Chemo Brain and Work
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
JUNE 23, 2021
For a long time, there was controversy regarding the reality of chemo brain. Although many patients reported the same experience and issues, some doctors insisted that it was not real. Fortunately, those attitudes have changed, and there is universal acceptance of this all-too-common problem.
Medical people sometimes use other terms such as cancer treatment-related cognitive impairment, cancer-related cognitive change, or post-chemotherapy cognitive impairment. These all sound quite serious and scary, and patients are likely just to call it chemo brain or chemo brain fog. It is important to note here that some recent studies have found that the same phenomenon can happen to people who are treated for cancer, but who do not receive chemotherapy. Specifically, some people taking hormonal or endocrine treatments, often for breast or prostate cancers, have the same problems.
There are several theories about the cause of chemo brain. Some researchers think that some chemo drugs may pass through the “blood brain barrier” which is intended to keep unwanted chemicals out of the brain. If they get through, they could well affect cognition. There is widespread agreement that all the other drugs that usually accompany chemotherapy (anti-nausea, sleep aides, etc.) as well as the stress, anxiety and fatigue that are inevitable are also contributors.
Whatever you call it, the experience is described as a mental fuzziness and lack of focus. People can experience troubles with memory, word and name finding, and often lose the ability to multi-task. Especially as so many of us have worked virtually over the past year, concentrating for hours on screens is very tough. I have known several people whose work required close attention to details, and looking at spreadsheets, long lists of numbers, editing, or similar jobs may feel impossible. The very good news is that chemo brain is not permanent. Most people feel that their cognition has returned to normal within a few months. If it takes longer, you will learn strategies and workarounds to help.
Chemo brain is frustrating in one’s personal life, but it can be more difficult at work. Most people going through cancer treatment have to make some adjustments in their professional lives. Whether that means taking a leave or working shorter days or, at the least, taking time off when going for medical appointments or recovering from surgery or treatment, it often means feeling more pressure to perform while at work. If you know that your colleagues have been covering for you, you want to pick up your own responsibilities ASAP.
The first piece of advice is the usual reminder to take care of yourself. Try to get enough sleep, eat well and exercise. Be gentle on yourself and remember that you are recovering from something very difficult. The second is to remember how you have, hopefully, learned to accept and even ask for help. Talk with your manager or your co-workers whom you trust. Explain that you are feeling side effects from your treatment and could sometimes use their assistance. For example, you could ask a colleague to read a report you have written before you submit it or talk with you about a project. Being with other people helps stimulate our brains. Don’t hide in your office or at your desk; interact with others. If you are working from home, consider meeting a colleague somewhere for a snack or a walk. At the least, have some conversations that are not only focused on work.
Do whatever you can to reduce your overall stress level. Consider meditation or deep breathing when you begin to feel distressed. Get outside every single day; fresh air helps. Make lists and prioritize. When you are working on whatever is most important, try to ignore thoughts about other tasks. You probably don’t need to check your email or messages every half hour; put aside chunks of time during the day to catch up. Establish routines and stick to them. If you always have lunch at noon, do so. If you always check in with a colleague at 2 pm, keep it up. There is a nice phrase: rehearse to remember. This means saying things aloud; if you are introduced to someone, use their name a few times in that first conversation. If you are going into another room to get something, tell yourself out loud what you are fetching. Print out instructions and read them aloud. Clear your desk or workspace so objects and piles are not distractions.
Remind yourself, out loud, that you are managing or have managed cancer treatment, and that you can certainly contend with some forgetfulness, too. It will get better.