Metastatic Breast Cancer and “Chemobrain”: Cognitive Side Effects of Treatment

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Metastatic breast cancer treatment side effects

Cancer treatment can have unintended consequences. For patients with metastatic breast cancer (cancer that has spread), treatment often affects more than just the breast. Radiation, chemotherapy, and hormonal therapies can all harm nearby or distant healthy tissue—including the brain. One potential side effect of treatment is a condition called chemobrain.


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What is chemobrain?

Chemobrain can cause difficulty with mental processing, such as concentrating on tasks or doing more than one thing at a time. You may have trouble finding the right word or recalling dates or phone numbers. Other symptoms include problems with motor functioning, visual-spatial skills, and processing speed. Some cancer patients who perform normally on cognitive function tests still say they experience problems with mental functioning.


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Who gets chemobrain?

If you undergo chemotherapy, radiation, or other systemic cancer treatment, you can develop chemobrain. In more than 60 studies of breast cancer patients treated with cancer-killing therapies, 70 percent reported some degree of cognitive impairment.


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What causes chemobrain?

Cancer treatments sometimes trigger inflammation, which may affect your mental functioning. Some chemotherapy medications can cross the blood-brain barrier (a filtering system that keeps certain substances out of the brain) and play a role in chemobrain. If you’re receiving hormonal therapies for metastatic breast cancer, low levels of estrogen can also cause cognitive side effects.


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How long does chemobrain last?

Sometimes, cognitive side effects last only as long as the treatment itself. For other patients, chemobrain continues after treatment ends. About one-quarter of patients find their chemobrain symptoms persist long term.


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Contributing factors to chemobrain

A cancer diagnosis and treatment can cause stress, sleep problems, fatigue, trouble eating, depression, and anxiety. These factors can all cause cognitive difficulties in and of themselves, and can worsen treatment-related mental processing problems. Other coexisting health problems, such as cardiovascular disease or diabetes, may also contribute to cognitive impairment. Even surgery and anesthesia may play a role.


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Managing chemobrain: Talk to your doctor

If you’re experiencing cognitive difficulties during or after treatment for metastatic breast cancer, talk to your doctor. Managing side effects is part of your overall cancer care. Keep a written record of your problems and when they occur, so you can tell your oncologist. He or she may change your cancer medications, prescribe something to help alleviate symptoms, or refer you to a rehabilitation specialist or occupational therapist for memory and attention exercises.


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Try to reduce your stress

It may be easier said than done, but finding ways to lower your stress level is important. Try deep breathing exercises, physical activity (exercise sends blood to your brain), or exploring natural environments. If your stress is persistent and disruptive, consider seeing a mental health professional. Biofeedback or talk therapy may help, especially if your cognitive problems cause you significant distress.


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Focus on one thing at a time

Our ability to multitask seems to be a badge of honor these days. However, doing one thing at a time—and giving it your full attention—is always a good idea, and especially so when you’re struggling with chemobrain. Prioritize the things you must do, and then do them one at a time.


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Rely on memory aids

Chances are you already use a calendar or cell phone app to keep track of appointments and other to-dos. Use electronic alerts, reminders, tasks lists, and other memory aids to help you stay on top of your responsibilities.


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Set yourself up for success

If you’ve been away from work during cancer treatment, consider taking workshops or attending industry events to brush up on your skills and boost your confidence. Arrange your home and workspace so that everything is in its place and easy to find. Rely on routines to keep you on track and get plenty of sleep at night so you’re fresh during the day. Don’t be afraid to ask for help when you need it.


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Know your rights

The Family and Medical Leave Act requires employers with 50 or more employees to grant you leave for health reasons, even in small increments, such as an hour to go to the doctor. Take advantage of it. Moreover, your employer has a legal obligation not to discriminate against you because you have cancer, so don’t let these sorts of worries add to your stress.