Chemo brain

Chemo brain refers to changes in memory, concentration and the ability to think clearly. Your doctor may call these problems cancer-related cognitive changes (CRCC). At the moment we don’t know exactly what causes these problems, or how many people are affected by them.

The symptoms of chemo brain were first linked to chemotherapy. But the term chemo brain can be misleading. Changes in memory and concentration can affect people with cancer who haven’t had chemotherapy.

Symptoms are mild or subtle. But they can be frustrating and affect everyday life. They include:

  • difficulty concentrating
  • trouble remembering things
  • extreme tiredness
  • a feeling of mental ‘fogginess’.

Research is still going on to find an effective treatment. But there are things you can do to help yourself:

  • Plan your day so you do more difficult tasks when you feel at your best.
  • Make lists and take notes to help you remember things.
  • Do mental exercises, such as crosswords.
  • Reduce your stress levels by listening to music or going for a walk.
  • Talk to your family, friends, doctor or nurse for more support.

What is chemo brain?

Chemo brain causes changes in memory and concentration. It can also affect the ability to think clearly and put thought into action. Some people notice these kinds of changes during and after cancer treatment.

These problems were first noticed by women who had treatment for breast cancer. They had changes in memory and concentration, which they linked to their chemotherapy treatment. This is why it is called ‘chemo brain’ or chemo-fog.

Although it is commonly used, the term ‘chemo brain’ can be misleading. Research shows that changes in memory and concentration can also happen in people with cancer who have never had chemotherapy. Your doctor may call these problems cancer-related cognitive changes (CRCC), mild cognitive impairment or cognitive dysfunction. The word ‘cognitive’ refers to thinking or the way we process information. Impairment or dysfunction means that something isn’t working properly.

It’s not clear which treatments may cause symptoms of chemo brain. Sometimes they may be caused by the cancer itself or by emotions such as anxiety and depression. The effects of chemo brain are usually temporary. But while they last, the symptoms can be frustrating and interfere with your normal activities. They may delay some people from going back to work, school or to social events.

Signs and symptoms of chemo brain

The symptoms of chemo brain are usually mild. But you may find doing certain things is more difficult than usual. Common symptoms include:

  • being unusually disorganised
  • difficulty concentrating
  • not being able to focus on what you are doing
  • difficulty doing more than one thing at the same time (multitasking), such as answering the phone while cooking
  • taking longer than usual to complete certain tasks
  • difficulty learning new skills
  • trouble finding the right word or being unable to finish sentences
  • trouble remembering facts you would usually remember, such as names and dates
  • extreme tiredness (fatigue)
  • mental ‘fogginess’.

If you have symptoms of chemo brain, you should talk to your doctor about them.

It can be helpful to keep a record of your symptoms to show the doctor. It helps them to see how often and how much they are affecting you.

Who gets chemo brain?

It’s not clear how many people develop problems with their concentration or memory during or after cancer treatment. Different research studies suggest quite different figures. But as many as 78 in 100 (78%) of people with cancer may be affected. It can affect both men and women.

Causes and risk factors for chemo brain

The causes of chemo brain are unclear. Research suggests that it may be caused by a combination of factors. Some cancers, such as brain tumours, have a higher risk of causing problems with memory and thinking. Other risk factors include:

  • Cancer treatments, including chemotherapy, hormonal therapy, radiotherapy and surgery.
  • Treatment to the brain – for example, chemotherapy into the fluid around the spinal cord (intrathecal chemotherapy) or radiotherapy to the brain.
  • High-dose treatment with chemotherapy or radiotherapy.
  • Side effects of cancer treatment, such as infection, low number of red blood cells (anaemia), extreme tiredness (fatigue), sleep problems, poor nutrition and menopause.
  • Emotional reactions to cancer and treatment, such as anxiety and depression.
  • Non-cancer drugs such as painkillers or anti-sickness (anti-emetic) medicines.

Can chemo brain be prevented or treated?

It’s difficult to prevent or treat chemo brain because it’s not clear what causes it. A number of drugs have been tried to help people, but so far, none have been shown to be successful. Research is going on to find ways to prevent chemo brain and effective treatments for people who have it.

Chemo brain does not affect everyone and is usually mild. It’s worth remembering that the benefits of your cancer treatment will usually far outweigh the risk of developing chemo brain. Your doctor or nurse will be happy to talk about your treatment with you if you’re worried.

