Chemo Brain (Cancer Brain) is Real

As an oncologist, let me tell you that yes, "chemo brain" is a real thing. I personally prefer the term "cancer brain" since people who have cancer but don't get chemotherapy still suffer from this. The problem is that the medical community can't quite perfectly explain it or predict it or even treat it, so many of us often brush it to the side. I, for one, am not intimidated by something I can't cure, so let me offer you my opinion on what I think it is and why I think it is real.

---

One part post traumatic stress disorder

No, I do not think everyone with cancer has PTSD like those who experience horrific events. However, it has long been recognized that when a life-changing emotional stress occurs, the brain is changed in a way effects a person's ability to live and think normally. To have cancer is to be told that your body has betrayed you and you might die. You were healthy yesterday and now you're a sick person. Wait....and now you're supposed to be FINE with that? Yes, you will persevere, but your brain and your thinking has changed. Again, I don't blame the cognitive effects totally on this concept, but knowing that this is a well-recognized entity supports the theory that chemo brain is real.

One part neuro-hormonal axis disruption

For those of you with breast cancer and prostate cancer, we also completely screw up your hormones. If your cancer needs estrogen, testosterone, or androgens to thrive, we give you medicines that take those away from the cancer...but also from the rest of you and your brain. Talk to a woman who has been through normal, natural menopause and she'll tell you that she is more forgetful than she used to be. I also believe in pregnancy brain, by the way. Sometimes I'm surprised that I did as well as I did on my internal medicine board exam being 7 months post-partum. I count these in the same category.

One part inflammation (anti-exercise)

Having cancer and taking treatments that beat up the body means having to reconstruct yourself over and over again with each cycle. Your doctor monitors your blood counts and tells you that they fall and rise and you get to repeat the cycle. As the cancer dies, your body has to clean up the dead debris as well. But the immune system is dysregulated by the chemo and so it is that much harder for things to recover. I suppose this is like the opposite of what exercise does for you. Talk to any fitness expert and they will tell you how exercise (which I call "good inflammation") improves thought clarity. What cancer and chemo do to your body is the opposite of that.

One part exhaustion

Reconstructing the body after treatment and harboring an uncontrollable growth within the body takes energy. Not only that, but the emotional toil and inflammatory effects also effect sleep quality, so even if you're sleeping more, you may not be sleeping well. Many studies have been done on the effects of poor sleep and fatigue on the ability of the brain to retain and recall information. Those of us who used to work 36-48 hour shifts can absolutely attest to this.

One part medication effect

Pain, nausea, and insomnia are common in patients with cancer. You don't have to suffer. You shouldn't suffer. Still, some of the medications that alleviate suffering can disrupt some of the pathways of clear thinking. Am I telling you to stop your medications? Goodness, no. In fact, if there is one area where I am very hopeful for the future of cancer treatment, it is supportive care for treatment. I mean finding better options for symptom control without collateral damage. But for now, the truth remains that some supportive medications can blunt thinking.

Mix them all together....

So yes, if medical science has proven the existence of these other things, chemo brain is real. But now what? What are you supposed to do? I, for one, am NOT going to tell you to suck it up and drive on. I'm going to reiterate what the American Cancer Society, Dana Farber, MD Anderson, and the rest have to say.

1. Exercise

No, don't go out and push yourself to exhaustion or hurt yourself, but just move. I personally enjoy YouTube's JessicaSmithTV. She has TONS of videos ranging from 5-10 minutes to 40 minutes with anything from walking in place (which is surprisingly harder than it sounds) to yoga for beginners and beyond. My favorite part is her mantra: "Something is always better than nothing."

2. Cut yourself some slack

It sucks. I can't say that from personal experience, but I listen to stories every day from highly functioning people who just feel that they can't work like they used to and it is frustrating. I can only imagine. I have a job that demands that I stay on top of the ever-changing environment of cancer and then I get to go home and try to recall grammatical terms to assist my kids with their homework (what the heck is a gerund again?). I don't know what I would do if I couldn't stay on top of that. You are amazing. Hang in there (and let Siri, Google, and/or Alexa remind you of things...Google finds my phone one a weekly basis).

3. Get help if you need -it doesn't have to be permanent

I know that I said some medicines can cloud the mind, but some can help. The class of medicines known as "anti-depressants" are, in my opinion, better referred to as "neuro-modulators." This class of drugs can help with neuropathy, body aches, sleep patterns, as well as mood from depression to anxiety. Many of my patients fear that once they start them, they will become dependent on them. I think of them more as correcting an imbalance that was put that way by all of the factors above. Even if your cancer treatment is going to last into the indefinite future, your body will adapt to everything little by little. I always offer my patients a trial off of their neuro-modulators / anti-depressants, but many choose to stay on them because for many people, they do help. I don't promise they will, but it can be worth a try. That all said, it does NOT have to be chemical, either. Acupuncture, yoga, aroma therapy, massage, medication, support groups - I believe in all of it.

---

So there it is, my take on cancer brain and the advice I give my own patients. I'm sorry that you or someone you know has to go through this.

Thanks for reading.

Dr. G