Chemobrain in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the part of the overall treatment plan.
Around 70% of cancer survivors report difficulties with memory and concentration after undergoing chemotherapy – this is conversationally referred to as “Chemobrain,” which is described as a mental clouding or fogginess, during and after cancer treatment.
Chemobrain refers to the cognitive impairment that can occur after cancer treatment. It’s not limited to people who undergo chemotherapy (surgery and radiation can also contribute), but it’s more noticeable if one has undergone chemotherapy.
Symptoms of chemobrain can be very frustrating because no matter how well your child speaks or writes, it can cause them to forget words that they have used often, making them have to resort to saying “that thing” or “the thing” instead of “that car” or “the cat” for instance.
Symptoms of chemobrain also include:
- Forgetting things that you usually have no trouble recalling (memory lapses)
- Trouble concentrating (your child can’t focus on what they are doing, has a short attention span, and may “space out”)
- Your child may have trouble remembering details such as names, dates and sometimes larger events such as exams, birthdays etc
- Your child may also have trouble multitasking, such as answering you while playing or doing homework, without losing track of what they were doing in one of the two
- Your child may take a lot longer to finish simple tasks (disorganised; slower thinking and processing)
- Your child may also have trouble remembering common words (unable to find the right words to finish a sentence)
Some days it can be just one or two symptoms that befuddle your child and on other days they can hit the jackpot and experience all of the symptoms, which can be devastating to them.
Chemobrain is partially based on body and mind fatigue. Animal studies have shown that chemotherapy may cause temporary reductions in cell growth in brain areas (e.g. the hippocampus) that control learning and memory.
Genetic differences (small variations in DNA sequences in genes, called polymorphisms) may also increase risk. These occur in a variety of genes, not just cancer-causing genes.
There have been studies measuring people’s subjective complaints and objective neuropsychological testing before and after chemotherapy. Brain imaging studies have been done to measure blood flow and water diffusion in the brain before and after chemotherapy as research is ongoing as to the exact cause.
The best way to get a complete picture of your child’s cognitive functioning is for them to undergo a formal assessment by a neuropsychologist (a psychologist who specialises in the brain), which usually involves standardised clinical neuropsychological tests – pencil-and-paper or computer-based tests that measure memory, language and perception.
Your child’s oncologist can refer them for this evaluation. Information from neuropsychological testing can also be extremely helpful to share with your child’s school so that they can get extra time for exams, homework etc.
For most patients, chemobrain improves within 9-12 months after completing chemotherapy, but many individuals still have symptoms after six months. A smaller fraction of people (approximately 10-20%) may have long-term effects.
For the minority who do suffer long-term effects, these can last up to 10 years after completing treatment. However, these side effects should be stable and not worsening. If they are getting worse 10 or more years later, you should speak with your child’s doctor.
Regular exercise is helpful for alleviating chemobrain symptoms. Aerobic exercises – walking, running, dancing, or cycling, for instance, are probably better, but one study did show that resistance and strength training helped as well.
It’s also important to make sure your child is receiving treatment for any depression, anxiety, or sleep problems (including sleep apnoea). Make sure you also have had your child’s thyroid, vitamin D and B12 levels checked.
Cognitive treatments including brain games through websites such as lumosity.com and positscience.com, and EEG biofeedback (another form of “brain exercise” that naturally trains your child’s brainwaves to be in a less turbulent state), are significantly more effective than medications for treating chemobrain.
There are some studies that suggest that EEG Biofeedback is helpful. However, there is no research testing whether transcranial magnetic stimulation (non-invasive) or deep brain stimulation (surgical/invasive) may be useful for chemobrain. These treatments are however effective for some individuals suffering from depression and may improve cognitive symptoms associated with depression in those individuals.
How can cancer patients manage the symptoms of chemobrain?
Tips to Manage Chemobrain
- Set your child up for repeat reminders whenever possible: The reminder bells, calendars and other features of smartphones can be a lifesaver for your child, and so can the help of others.
- Help your child to exercise their brain: Exercising your child’s brain through writing can be a big help. Sign them up for classes, or help them to practice simple memory games or word puzzles.
- Take care of your child’s health: Regular physical activity and a healthy diet are not only good for your child’s body, but will also improve their mood, make them feel more alert and decrease their fatigue. If they are physically healthy, they will be more mentally able to handle cognitive tasks.
- Routines are your child’s friend: Set up routines for your child and make sure they follow them. Pick a certain place for commonly lost objects and put them there each time. Try to get them to keep the same daily schedule.
- Let your loved ones know what your child is going through: Often, the people in your child’s life will not immediately recognise that they are struggling, or may not associate it with their cancer treatment. By communicating with your loved ones, they will know to be more patient with your child to and help them when they struggle to remember a certain word or where something is.
- Give your child extra time: Teach your child to allow extra time to accomplish their errands and tasks, especially while undergoing chemotherapy. Tell them not to become overwhelmed because they aren’t functioning at their best. Remind them that they are still healing, so they need to use common sense about how much they can manage.
- Teach your child to track their memory issues: They should keep a diary of when they notice problems and what is going on at the time. Medicines taken, the time of day and the current situation might help you to help them figure out what affects their memory. This will also be useful when you talk with your child’s doctor about these problems.