Do You Have Chemobrain?

Sometimes when I am giving a speech and am embarking on the subject of fatigue, I’ll ask the audience members to raise their hand if they are not tired. Usually not more than one or two hands go up. People laugh in that “ah ha” sort of way, and I imagine that they are thinking, “Wow, I didn’t realize that so many people feel tired like me.”

Indeed, whether you’ve been diagnosed with cancer or not, fatigue is a universal complaint. Life is tiring. New technology and the ever-increasing pace only makes us more tired. So how do you figure out if you have normal fatigue, cancer-related fatigue, and/or chemobrain?

Actually, it’s not all that hard to theoretically sort out if you understand the definitions of cancer-related fatigue, pathologic fatigue and mild cognitive impairment (aka “chemobrain”). By definition, cancer-related fatigue (CRF) is an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with functioning.i CRF becomes pathologic when it occurs during normal daily activities, persists for long periods of time, and doesn’t respond to rest.ii,iii

The term “chemobrain” refers to survivors’ complaints of mild cognitive impairment (MCI) during or following chemotherapy. The term chemobrain is widely used by patients but is somewhat controversial in the medical literature. In fact, not all experts agree on the use of the term, the etiology of the symptoms and whether this is a legitimate diagnosis.iv,v However, it certainly seems quite plausible that chemotherapy, which affects virtually every part of one’s body, may affect the brain as well.

The symptoms of MCI are often subtle and may consist of survivors reporting that they feel fatigued, confused, mentally “foggy”, forgetful or have difficulty concentrating and remembering things.vi This constellation of symptoms was described by patients in the 1970s but only in the past decade or so has chemobrain been systematically studied. Both fatigue and MCI may be symptoms of many medical problems including anemia, cardiac or respiratory dysfunction, stress, depression, sleep disorders and so on.

MCI is not the same as cancer-related fatigue, though both conditions may have fatigue as a major patient complaint. By definition, MCI has the additional components of cognitive impairment such as memory loss and/or poor concentration.

MCI may occur in anyone who is undergoing chemotherapy for a malignancy. Bed rest does not seem to improve the symptoms of MCI, though if someone is not getting enough sleep, it is important to intervene and try to improve the sleep pattern. A lack of sleep is known to cause cognitive dysfunction. While bed rest does not seem to improve the symptoms of MCI, if there is a history of insomnia, sleep apnea or some other sleep disturbance, this may be exacerbating the symptoms and should be addressed.

MCI and CRF often go hand in hand and may be difficult to distinguish from each other. After all, it’s hard to think clearly when you are really tired. So, if you are having problems with mental processing—either speed or accuracy. Or, if you think that your memory isn’t as sharp as it was before you went through chemo, is that MCI or CRF or both?
And, let’s say that you’ve been more discouraged lately, perhaps even a little depressed. These are relatively normal responses if you have been diagnosed with cancer. Your mood may be affecting your energy level and ability to be really focused. So how can you sort this out and arrive at the right diagnosis?
Well, the reason I wrote earlier that it’s not all that hard to theoretically sort out using various definitions, is because in reality, it’s a lot harder to figure out who has what and why. When I treat cancer survivors, I often order tests that help me to rule in or rule out specific problems such as sleep apnea or anemia. Then, I recommend appropriate treatment for symptoms of fatigue, depression, anxiety, etc.

Both CRF and mood disorders have research support for specific interventions, including prescription medications (in some cases), improving sleep patterns and increasing physical activity. Cognitive behavioral therapies (CBT) such as progressive muscle relation, meditation, and biofeedback may also have a role in improving symptoms of fatigue and some mood disorders.

On the other hand, at present, there is no specific treatment for MCI.vii Some doctors may try medications that improve alertness, and CBT is reasonable and safe to try as well. It’s also possible that exercise may improve symptoms of MCI, perhaps by increasing blood flow to the brain, but this is theoretical.

If you think that you have CRF or MCI or both, it’s a good idea to talk to your physician about your symptoms. It might help your doctor if you keep a log and write down what your symptoms are and when they occur during the day. You may also note what you are doing when they occur. Your specific symptoms, when they occur, and your activity level when you are most symptomatic will help your physician to sort out the potential diagnosis.

Keep in mind that improving your fatigue and mood will help you feel better overall. This might also result in your brain working more efficiently and faster.
Things you can try at home include:

  • Focusing on strategies to improve your sleep
  • Becoming more physically active
  • Meditating or other strategies to reduce stress
  • Resting appropriately
  • Eating healthy meals and snacks (skipping meals can make you tired and may affect brain function)

iNational Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. 2009, National Comprehensive Cancer Network: Rockledge, PA.
iiDimeo FC. Effects of exercise on cancer-related fatigue. Cancer 2001;92(6 Suppl):1689-93.
iiiFukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994;121(12):953-9.
ivHurria A, Somlo G, Ahles T. Renaming “chemobrain”. Cancer Invest 2007;25(6):373-7.
vCastellon S, Ganz PA. Neuropsychological studies in breast cancer: in search of chemobrain. Breast Cancer Res Treat 2009:116(1):125-7.
vivan Weert E, Hoekstra-Weebers J, Otter R, et al. Cancer-related fatigue: predictors and effects of rehabilitation. Oncologist 2006;11(2):184-96.
viiNelson CJ, Nancy N, Roth AJ. Chemotherapy and cognitive deficits: mechanisms, findings, and potential interventions. Palliat Support Care 2007;5(3):273-80.

The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.

Category: Experts Speak

Tags: cancer-related fatigue, chemobrain, cognitive behavioral therapies, depression, memory loss, mild cognitive impairment, sleep disorders