Connie Carson

For decades, people going through cancer treatment apologized for, complained of and joked about mental cloudiness.

Although it is often referred to as “chemobrain,” this issue is the result not just of chemotherapy but of other types of cancer treatment, as well, which is why many health care providers refer to it as “cancer treatment-related cognitive impairment” (CTRCI). For many, this means having trouble remembering details, concentrating, finishing tasks, multi-tasking, recalling words, being organized and maintaining daily calendars of events. These vague and frustrating changes are real, not imagined, and can affect everyday life for as many as 75 percent of all cancer survivors. Few are aware that speech-language pathologists are experts in helping people improve their cognition.

CTRCI has been documented in people with breast, colorectal, lung, testicular, prostate, ovarian and blood cancers. By definition, however, this syndrome does not include patients with brain tumors or metastatic disease to the brain, as, in these cases, there are other factors involved in cognitive changes.

By no means does this side effect infer that a person should not have chemotherapy, as that treatment can be lifesaving; moreover, sometimes these problems occur even if a person has not had chemotherapy. There’s growing evidence that endocrine therapies, general anesthesia, hormone ablation therapy and even the disease process itself can impact memory. Other factors that can affect cognition include hormonal changes, multiple drugs interfacing with one another, stress, anemia, infection, nutritional deficiencies, sleep disorders, depression, anxiety, sadness, advancing age, the presence of symptoms before treatment, lack of exercise, fear and fatigue.

Patients first reported the symptoms of CTRCI over 35 years ago. Doctors thought these changes would go away once treatment was over; however, many say their problems continue for years, if not decades.

Extensive research previously suggested that nothing could help, but, these days, there’s at least one excellent option. A 2014 evidencebased review of the literature including hundreds of articles and thousands of cancer patients explored the effectiveness of individual and group cognitive training, qigong, vitamin E, pharmacologic approaches, exercise and meditation. While some approaches, such as exercise, looked promising, the review did not establish their effectiveness; only cognitive training was deemed “likely to be effective” based on the studies included in the review.

 But who provides cognitive training? Speech-language pathologists are experts in helping patients deal with word-finding problems and memory deficits by providing practical compensatory strategies. For example, when you are working on your emails and the phone rings, don’t answer it. Keep working, then listen to your voicemail messages later. If you are tired at 2 in the afternoon, stop. Take a quick break, fix a cup of tea and come back to the task refreshed. If you can’t keep your calendar on your iPhone…don’t! Write things down on a paper calendar that your mind can process differently.

These are just a few examples. Speech-language pathologists have tools to help you plan your day, organize your life and complete your goals. Your memory problems may not go away, but your behaviors can change. These professionals can offer cognitive training exercises such as puzzles designed to boost specific skills — for instance, time management, daily scheduling or remembering words. Speech-language pathologists can also choose memory- or cognition-boosting computer programs that are specifically applicable to you, while steering clear of those that may be less helpful. Finally, they can help family members understand this deficit better, so that pressures at home may be reduced.

You may be able to find a speech-language pathologist by asking your medical team for a recommendation. If they cannot make one, you can search on your own for someone who specializes in treating patients with mild cognitive impairment; a speech-language pathologist who treats patients after concussions or mild traumatic brain injury will know appropriate techniques.

For help in this search, you can visit the website of the American Speech-Language-Hearing Association at ASHA.org, click on speechlanguage pathologists, and then, in the orange box, click on “the public” and then on “find a professional.” Type in your city and, hopefully, you’ll find someone able to treat your mild cognitive impairment.

So, realize that your cognitive problems are legitimate, enjoy the world around you, be as fit as possible — and talk with your doctor about the possibility of a referral to a speech-language pathologist.

Articles

Speech pathologists can help ease “chemobrain” through cognition training, and by teaching patients to compensate for deficits in memory or skills.


Connie Carson

Refreshing Your Memory: Easing the Effects of Chemobrain Through Training

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