Clearing the Mind: Coping with "chemobrain"

Understanding 'chemobrain' to find better ways to cope

People who have undergone treatment for cancer often report that they just don't seem to be able to think as clearly as they used to. They have trouble remembering things from one minute to the next. They can't think of the right word or they forget people's names. And multitasking is simply out of the question.

For some, the problems can be severe, leading to difficulties at work and at home.

Researchers have struggled to understand the syndrome that has come to be known as "chemobrain." One of those researchers is Bernadine Cimprich, a U-M associate professor of nursing who has studied the cognitive functioning of women with breast cancer. We spoke with her about what chemobrain is and how people can cope with it.

Q: How many people are affected by chemobrain?

A: We believe that about one-third of women treated for breast cancer have cognitive problems that interfere with day-to-day living. But that's just an estimate. Even subtle changes not easily detected on usual cognitive tests can be very bothersome. We started talking about chemobrain with the breast cancer population because the bulk of studies of cognitive problems have been focused on this group. However, we don't think it's unique to breast cancer or to women.

Q: What causes chemobrain?

A: That's the puzzle. I actually don't think "chemobrain" is a good term for it because it focuses on a possible source that may or may not be the total story. Cognitive changes have been detected with chemotherapy but other factors also might be involved. My research-as well as other people's research-shows that some women have cognitive differences before they ever have treatment. We've looked at women at that point after diagnosis and just before treatment and we could already detect cognitive difficulties. We can't blame it on chemotherapy, surgery or any type of treatment. We can't blame it on older age because we also assessed women without breast cancer of similar ages, and they didn't exhibit the same problems.

Bernadine Cimprich, PhD
Bernadine Cimprich's research has found that spending time in nature has a measurable impact on reducing fatigue, which probably plays a role in "chemobrain."

Q: If it isn't caused by chemotherapy alone, then what other factors are involved?

A: There are probably brain networks that are vulnerable to fatigue and stress-which obviously both occur with a cancer diagnosis. We have networks that are responsible for working memory and attention that help us block out distractions and keep track of things. If these networks are vulnerable to stress and fatigue in the first place and then you add therapies that may have toxic effects, it may compound the problem. There may also be genetic factors that increase a person's sensitivity to cognitive side effects of chemotherapy. And depression or menopausal symptoms could add to cognitive changes, too. So it could very well be that there is more than one source for these cognitive problems.

People who have undergone treatment for cancer often report that they just don't seem to be able to think as clearly as they used to. They have trouble remembering things from one minute to the next. They can't think of the right word or they forget people's names. And multitasking is simply out of the question. For some, the problems can be severe, leading to difficulties at work and at home. Researchers have struggled to understand the syndrome that has come to be known as "chemobrain." One of those researchers is Bernadine Cimprich, a U-M associate professor of nursing who has studied the cognitive functioning of women with breast cancer. We spoke with her about what chemobrain is and how people can cope with it.

Q: How many people are affected by chemobrain?

A: We believe that about one-third of women treated for breast cancer have cognitive problems that interfere with day-to-day living. But that's just an estimate. Even subtle changes not easily detected on usual cognitive tests can be very bothersome. We started talking about chemobrain with the breast cancer population because the bulk of studies of cognitive problems have been focused on this group. However, we don't think it's unique to breast cancer or to women.

Q: What causes chemobrain?

A: That's the puzzle. I actually don't think "chemobrain" is a good term for it because it focuses on a possible source that may or may not be the total story. Cognitive changes have been detected with chemotherapy but other factors also might be involved. My research-as well as other people's research-shows that some women have cognitive differences before they ever have treatment. We've looked at women at that point after diagnosis and just before treatment and we could already detect cognitive difficulties. We can't blame it on chemotherapy, surgery or any type of treatment. We can't blame it on older age because we also assessed women without breast cancer of similar ages, and they didn't exhibit the same problems.

Q: If it isn't caused by chemotherapy alone, then what other factors are involved?

TIPS

Chemobrain is probably compounded by stress and fatigue. Bernadine Cimprich, U-M associate professor of nursing, said research has found that exercise, yoga, meditation and spending time in nature have a measurable impact in reducing fatigue. In addition, consider these lifestyle approaches:

Focus on the priorities that are most important to you. Delegate tasks or leave other things undone.

When you approach a task that requires a lot of mental energy, break it down into smaller goals.

Don't try to multitask, especially in situations where it could be dangerous, for example, when driving or while cooking.

arrowSchedule your day in advance. Having a structure will help you complete tasks.

arrowRely on family and friends to help you. If you're having trouble making simple decisions-like meal planning-ask if they would help with decision-making and shopping.

arrowUse a buddy system. For situations where you are concerned that you may be making a mistake, ask someone to look over your work. If you need to read something complex, ask someone to talk it over with you to make sure you fully understand.

A: There are probably brain networks that are vulnerable to fatigue and stress-which obviously both occur with a cancer diagnosis. We have networks that are responsible for working memory and attention that help us block out distractions and keep track of things. If these networks are vulnerable to stress and fatigue in the first place and then you add therapies that may have toxic effects, it may compound the problem. There may also be genetic factors that increase a person's sensitivity to cognitive side effects of chemotherapy. And depression or menopausal symptoms could add to cognitive changes, too. So it could very well be that there is more than one source for these cognitive problems.

Q: What research is underway to better understand this phenomenon?

A: We opened a study this summer that uses functional MRI-a type of scan that can show blood flow with brain activity-to detect changes in cognitive functioning. We'll be looking at women to see if changes in attention and working memory develop, how long they last and whether they get better after chemotherapy. In order for us to really be able to get a handle on how to treat people, we need to understand what the problem is.

Q: What kind of treatment is available to address cognitive problems?

A: We don't have treatment for chemobrain because we're not sure what the source of the problem is. If someone's cognitive functioning is compromised, she is at high risk for further loss of functioning from stress and fatigue. We can always work to find ways to reduce stress and fatigue. (See Tips.)

Q: What should people do if they suspect they have chemobrain?

A: The first thing is to let your health-care team know the problems you are experiencing to see if further evaluation is needed. We can recommend a lifestyle approach to help conserve mental energy and improve functioning.

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Thrive Issue: 
Summer, 2008