Michelle Ferretti, LCSW, OSW-C

at the tip of my tongue, but that’s where it stays.”

“I recognize the face and I know I know the name, but I just can’t find it.”

“I still feel like things are more jumbled up in my head than they used to be, and it’s so much harder to clear them.”

“I’m just not as sharp as I used to be.” Sound familiar?

Those are quotes from participants in the Life With Cancer program at Inova Schar Cancer Institute in northern Virginia. The program offers free education and services designed to help patients, survivors and their families cope with cancer, its treatments and survivorship. This includes a course designed to educate patients on handling cognition changes often called brain fog or chemo brain.

Although many patients receiving chemotherapy, surgery, radiation or other cancer treatments experience changes in attention, memory or thinking during the course of therapy, the vast majority recover within a year after treatment is completed. However, for some patients, symptoms persist.

Genetics, age, hormonal changes and other medical conditions also can contribute to this fog, known in the medical community as cancer-related cognitive impairment (CRCI). Other contributors include poor sleep and nutrition, lack of movement, long- term emotional imbalance, and use of alcohol or other substances.

• Trouble focusing, making it hard to complete tasks or follow instructions or conversations.

• Struggling to find words or remember names.

• Disorganization leading to problems with multistep tasks.

• Emotional changes, including loss of motivation, increased isolation or changes in perspective.

Many factors that play a role in CRCI cannot be controlled, such as genetics and necessary cancer treatments. However, factors that can be controlled include response to

strong emotion and management of stress, sleep, exercise and nutrition.

All can affect the body’s internal environment by changing hormones and other biochemicals that affect brain function. The following strategies can help counteract this:

Emotions themselves do not cause CRCI but over time can further symptoms, particularly when depression or anxiety arises. Meeting with a therapist familiar with cancer is one way to get support and learn coping techniques. Connecting with others, engaging in exercise and eating well are also ways to manage strong emotion.

Sleep disturbances can lead to a lack of mental clarity, mood changes, decreased pain tolerance and an increase in the inflammatory response that can exacerbate CRCI. Practice good sleeping habits and consider cognitive behavioral therapy for insomnia, which is the first-line treatment for chronic insomnia, according to the American Academy of Sleep Medicine.

Exercise and movement, especially outdoors, can decrease stress. Done at adequate intensity, exercise can improve cognitive function in as little as a month. Physical activity can also ease emotional symptoms and sleep problems. Exercise can be done formally, such as in a gym, or informally, such as walking or climbing stairs.

Learn ways to cope and build emotional resilience. 

Mind-body interventions, including meditation, medical qi gong and mindfulness- based cancer recovery, have proved effective for CRCI. Practicing these strategies can lead to better under- standing of, and the ability to alter, seemingly automatic reactions to challenging events.

CRCI presents many challenges when it comes to managing roles, responsibilities and relationships. The following strategies can be helpful in coping with these obstacles:

Smartphones, computers, tablets, Post-it notes, pillboxes, calendars and centralized noticeboards can keep track of information such as appointments, finances, medications, lists, diet and exercise.

When tasks become habits, the brain starts to implement them with less cognitive effort.

Solving crossword puzzles, visiting museums, reading, playing

a musical instrument, creating art or taking a course challenges the brain and helps create new neuronal connections.

Say the steps out loud when performing a complicated task. 

This script can help with preparation, staying on track and evaluating progress. Eventually, the brain may not need the support of the script.

Request workplace accommodations if needed. 

Individualized adjustments can include extended time to complete assignments, relocation or redesign of the workspace, a modified schedule or the use of leave. Speak with a manager and a human resources representative to make such arrangements.

Seek support from trusted friends and family members. 

Being socially engaged can help regulate the nervous system, make the brain more receptive to learning, and be emotionally and logistically helpful.

Practicing these strategies will help you better manage brain fog’s impact on your life. CRCI is real.

Life With Cancer therapists Drucilla Brethwaite, LCSW; Michelle Ferretti, LCSW, OSW-C; Tyler Pudleiner, M.S., a nurse practitioner; Rebecca Babb, M.S.N., APRN, CPNP-AC; and Dr. Sermsak Lolak, M.D., a psychiatrist, co-facilitate a brain fog program at Inova Life With Cancer in the Washington, D.C., area. Over four weeks, clinicians provide an overview of cancer-related cognitive impairment and evidence- based strategies to help participants develop personalized brain fog plans. To learn more about the program, visit lifewithcancer.org. 

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