Coping with chemo brain

The symptoms of chemo brain are usually temporary and often get better with time. But for some people, symptoms can continue for years after treatment. There are a number of things you can do to help yourself. Your doctor or specialist nurse can give you more information and support.

Keep a diary

Keeping a record of your symptoms may help you work out if certain things make your memory worse. For example, you may notice that symptoms seem worse first thing in the morning, or when you’re tired or hungry. This can help you to plan your day so that you do more difficult tasks when you feel at your best.

Learn new ways of coping

You may find it helps to do certain things that help you remember more. For example:

  • Make lists, such as shopping lists or ‘to-do’ lists, so that you feel confident you won’t forget anything.
  • Use Post-it® notes with reminders on them and put them where you can easily see them.
  • Keep a calendar or diary, or use your mobile phone calendar. They can help you remember important dates and appointments.
  • When making arrangements, check at the time to make sure you have the right information.
  • Carry a notebook and make notes during conversations, after meeting new people or after making arrangements.

Mental exercises

Memory exercises may help to train your brain and improve your memory and concentration. You can help keep your mind active by doing crosswords, word games or number puzzles like Sudoku.

Keep active

Being more physically active can help you feel more alert and reduce tiredness (fatigue).

Reduce stress

Stressful situations can affect everyone’s memory. Relaxation can help to reduce stress and may help to improve your memory and concentration.

Do some activities that help you relax, such as listening to music or going for a walk. You could try using relaxation CDs or DVDs, or do some relaxation exercises.

Talk to your family and friends

Many people find that talking to family and friends about what they are going through can help. Chemo brain is often less obvious than other side effects of treatment, so you may need to explain how you are feeling and how it’s affecting you.

Your family and friends may not be aware of chemo brain as a side effect of treatment. If they’ve noticed any symptoms, they may be relieved to know that these are fairly common and usually get better with time.

Your family and friends will be able to support you better when they understand more about how you feel. They may also be able to suggest ways they can help.

Talk to your doctor or nurse

Tell your doctor or nurse if you think you may have some of the symptoms of chemo brain. They can check for side effects of treatment (such as anaemia) that could be contributing to your symptoms. Tell them about any medicines you are taking, as some medicines can make symptoms worse. They can also refer you to other people for specialist help, such as a counsellor or a support group.

Before you see your doctor, it’s a good idea to write down how these changes are affecting you and to make a list of questions to ask. If your memory is bad, it may help to take someone with you or to record the conversation (with your doctor’s permission) so that you don’t forget anything.

Our cancer support specialists can support you, too. They can also give you details of support organisations and counselling services in your area.

Other things that might help

Some other tips that might help are:

  • Keep things simple – don’t take on too much. Try to do one thing at a time.
  • Develop a manageable daily routine and try to keep to it.
  • Avoid distractions – for example, if you need to concentrate on something, sit in a quiet area and turn off the TV/radio.
  • Eat a healthy, well-balanced diet, especially lots of fresh fruit and vegetables. Your doctor or nurse can give you advice or refer you to a dietitian, if needed.
  • Take regular breaks, and get plenty of rest and sleep.
  • Seek support from others in a similar situation – perhaps join an online forum such as our Online Community or a local support group.

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Research into chemo brain

To help understand more about chemo brain, research is being done to find out:

  • which chemotherapy drugs or combinations of drugs affect cognitive functioning
  • whether other cancer treatments affect cognitive functioning
  • what can be done to reduce the risk
  • which treatments can be used to improve symptoms.

You may be asked to take part in a research trial, and your doctor or nurse will explain fully what this involves. You don’t have to take part in the trial if you don’t want to, and you don’t have to give a reason why.

Back to Other side effects

Avoiding infection

Cancer and its treatments can weaken the immune system. It’s important to try and avoid infection if your immunity is reduced.

Difficulty sleeping

If you are having difficulty sleeping, there are things you can do to help.

Nausea and vomiting

Cancer and its treatment can make you feel sick (nauseous) or be sick (vomit). There are drugs that can help control this.

Peripheral neuropathy

Cancer or its treatment can damage the nerves that are outside the brain and spinal cord. This is called peripheral neuropathy.