Chemo Brain: A Survivor's Ongoing Struggle

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Breast cancer survivor ponders her chemo brain and her hair loss several years out from chemotherapy.

How much chemo brain do I have? How damaged am I? Some? More than a little? A little? Very little? Or not at all? I don’t want to use chemo brain as a crutch when I mix up words or forget things. My hair was damaged by chemotherapy and mostly returned. It is thinner and grayer now. My brain, well, mostly returned too. I am grateful that chemotherapy is there to treat cancer, but I don’t feel the same since chemotherapy. How about you?

We as cancer survivors are living longer thanks to chemotherapy, other treatments and earlier detection. That is good news, but how do we know what is aging or other diseases and what is damage from chemotherapy? This is frustrating. Does the treatment differ if it is chemo brain rather than some type of dementia or other issue? What treatments are available?

When will doctors test and evaluate the memory, ability to concentrate, multi-tasking and other chemo brain symptoms of cancer patients before and after chemotherapy? If the doctors had before and after records that would be helpful ... right? Could newly diagnosed patients who discover they will have chemotherapy request testing to establish their pre-chemotherapy cognitive baseline?

Please don’t misunderstand me here: I am grateful to be alive. I am grateful chemotherapy was available. I am optimistic about the new treatments coming out almost every day. Without cognitive evaluation before and after chemotherapy, I feel a little like I came out the other side of my cancer diagnosis healed but with collateral damage that there isn’t treatment for — yet.

I try to be an adult. Life in general causes collateral damage: Non-cancer health issues and medical procedures, relationship difficulties and car accidents, to name a few. It is accepted that chemo brain exists, but what can we do to treat its effects?

I feel like chemo brain causes a lot of collateral damage of its own to relationships, employment issues, abilities and mental health. I also believe that we, as humans, are amazingly resilient. Our brains learn to adapt and so do we. With all of that, I would like to know how to help treat my chemo brain.

Should I read more? Write more? Exercise more? Do more puzzles and brain teasers? I also want answers: Will these activities cure my chemo brain? How much will they help? Cancer survivors who have had chemotherapy deserve more answers, I think.Cancercare.org suggests seeing a neuropsychologist for further evaluation. The American Cancer Society offers strategies for day-to-day coping. More research needs to be done. Am I being too impatient?

It's kind of funny that now there is a cold cap to keep my hair if I need chemotherapy down the road. I think that is a good thing. My hair loss really felt like a noticeable and isolating big red flag that didn’t let me have a choice to be “normal” around other people for months.

Hair loss for me was a big issue, though, ironically, I have never really liked my hair. Ultimately, we are just talking about hair here. What about brain damage and brain repair or something preventative, like the cold cap, to protect my brain?

Let’s hang tight to our gray matter and hope medicine catches up to create solutions for chemo brain. I am tired of the fatigue, short attention span and other cognitive issues. I also believe that science will catch up, so I will try to be flexible and hang in there!

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For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray. Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.  If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.  “As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.” In June 2023, many patients were unable to receive certain chemotherapy drugs, such as carboplatin and cisplatin because of an ongoing shortage. By October 2023, experts saw an improvement, although the “ongoing crisis” remained.  READ MORE: Patients With Lung Cancer Face Unmet Needs During Drug Shortages “We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.” Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges. Transcript: Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
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Image of a man with a beard.
Image of a man with gray facial hair and a navy blue suit with a light orange tie.
Image of a woman with black hair.
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