Cognitive Challenges and Cancer: Information to Know

Written by: Beth Dougherty
Medically Reviewed By: Eric Zhou, PhD

Words like “chemobrain” and “chemofog” — terms now used by patients, doctors, and scientists to describe cognitive decline that some patients experience in response to cancer therapy — didn’t exist a few decades ago. Today, however, there’s a general awareness that cancer treatments can take a toll on the brain. 

Oncologists don’t yet have a good way to predict cognitive effects of any given therapy on an individual patient. But there are things patients can do if they suspect they’re experiencing cognitive changes during or after cancer therapy.  

How does cancer therapy cause cognitive problems? 

The term “chemobrain” was initially coined when oncologists started to notice that some patients experienced cognitive decline during or after taking traditional chemotherapy. Researchers are learning more about how different cancer treatments influence the brain.  

A recent review suggests that many forms of cancer therapy, including chemotherapy, endocrine therapy, immunotherapy, and targeted therapies, have the potential to cause brain toxicities. Those toxicities could include changes in neurotransmitter levels, interrupted regeneration of brain cells, and inflammation that can result in neurodegeneration. These findings are giving researchers insights that could someday lead to improved therapies.  

Many forms of cancer therapy, including chemotherapy, endocrine therapy, immunotherapy, and targeted therapies, have the potential to cause brain toxicities. 
Many forms of cancer therapy, including chemotherapy, endocrine therapy, immunotherapy, and targeted therapies, have the potential to cause brain toxicities. 

Are cognitive issues such as ‘chemobrain’ temporary or permanent? 

Cognitive impairments are not always permanent. Some patients will recover soon after therapy is stopped, some within a few years, and some might have persistent cognitive challenges.  

Every patient is unique, and risks of cognitive decline vary depending on the individual, their pre-existing risk factors, and their specific cancer treatment. But that doesn’t mean patients have to fly blind through therapy. Rather, it underscores how important it is for patients, caregivers, and providers to pay attention to cognitive changes and respond to them.  

What do I do if I think I am experiencing ‘chemobrain’ or cognitive decline? 

Signs of cognitive changes include a decline in attention, memory, processing speed, or planning capabilities. If you start experiencing any signs of cognitive decline, talk to your medical team. Do so even if you are taking a form of therapy that isn’t traditional chemotherapy.  

“If families are noticing signs of decline, it warrants attention,” says Eric Zhou, PhD, a psychologist at Dana-Farber. “The medical team wants to know about any side effects of treatment that you are experiencing, so it’s important to let your care team know what is going on.”  

What options do I have if my cancer treatments are affecting my brain? 

Your medical team might suggest a neuropsychological evaluation to get an assessment of your cognitive abilities and performance. This information can help your care team plan your treatment and potentially detect further changes as you continue with treatment. 

“It’s important for patients who experience cognitive decline to actively raise this issue as early as possible,” says Zhou. 

Are there forms of cancer that directly affect cognition? 

Tumors in the brain either from brain cancer or from cancer that has migrated into the brain (called brain metastases), have the potential to alter cognition. Treatments that involve the brain, such as surgery or radiation, can also affect cognition. Care teams within Dana-Farber, including the Center for Neuro-Oncology, provide care for patients with brain tumors with a focus on maintaining quality of life. This care can include working with neuropsychologists. 

What treatments exist to help me if I’m experiencing cognitive changes? 

Researchers have investigated several pharmacological agents, but so far none have emerged as a definitive treatment of cognitive decline associated with cancer therapy.  

Alternative approaches have shown some positive results: 

  • Cognitive rehabilitation, which involves efforts to create a structured environment, use reminders and daily calendars, or reduce distractions. It also might include brain training, such as using puzzles and games to challenge memory and attention.  
  • Physical activity, which includes exercise, such as walking or strength training.  
  • Mindfulness activities, which include meditation or mind-body activities that blend movement, breathing and attention. 

The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber has programs that can help you get started with meditation, exercise, and more. 

What can I do on my own to cope with cognitive impairment? 

Getting sufficient, high-quality sleep, maintaining a healthy diet, and getting regular exercise are also important to maintain overall health. 

“The same things that you would normally do to stay physically healthy are also good for cognition,” says Zhou. 

Dana-Farber has several resources that can help you learn more about sleeping, exercising, and eating well during and after cancer therapy:

Dana-Farber’s Psychosocial Oncology team can help you cope with what you are experiencing. . 

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