Sleep disturbances in cancer survivors often go hand-in-hand with cognitive dysfunction, also known as “chemo brain”. Categorized as a late effect of cancer treatment, chemo brain can appear up to six months after chemotherapy has been completed. At a time when cancer survivors are hoping for a return to some type of “normal life”, chemo brain can thwart that goal. Most chemo brain sufferers report difficulties with short term memory, a slower processing speed, and the frustrating necessity of working harder than they used to on mental tasks such as reading. (1) Most chemotherapies do not cross the blood brain barrier, but still have an effect on the speed and frequency of neuron growth and connections. Studies show that hormonal treatment, which can be part of treatment for breast, prostate and ovarian cancers, can also cause milder chemo brain symptoms. (2) 

The good news is that chemobrain, for most cancer survivors, will diminish over time. Also, because the brain remains plastic throughout a lifespan, it can be trained to compensate for deficits and improve in areas of cognition like short term memory, focus and word fluency. Chemobrain also does not cause or increase risk of dementia or Alzheimer’s disease. Some treatments for chemobrain, such as neurofeedback, also help decrease signs of age-related mental decline. For example, giving memory cues helps chemobrain patients but not Alzheimer’s sufferers. The best news is that there are now treatments that may help cancer survivors who experience more severe cognitive difficulties. Before deciding which treatment may be best, it is helpful to rule out other medical issues that may be contributing to cognitive problems.

Sleep and "Chemo Brain"

One of the medical issues that can produce symptoms similar to chemobrain is insomnia and the medications prescribed to treat it. In a presentation available on YouTube, Dr. Fremonta Meyer of the Dana-Farber Cancer Institute’s Department of Psychosocial Oncology and Palliative Care cautions cancer survivors about using sleep medications. Sleep medications can cause mental fog and decrease the ability to multitask or process information quickly. Ruling out sleep apnea is also important. Dr. Meyer suggests patients with other neurological symptoms see a neurologist first. For others whose emotional distress is foremost, she highlights the helpfulness of seeing a psychiatrist. Many antidepressants can help not only depression but also sleep difficulties. For the rest, having neuropsychological testing can pinpoint the most severe cognitive deficits, which can then be treated through a variety of methods.

Cognitive behavioral therapy can be helpful when used as a type of cognitive rehabilitation.(3) This type of rehab can be performed by a speech and language therapist, and may be covered by insurance similar to physical and occupational therapies. By identifying cognitive tasks that cause the most difficulty, cognitive rehab can offer coping strategies, stress relief, and ways to compensate for any deficits. Neurofeedback is also an emerging aid for chemobrain sufferers.(4) Research shows this type of brain training can increase the number and strength of connections between neurons in the brain.

Chemo brain is a complex set of symptoms that can be made worse by other common side effects of cancer treatment such as insomnia. Speaking with your oncologist can help get the ball rolling on treatment for this frustrating problem.

References:

1.Burtchell J. Healthline.com. Jan. 11, 2016. Fighting post-treatment fog: chemo brain explained. Available from URL http://www.healthline.com/health/chemo-brain

2.Expert voices blog. Oct. 27, 2015. American Cancer Society. Available from URL http://blogs.cancer.org/expertvoices/2015/10/27/does-hormone-therapy-for-breast-cancer-affect-the-brain/

3.McNeil C. Treating Chemobrain: Rehabilitation Therapies Emerge. J Natl Cancer Inst.2012 Nov 21;104(22):1691-


4.Nelson R. Neurofeedback Improves ‘Chemo Brain’ In Cancer Patients. Nov. 17, 2011. Medscape. Available from URL http://www.medscape.com/viewarticle/753754