Coping With the Mental Side Effects of Chemotherapy

You were warned: Be prepared for the possibility of nausea, diarrhea, fatigue, and hair loss while undergoing chemotherapy. But you were probably not told about that unsettling state of fuzzy thinking, difficulty focusing, and memory loss that you've been experiencing. In this Special Report, Johns Hopkins discusses chemobrain -- and provides nine tips to help you cope.

Researchers now believe that from 40–80% of individuals undergoing chemotherapy experience a phenomenon they call chemobrain. Some healthcare providers have questioned whether chemobrain actually exists, as it was thought that chemotherapy drugs could not cross the blood-brain barrier that blocks most medications.

But surprising new evidence suggests that chemobrain is real and is related to structural changes in the brain caused by chemotherapy drugs. Although most research to date has been conducted on women with breast cancer, this phenomenon does not appear to be unique to any single type of cancer, and people with colorectal cancer have reported experiencing it as well.

A recent study that looked at images of the brains of women who had chemotherapy found striking physical changes after treatment. Researchers in Japan compared MRI (magnetic resonance imaging) scans of the brains of 51 women who had undergone chemotherapy for breast cancer with those from women who had surgery only. One year after treatment, areas of the brain that are crucial for memory and problem solving were significantly smaller in the chemotherapy group. In addition, the greater the reduction in brain size, the worse the women performed on tests of memory and concentration. The good news: Three years later, both groups tested about the same, which suggests that those with chemobrain recovered.

In spite of the apparent adverse effects of chemotherapy on the brain, for many people the benefits of chemotherapy treatment outweigh the risks. And, as with other chemotherapy side effects, chemobrain doesn't affect everyone equally.

You may have no side effects, while others may have a few and still others, many, and they can be short term or last for years. The type and extent of the side effects can be related to the dose of medication given (higher doses tend to have more adverse effects), the drugs used, and your gender. In general, women are more likely to be affected than men, and the effect is greater in females, perhaps because the chemotherapy drugs cause hormonal changes similar to menopause.

9 Tips To Help You Cope -- It helps to remember that chemotherapy ends. Even if you have an ongoing chemotherapy schedule, there are periods without treatment, and during these times you're likely to experience fewer symptoms.

Of course, knowing that chemotherapy can extend life and help lower the risk of recurrence makes it easier to cope with the side effects. In a recent study of 150 people treated with chemotherapy for colorectal cancer, 35% would be willing to have the treatment again, even if it only cut the risk of recurrence by 1%.

Here are nine strategies to help you cope with your chemotherapy side effects:

1. Keep track. Note your symptoms, and talk with your doctor and healthcare team about changes you notice and ask what can help. Experienced chemotherapy nurses have many tips and suggestions for coping.
2. Ask for referrals. Consider counseling for emotional stress, cognitive retraining for chemobrain, and support groups.
3. Write it down. A daily organizer or a notebook to write down "things to do" and completed tasks helps counter chemobrain.
4. Post-it. Stick-up notes are great reminders.
5. Sleep on it. Getting enough sleep is important to keep your mind alert. If symptoms keep you from sleeping through the night, consider short naps.
6. Exercise your body. Physical activity helps with mental functioning and can relieve stress, pain, and other symptoms. Consider yoga and tai chi: The repetitive exercises are good for mind and body.
7. Exercise your mind. Puzzles and games help improve mental function as well as help distract you from thinking about more stressful concerns.
8. De-stress. Stress makes most symptoms worse. Deep relaxation and stress reduction courses may help. Films, videos, and music are relaxing for many people.
9. Simplify. Save energy for the most important tasks. Multitasking may be harder than it used to be, and keeping track of a full schedule may be physically and mentally stressful.

** The National Cancer Institute has an excellent brochure with suggestions for dealing with other common chemotherapy side effects. You can order a free printed pamphlet by calling 800-4CANCER (422-6237) or go to www.cancer.gov/cancertopics/coping and click on "Chemotherapy and You: Support for People With Cancer."