Photo by Robert Hood / Fred Hutch
Michelle Dawkins, age 56, takes her time finding the answers to questions and often seems to be thinking things over for a while before she replies. In fact, there is a medical reason for her reticence. First diagnosed in 2000 with breast cancer, Dawkins has been treated for cancer four times since then, including surgery, radiation, and multiple rounds of various chemotherapy drugs.
As might be expected, the cancer recurrences and repeated treatments have changed her life. For Dawkins, however, it is the ongoing memory problems that have become a day-to-day burden.
“I used to be able to easily remember names along with faces,” she said, “then I stopped being able to do even that. I started writing things down or trying to remember in a different way.” But the glitches have not gotten any better over time.
People who have been treated for cancer have known about this problem for years, even if they didn’t talk about it much or ask their doctors for help. Recently, the cluster of symptoms known most commonly as “chemo brain” has garnered medical attention and initiated a wave of discussion. Important work is now being done to understand the condition and, more crucially, to help alleviate it.
The mystery of chemo brain
The condition commonly involves cognitive changes including reductions in short-term memory and information-processing speed, and limitations or changes in an individual’s ability to organize information. The changes can be subtle and may be noticed only by the person experiencing them.
Signs of chemo brain can include:
- Trouble remembering names
- Difficulty concentrating or paying attention
- Lapses in short-term memory or being forgetful
- Inability to find the right word for something
- Problems with planning ahead and organizing things
Acknowledging the reality of chemo brain is a huge and needed start, but there is a long road ahead, according to Dr. Monique Cherrier, research associate professor of psychology at the University of Washington and affiliate investigator with Fred Hutchinson Cancer Research Center. Right now, it’s an unfortunate truth that curing cancer involves exposing people to chemotherapeutic agents, often to the point of toxicity.
“For a long time, we thought that these drugs did not cross the blood-brain barrier,” she said, “but there are studies now using animal models that show chemotherapy can cause cognitive deficits.”
It’s not entirely clear what mechanism leads to the reported and measureable mental shortcomings associated with cancer and cancer treatment. “I don’t like the term ‘chemo brain,’” said Cherrier. “There are so many factors that can reduce one’s optimal cognitive functioning” -- especially during cancer treatment, it seems. Immune system changes, hormonal fluctuations, the specific side effects of various drugs, crushing overall fatigue, chronic stress, psychological issues, and even the underlying effects of age all play a part in the spectrum of cognitive dysfunction that can manifest around cancer care.
Openly accepting that cognitive functioning can be impaired means that more work can be done to understand and, ultimately, alleviate the constellation of symptoms that affect patients. Cherrier is currently conducting a study focusing on cognitive rehabilitation exercises most commonly used for people with head injuries.
"There is strong literature showing that cognitive training helps the head injured population regain functioning and get back to work,” she said. “So we put together a seven-week training program for people with cancer.”
The program is group based; seven to 10 people meet weekly and not only learn new skills, but also get to practice them on each other. “We have taken the best of what is out there in cognitive rehabilitation exercises,” said Cherrier, “and then we tailor the program by asking participants to list their top concerns.”
The program also delivers education about how cognition works. “I am training participants to be their own scientists,” Cherrier said. “When you cannot think of a word or forget something, I tell them, let’s examine what factors could have contributed to that incident.”
Stress reduction is also a featured tool in the study. Fred Hutchinson Cancer Research Center behavioral psychologist Dr. Bonnie McGregor has combined forces with Cherrier to bring mindfulness meditation techniques to study participants.
“This is the first time looking at the effects of stress management in people with cancer,” said McGregor. Stress is associated with increased production of proteins called inflammatory cytokines, which research has linked to cognitive impairment. “It makes sense that reducing stress would help, and we are very optimistic.”
What you can do
Participants complete a battery of questionnaires before their first session and again at the end of the seven weeks. The preliminary data look promising, said Cherrier. When results are finalized, the researchers hope that the program will be offered to more patients in additional settings. Until then, if you are affected by chemo brain, there are some steps you can take.
- Try mindfulness. “If you can attend to things longer, you are more likely to store them [in memory],” said McGregor. Any kind of yoga or mindfulness practices such as sitting or walking meditation can help you develop your ability to pay attention, and could lead to better memory retention. Classes are often available at little or no cost through hospitals, doctor’s offices, or community centers.
- Sample some cognitive practices. Many of the training techniques used in the study are commonly available through books or websites, said Cherrier. Research participants gain extra benefits from the group setting and from receiving tailored instruction, but it could not hurt to try some cognitive exercises on your own. Search for “brain exercises” or “brain training” and look for activities, such as word puzzles or math quizzes, which may tie in to a specific challenge you are facing.
- Get some physical exercise. Memory and executive function (decision-making abilities, basically) have been shown to improve after mild to moderate physical exercise. “You have to be careful if you are already fatigued,” said McGregor, “but exercise can reduce levels of inflammatory cytokines.” A midday walk is a gentle place to start.
- Ask for help. After treatment, Michelle Dawkins found herself reading things over and over again for her business administration class. “It got to the point where I had to ask for extra time for testing,” she said. Dawkins’s doctor wrote a letter requesting extra time for her to take tests, and she was able to complete the class. Find out if special accommodations are available; it might be just the help you need.
- Work on your strengths. Cherrier reminds patients to not focus on their weaknesses. “What can you do to work on your strengths?” she asks. Try building on the things you can still do well—perhaps cooking from recipes, playing board games, or completing jigsaw puzzles.
- Learn about Dr. Monique Cherrier's 7-week workshop on cognitive complaints, chemo brain
- 8 things you should - and shouldn't - say to a cancer patient
- Many patients recover from 'chemo brain' five years after treatment