Cognitive impairment or 'chemo brain'

Many people report feeling vague, mental fogginess, difficulty concentrating or memory loss while being treated with chemotherapy and/or hormone-blocking therapy. This is often referred to as cognitive impairment.

The terms ‘chemo brain’ or ‘chemo fog’ are often used to describe these feelings.

What causes cognitive impairment?

While cognitive impairment is a very real experience for many people undergoing treatments such as chemotherapy and hormone-blocking therapy, it is not clear what exactly causes memory and concentration problems in people affected by cancer. Possible causes for cognitive impairment include:

the stress of the cancer diagnosis
the chemotherapy treatment itself
hormonal changes related to hormone-blocking treatments
the ‘natural’ ageing process.

Remember to go easy on yourself

It's important to remember in addition to dealing with cognitive changes after a diagnosis and treatment for breast cancer, you are managing lots of other things that can impact on your thinking as well. This can be anxiety and depression due to things around your diagnosis or family or work issues.

Talking to your treating team about the different things that might be impacting your cognitive function and working together to develop a plan on how you might address those things, can be helpful. For example, anxiety and depression could be managed through psychological counselling or medication if the doctor feels this is the best thing for you.

Getting support from family or friends to help with practical tasks can also be useful to reduce everyday demands.

Managing cognitive impairment

Some people find that doing crosswords, Sudoku or other mind-exercising puzzles helps them to feel more alert and improve their memory. Other suggestions to help you manage cognitive impairment include:

At the start of the day, allocate some quiet time to planning out the day.
Begin with easy achievable tasks - set an overall goal, then break that down into smaller more immediate goals, tasks or lists.
Tick off the task once complete.
Set yourself some time frames - but be realistic to start with. Gradually work towards improving the time spent on tasks.
Take regular breaks.
Return focus to the task at hand i.e. one task at a time (go back to your list!).
Keep your lists and plans for a while, as you might need them to refer to.
Use computer and mobile phone-based reminders.
Take time to relax and wind down.
Try and get enough sleep.

Other strategies that may be helpful include:

Mindfulness – any kind of yoga or mindfulness practice such as sitting or walking meditation can help you develop your ability to pay attention and could lead to better memory retention.
‘Brain exercises’ or ‘brain training’ including activities, such as reading, sudoku, word puzzles or maths quizzes. Using digital ‘brain training’ applications (such as Brain HQ) have also been found to improve how people affected by cancer perceive their memory. Learning a new language, musical instrument or skill can also be helpful.
Physical exercise – Memory and executive function (decision-making abilities) have been shown to improve after mild to moderate physical exercise.
Note-taking – Carry a notebook (or make notes or voice memos in your phone) and write down things that are important to remember.
Try rituals that help you remember, such as putting your keys in the same place each evening.
Work on your strengths – Rather than focus on your weaknesses, try doing things that you know you can do well and don’t be too hard on yourself.
Stress management – Think about stress management techniques that have worked for you in the past and try them again now.

If you are experiencing symptoms of cognitive impairment talk to a member of your treating team for management strategies and support.

I really began to worry when I noticed I was forgetting things. I started doing crosswords, which helped me to focus. I also found that my diary became my best friend!

Anna, BCNA member

Finding support

Cognitive changes related to breast cancer treatments can be distressing and it is important to reach out to your treating team for support.

Ask your treating team if there is a cognitive training rehabilitation program available that you may be able to access. You may also be able to be referred to an occupational therapist that works in your health service to assist with strategies to improve cognitive impairment. Cognitive rehabilitation is geared towards improving, restoring or maintaining mental function through structured repetition of tasks that pose mental challenges requiring the person to problem solve.
Ask your GP for an occupational therapy care plan as part of the Chronic Disease Management Plan.

To find an occupational therapist who works in private practice in your area, visit Occupational Therapy Australia.

If you are struggling at work, you may be eligible for Service Australia's Work Assist program that can help make changes in your workplace so that you can keep working.
Make sure you are receiving psychological treatment for any depression or anxiety you are experiencing, through your GP and psychologist, as these can further impede and complicate cognitive difficulties.

Things you can do now

Watch BCNA’s webcasts:
- Ask the Expert: Managing cognitive changes related to breast cancer treatments with Jo Lewis
- Managing stress and improving wellbeing with mindfulness and meditation
Listen to BCNA’s podcast Managing fatigue.
Visit My Journey, BCNA’s online tool for information tailored to your diagnosis.
Join our Online Network if you think that talking to others online and sharing experiences will help.
Contact BCNA’s Helpline on 1800 500 258 between 9.00 am and 5.00 pm AEST Monday to Friday, for information about the services and support that may be available for you and your family.