Heather (front, left) with the facilitator team from Survivor Conference 2011 in Ottawa, ON.
By Heather Palmer, PhD
September 30, 2013
Cancer related brain fog is a frustrating and life altering side effect of some aspect of cancer. We say “some aspect” of cancer because it is not only caused by chemotherapy. People who have not yet started chemotherapy, or never actually receive it can also experience brain fog. In fact, some people even notice “fogginess” and an increase in cognitive slips weeks and months before diagnosis.
So what is brain fog? What are the common symptoms?
While most people talk about the changes in their “memory,” the complexity of the brain and the many factors that contribute to “memory” suggests that changes are occurring in multiple areas such as:
- planning;
- organizing;
- multi-tasking;
- ability to concentrate;
- reading;
- comprehension;
- word finding;
- spelling;
- following conversations;
- speed of movement and thinking; and,
- coordination and spatial skills (which when combined result in clumsiness such as a tendency to drop items and bump into things).
While this list is not complete—and some may notice changes in other areas as well—it comprises the most commonly described changes as defined by cancer survivors.
One of the most frustrating aspects of changes such as these is that they can be unpredictable and most people are unprepared to experience them. Let’s first address unpredictability. Many will notice a lack of consistency in their function. In other words, sometimes they can read, remember, multitask, organize and yet other days they can not. The good news is that the fact that you can do it sometimes suggests the functional ability remains. The bad news is that it can be tricky to identify the factors and barriers that contribute to when it is “working” versus when it is “not.” These barriers are often new to you because there is something about the cancer and/or its treatment that has caused them. Therefore, it is important to always be on the lookout for barriers to successful function.
Barriers can include fatigue, pain, distress/worry, medication, changes in hearing and vision, time of day, interest, and complexity. In a very general, bottom line, matter of fact kind of way, if there is a barrier to getting information into your brain, it is unreasonable to expect your brain to pull it out later. When people are tired, in pain, and worried, they don’t process information particularly well. Therefore, it is not surprising they have difficulty functioning and remembering when they need to utilize that information. Similarly, medication, factors affecting sight and sound (heavy accent, speaking fast, noisy background, blurred vision, visually complex material, etc.) can also affect one’s ability to process information.
How to deal with brain fog
If you recognize that any of these factors are present, then you should realize your brain is not functioning at peak capacity. If it is a busy time of year at work, you have a particularly heavy course load at school, or you are in the midst of exams, you will need to make a more conscious effort to recognize these barriers because they are more likely to rear their ugly heads under these situations.
This will inevitably require you to:
- improve planning and organizing;
- make an effort to space out activities during the day to maximize alert times and minimize fatigue times; and,
- increase your reliance on external strategies such as calendars, notes, lists, and timers.
Just as changes in workload will require you to be more consciously aware of your abilities, so do increased social activities—even ones as regular and predictable as family events such as birthdays, holidays, Christmas, etc. Self-awareness and planning alone can help remove much of the unpredictability related to the fluctuations in your cognitive performance. So work on it, because something about the cancer and/or its treatment has likely affected your ability to “wing it” and pull it together last minute. If you do manage to “get through,” it is likely you will feel extreme fatigue for hours and days following.
Unfortunately, brain fog—especially cancer related brain fog—is not well understood and many people are not forewarned that there is a good likelihood they will experience changes in their thinking capacity. While many will actually experience these changes during treatment, most people will notice greater impact on their life following treatment as they work towards getting back into their life before the diagnosis. In particular, many will notice a tendency to get easily distracted, leaving a trail of unfinished activities behind them. They may discover three-day old laundry still in the washing machine, or an intention to return a phone call but not actually do it, projects started but not completed, and a rhythm guitarist’s “up/down, up/down, up/down” approach to going upstairs to get something but consistently forgetting what it was.
The ability to successfully move throughout your environment and make progress on tasks is heavily dependent on information popping into mind at the right time. What seems to be happening to many cancer survivors is a disruption in their “mental pop-up.” This can make multi-tasking very difficult because the thought “I must go change my laundry,” “I must call Tony back,” “It is time to get dinner started,” and “I’m going upstairs to get my glasses” don’t naturally pop into mind the way they use to.
One simple solution to this is to reduce your multi-tasking and make conscious decisions about what you are doing and why. Constantly stop and clarify throughout your day and ask yourself several questions such as “What am I doing? Where was I going? What is the priority for now?” You will be amazed by the improvements you will see. You will likely feel a little more cognitively on the ball, you will complete actions and you will remember what you did because you were more consciously aware and engaged in the activity.
There are so many simply, subtle, easy solutions to manage a large number of the cognitive changes you may be experiencing, but it certainly starts with being aware that there has been a change in your thinking, planning appropriately to address the changes, and a willingness to accept that you may need to do things a little differently (at least for the moment).
Heather Palmer has a PhD in Neuropsychology and over 20 years experience understanding brain/behaviour relationships. As an educator and researcher, through Maximum Capacity Inc., she provides programs and services to individuals experiencing changes in brain function.
