Could your brain fog be due to chemo?

Cancer treatment can turn a person’s life upside down and bring a range of unpleasant side effects — fatigue, nausea, hair loss and diarrhea, to name a few. One lesser-known side effect is chemo brain.

Technically known as cancer-related cognitive impairment (CRCI), chemo brain can cause confusion, memory problems, difficulty focusing and concentrating, trouble multitasking, and issues with word retrieval.

“The condition is also sometimes called cancer brain fog,” says Linda Hutkin-Slade, a clinical oncology social worker at Sharp Grossmont Hospital. “The exact cause isn’t fully understood. It’s often linked to chemotherapy, but radiation, anesthesia, treatment side effects and even cancer itself can contribute to it.”

Confusing chemo brain for other conditions

Some patients with chemo brain worry they have dementia because there are similarities between the two conditions. Both cause cognitive issues, but they’re fundamentally different. Dementia is a progressive, long-term condition with no cure, while CRCI is typically temporary, developing during or shortly after cancer treatment begins and improving after treatment ends.

“Patients will report cognitive changes to their health care team, but the team is at a loss how to help the patient,” says Hutkin-Slade. This leads to many patients feeling more isolated, adding stress during an already difficult time.

Up to 75% of cancer patients experience CRCI during chemotherapy, and about 35% continue to struggle with cognitive issues after treatment ends.

Interestingly, a noninvasive brain scan called functional magnetic resonance imaging (fMRI) can show changes in the brain resulting from cancer treatment. “We see changes in areas of the brain responsible for memory, planning, thought processing and inhibition,” she Hutkin-Slade.

Before this technology, patients’ symptoms were often dismissed or written off as menopause or anxiety. “It was like a double-whammy — cancer and cognitive impairment,” she says.

A patient’s experience

Tiffani West is an education specialist who was diagnosed with breast cancer in 2023 and treated at Sharp Grossmont. Chemo brain began disrupting her life a few months into treatment.

“I had six rounds of chemotherapy, a double mastectomy, radiation therapy, immunotherapy and I’m taking Tamoxifen,” she says. Tamoxifen is a medication used to treat and prevent breast cancer from recurring.

Her symptoms started with forgetfulness. “I couldn’t remember the names of new people or statements familiar people made in the same conversation,” Tiffani says. “I struggled with word retrieval for names of familiar objects and common expressions. And I often lost track of where I put things or would put them in unusual places.”

For Tiffani, everyday things you take for granted, like retaining the information you read or having a simple conversation, became difficult. “I got lost while driving, and when conversing, I’d forget my point mid-sentence,” she says. And on an emotional level, she says she felt confused and scared.

Fortunately, Tiffani’s health care team was proactive. In her first weeks of treatment, they checked in with her to see if she was experiencing any difficulty.

“They were very reassuring and supportive,” she says. To help her regain focus, Hutkin-Slade recommended Sharp’s workshop, Memory and Attention Adaptation Training (MAAT) for Chemo Brain: Out of the Fog.

“MAAT is an eight-week program for cancer patients and survivors,” says Hutkin-Slade. “It helps to improve memory and manage CRCI.”

Sharp’s cognitive continuum of care

Sharp is the only system in San Diego that has a continuum of care program for patients experiencing brain fog. “Not many national programs even exist,” says Hutkin-Slade. “We’re just now hearing about other locations starting programs based on information and presentations our team has shared at national conferences.”

Sharp also offers free workshops, ongoing assessments and rehabilitation programs to help patients and caregivers navigate cognitive challenges, including:

• Chemo Brain (CRCI) Workshop: Improving Memory and Concentration

• How to Help and Support Someone with Chemo Brain: A Class for Loved Ones

Tiffany says MAAT was helpful for her, and she highly recommends more patient education. She notes that while cancer patients receive extensive information on the physical side effects of cancer treatment, there’s very little about how treatment could affect the mind.

“I was unaware of chemo brain and the impact it could have, and my hope is that others avoid feeling crazy if they struggle with memory loss or mental fog,” she says. “For me, the workshops and information provided a supportive community and helped me understand CRCI. Being prepared and informed makes it all less frightening.”

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