Chemobrain

 

“Chemo brain is real”

 

    Though chemo brain is a widely used term, it is somewhat misleading because even those of us who have not received chemotherapy reported a notable impairment in our thinking capabilities. For those who have had chemotherapy, there may be lasting cognitive effects, hence the term 'chemo-brain'. However, Naz told us it is widely recognised that the trauma of a breast cancer diagnosis plays a significant role. Active treatment (such as surgery or radiotherapy) and hormonal treatments (which can bring on early menopause, or more severe menopausal symptoms) also contribute to a reduction in our cognitive abilities.

 

    In our discussions we shared how often we run into a room to collect something, then forget what it is as soon as we get there. We lose track of where we've put our keys, leave messages for ourselves in order to remember key tasks and, just occasionally, we might even call our partner by the wrong name! Although there were exceptions, the overwhelming majority of us described experiencing significant difficulties in relation to thinking and retaining information. Of course it can be funny, but usually it is hard, sometimes upsetting, because it undermines our confidence and ability to function in our everyday lives.

 

    Naz explained that chemo brain happens after diagnosis but before treatment even begins. Whether our lapses are small or large, they arise because of our inability to hold something in our working memory. Recent research shows that there are reductions in grey and white matter in the brain – changes that are significant enough to show up on scans - in areas that support cognitive functions such as working memory (mentioned above), attention and concentration. This is due to the impact of trauma, and the because the worries and fears that occupy our working memory take precedence, our brains end up having to work harder in the long run. We find that we take longer, we make more errors, we feel sluggish, and our cognitive functions are slow.

 

    The effects of chemo-brain are amplified through chemotherapy induced cognitive decline. The mechanisms in our brains which are involved in cognitive function must work harder to achieve similar outcomes to those which individuals without a breast cancer diagnosis (matched controls) achieve with less effort, which explains why some of us experienced mental as well as physical fatigue. Our members provided consistent anecdotal evidence for these changes. Naz told us she is working to be able to understand this deficit in more detail.
 

    Our discussion also highlighted stress and fatigue make chemo-brain much, much worse and we feel we can become so incoherent that we may lose the ability to speak.  Particularly hard is the lack of understanding from our families who unintentionally undermine us when our lapses stop being funny and start being annoying. We find it hard to talk about our chemo-brain at work and some of us shared that we fear being seen as less competent in our jobs, which also makes us feel vulnerable. Perhaps hardest of all, is the lack of wider recognition and support available to us which is why sharing and talking - and laughing when we can - is so important for our resilience.

 

    Despite these troubling experiences, Naz wanted to point out that there is help at hand that we can implement ourselves. The brain has a plasticity that can be altered by cognitive exercises, and adding mindfulness and relaxation can be very helpful in regulating our emotions, which further assists mental clarity. By strengthening the relevant neural pathways and the emotional connections between our emotional and cognitive parts of the brain, we can increase our cognitive flexibility and improve our day-to-day ability to function efficiently.