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Working With Chemo Brain

You’re back at work after cancer treatment — or maybe nearly done with treatment and working at least part-time. You’re understandably eager to get back to “normal.” But if you’ve had chemotherapy (or even if you haven’t), you may notice your concentration, memory, or other work skills aren’t up to par. This mental fog isn’t your imagination. It’s called “chemo brain.” Experts actually prefer the term “cognitive dysfunction associated with chemotherapy” or “post-chemo brain,” to more accurately describe it.

What Is Chemo Brain?

By whatever name, if you have it, you know it: memory lapses, difficulty remembering details or concentration, inability to multi-task like the master you once were, problems remembering names or spelling common words, inability to think as fast as you once did, or difficulty remembering the steps of tasks you once performed easily.

Up to 30% of cancer patients who receive chemotherapy may experience chemo brain, according to the American Cancer Society. Exactly how it occurs isn’t certain, but some experts suspect some chemo drugs may slip past the “blood brain” barrier, which separates chemicals that belong in the brain from those that do not, and adversely affect cognitive skills.

While experts say they have a lot to learn about chemo brain, they do agree that it’s a real condition, not your imagination. Research suggests it may linger after treatment. The treatment itself may impact nerve and brain function, and those effects may be complicated by the stress of coping with the diagnosis and the fatigue from dealing with the stress and an overloaded schedule. Some people may be more genetically vulnerable to chemo brain than others.

Although research about chemo brain is still evolving, there are many steps you can take at work to improve the “fog” and perform better. Here, tips from the American Cancer Society, Mayo Clinic, and four experts:

  • Debra Barton, RN, Ph.D., AOCN, associate professor of oncology at Mayo Clinic, Rochester, MN
  • Grace Jackson, MD, psychiatrist, Wilmington, NC
  • Lori Hefner, cancer survivor, Pleasantville, CA, and founder of the website,
  • Daniel Silverman, MD, Ph.D., associate professor of molecular and medical pharmacology, University of California Los Angeles David Geffen School of Medicine and head of neuronuclear imaging, UCLA Medical Center
Chemo Brain: What to Do at Work
What You Can Do
  • Be aware of your stress level and work to reduce the stress. Excess stress by itself can impair your performance and thinking skills. Look to the source of the stress — a coworker playing a radio too loudly, constant chatter — and correct it.
  • Learn quick rescue techniques to combat stress during the day. One technique is deep abdominal breathing. Focus on breathing in deeply and exhaling deeply until you feel more in control.
  • Minimize exposure to any toxins — whether it’s open windows that let in polluted air or workplace materials that are toxic. The aim is to keep your brain as healthy as possible.
  • When you are feeling overwhelmed, write down a list of priorities. (A good idea even if you’re not feeling overwhelmed.)
  • Once you prioritize, tell yourself you will focus only on the first task that needs to be done. Don’t think about anything else. Otherwise, your concentration will suffer. As distractions decrease, concentration increases.
  • While multi-tasking is viewed as very efficient — and you may have been good at it before the cancer diagnosis — stop for a while, at least until you regain a better memory and other cognitive skills.
  • Rely more than ever on memory assists and take advantage of all the features. Perhaps you have always used a computer-based calendar, for instance. Now, use the alerts built into them to remind you of an upcoming meeting, a project due date, or other details. Learn the features of your smartphone that can help you stay on track.
  • Set up your work environment to boost concentration. That means clearing everything off your desk or your immediate work area except what you are working on first. Turn off your email. If you have difficulty ignoring the world, create an auto-reply message that tells people you will respond at a specific time each day. Then, when you do turn your attention to email, stay totally focused on that task so you get it done quickly. You can do the same with your voicemail message, choosing to return calls at a specific time.
  • Rehearse to remember. If you read something out loud, such as names or facts, some research suggests you are less likely to forget it. The reasoning? Visual and aural input together help you remember. You can use this technique to talk yourself through challenging tasks at the computer. Maybe there is a word-processing technique you used to know by heart but now don’t. Print out the “help” instructions, then read them aloud and talk yourself through it until it is second nature again.
  • Get in a rut. Put your keys, files, coat, and other items in the same place day after day. It will reduce the “Where is it?” stress when you are under fire and running late. At home, designate a “launching pad” where you put everything you need to take to work the next day — keys, files, day planners, a jacket. It will reduce that early morning stress and allow you to concentrate and focus.
How Coworkers Can Help
  • Ask for input from coworkers you know and trust. Tell them you need input to see if your work projects are up to standards. For instance, when you write a report, show one of your helpers the rough draft and ask for comments. Ask if you’ve missed any important points or if you need to improve the grammar.
  • Interact with coworkers. Being in a socially stimulating environment for some of the workday helps brain function. This “real world” connection is part of the recovery process. Somehow, the combination of thinking and talking is good for repairing the brain.
  • Ask a coworker you trust to help retrain you on the tasks you’ve forgotten. If you generally distribute the mail in the morning, or organize an office party, ask someone to walk you through the steps if you are having difficulty. If a coworker offers to do the task for you, gently decline and stress that you are trying to relearn.
  • Ask a coworker you trust to prompt you when he or she notices you need help remembering names, facts, schedules or other details.
How to Manage Your Lifestyle to Improve Focus

Just as your overall lifestyle habits affect your ability to perform when you haven’t had chemo, they can improve or worsen your chemo brain symptoms. Take stock of how you’re doing on the basic lifestyle habits to keep chemo brain problems to a minimum.

  • Get six to eight hours of sleep. Even if you feel you don’t have time between doctor appointments and work, make the time.
  • Fit in activity nearly every day. It doesn’t have to be an hour workout at the gym, just focus on taking the stairs instead of the elevator or going for a 20-to-30-minute walk. Exercise is often the first thing people give up when stressed for time, and it should be the last. Getting regular exercise also helps you sleep better. It will improve your energy level, sense of well-being, and thinking skills.
  • Improve your diet or maintain a healthy one.

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