations have an easier time returning to a productive life.
Barbara D. Wick of Chicago, for example, was working part time as an insurance consultant and serving on several not-for-profit boards while receiving chemotherapy for ovarian cancer. It was suddenly a challenge for her to deal with the complex problems presented by her professional and volunteer activities. "I found it difficult to deal with more than one factor at a time and scary to have to think on my feet," she said. "And I couldn't trust my memory." She continued working but stopped taking new clients and transferred a difficult account to someone else. Helped by a support group, Mrs. Wick adopted new ways to handle professional and personal demands.
"I learned coping techniques that are not really different from those that would be used for people with memory loss," she said in an interview. "I write everything down immediately, including appointments, doctors' comments, ideas of things to do, plans and promises I've made. This gives me something to go back to, and using more than one modality - listening and writing - reinforces my ability to remember the information. " She said she also became a "list addict.""At night, I make a list of what I have to do and where I have to be the next day," she said. "I've become religious about always putting things back in the same place - keys, cellphone, scissors, bills, everything. I pay bills on the same date and I double-check and proof everything, sometimes twice."
Strategies for Staying on Track
The symptoms of chemo brain - commonly mental fogginess that can cause problems with memory, concentration, word retrieval, number processing, following instructions and multitasking - are widely known. And the effects, the causes of which are still unclear, are sometimes long-lasting. In an excellent new book, "Your Brain After Chemo," Dr. Daniel H. Silverman and Idelle Davidson quote a 52-year-old woman who was treated four years ago with drugs and radiation for breast cancer:
"Ever since I got lost in the shopping mall garage and couldn't find my car, I always write down the level number and color code, etc., on the back of my parking ticket," she told the authors. "And I always place parking tickets in the same section of my purse so I know where to find them. For extra measure, I'll play a word game. If I'm parked on B1, for example, I'll make up a cue like: Be one with the universe."
Dr. Silverman, a leading researcher in the field, and Ms. Davidson, a health journalist and former cancer patient, offer a long list of suggestions to help people who are struggling with the cognitive effects of chemotherapy. Even though I don't have chemo brain, several of their tips already help me keep track of a complex life despite an aging memory. And while I'm not yet ready to buy a personal digital assistant, I plan to adopt several other strategies.
- Prioritize. Because multitasking can be overwhelming to people with chemo brain, it helps to list tasks in order of their priority and concentrate on one at a time.
- Develop routines. Prepare the night before for the next day. Review your calendar, lay out clothes, pack your briefcase, perhaps even set up breakfast and prepare a brown-bag lunch. Take medications and exercise at the same time each day.
- Rehearse. On the way to a meeting where you will have to be on top of your game, visualize the room or the people who will be there and practice what you will say.
- Use word associations or rhymes. Maybe Harry has lots of hair and Mrs. Gold lots of money. Perhaps your daughter-in- law's birth date is 2-4-68 or the combination on your gym lock is 2 (times) 6 (equals) 12.
- Rely on more than one sense. Try to link people and places with their scents, tastes, textures or unusual characteristics. Maybe Henry always wears a hat, or Rose's front door is red.
- Use a notebook to record information. My surroundings are covered with sticky notes, and I search frantically for something I know I wrote down somewhere. The authors suggest a single notebook so that everything is in one place, and dating the pages as you use them. They say, "This frees your desk and your mind from clutter."
- Post a checklist by the front door. Leave yourself a note of things to remember when you are going out - keys, wallet, walk the dog, close the windows, turn off the hose, check the faucets, lock the door.
- Write phone numbers on your phones. It doesn't take chemo brain to forget a phone number, and I've noticed that many people don't know their own cellphone number. Program as many contacts as you can into your cellphone, and keep a list of frequently dialed numbers next to your landline.
- Use a day planner. Write down all appointments immediately, with times, places and contact phone numbers. If you spend most of the day at a computer, you can use the calendar feature that alerts you to appointments. As a backup, I record things on a wall calendar and keep a paper tickle file, but this works well only if you check it regularly.
- Leave messages for yourself. If you have voice mail or an answering machine, you can use it to remind yourself of appointments or tasks you have to do. But again, this works only if you check it regularly.
- Timers can be lifesavers. I never put anything on the stove, in the oven or on the grill without setting a timer to warn me when to turn the heat down or off. I also have several 24-hour timers that I use as a wake-up alarm and to remind me when to move the car, pick up the grandchildren at school or put the laundry in the dryer.
- Get adequate rest. Even without chemo brain, fatigue is a memory destroyer. Don't skimp on sleep, and when you feel your brain dragging, take a 20-minute nap. Stress impairs brain function, so practicing relaxation techniques like meditation and yoga can be very helpful as well.
Let Others Help
Finally, don't bite off more than you can chew. Until and unless your brain recovers fully, simplify your life. Follow Mrs. Wick's example if you can and reduce your workload or your hours. Perhaps even take a vacation or a leave of absence. Less work done well is better than a lot done poorly. If those options seem like luxuries you cannot afford because you need to work, this is the time to rely on friends and family. Delegate chores. Say yes to people who offer to cook meals. Tell family members, especially, what coping tips you're using so they don't inadvertently derail your efforts. In as many ways as possible, give yourself a break.