Side Effects It’s NOT ALL in Your Head

A Closer Look at the Effects of Cancer and Cancer Treatment on Cognitive Function

girl with sticky note on foreheadMany survivors of cancer will experience changes in their thinking skills during and after cancer treatment. These side effects vary in severity and often improve with time. However, some survivors may experience lingering cognitive side effects that can persist long after treatment is complete. The good news is, once they are identified, most cancer-related cognitive issues can be effectively managed.

SYMPTOMS

Changes in cognitive function may result from cancer itself. Survivors with brain tumors might experience cognitive difficulties related to the location of the tumor, its size, and how fast it grows. However, survivors of cancers outside the brain may also experience cognitive symptoms, even before treatment begins. Treatments directed at brain tissue, as well as chemotherapy, hormonal therapy, and immunotherapy, can also lead to changes in brain function. Common symptoms include:

• Reduced processing speed 
feeling mentally slower
• Problems with multitasking 
being easily distracted; having difficulty managing multiple demands at once or switching back and forth between tasks
• Memory loss 
trouble recalling recent conversations, events, and intentions; misplacing possessions
• Word-finding difficulty 
getting “stuck” searching for the right word; specific words are “on the tip of the tongue”
Some survivors may experience lingering cognitive side effects that can persist long after treatment is complete.DIAGNOSIS

A neuropsychological assessment starts with a conversation with the survivor and their family. The neuropsychologist will ask about the nature and course of symptoms, including cognitive, behavioral, and emotional changes. Standardized testing will identify both areas of cognitive weakness and areas of cognitive strengths. In addition to naming specific concerns related to cancer and cancer treatment, this kind of detailed evaluation can identify or rule out other conditions that might contribute to similar symptoms, such as dementia, mood disorders, and fatigue.

TREATMENT


Currently, there are not a lot of medications available to address cognitive difficulties related to cancer and cancer treatment. Some people might benefit from the use of a stimulant medication, particularly to address fatigue. Cancer survivors should discuss the risks and benefits of this kind of medication with their physician. People receiving brain irradiation may benefit from taking the medicine memantine to protect the brain. 
Fatigue, sleep disturbance, and distress can worsen cognitive weaknesses, so it is important to get them under control.Researchers are continually looking for other ways to protect brain function from cancer and its treatment. However, right now, treatment for the cognitive side effects of cancer is most often focused on developing strategies to help survivors manage these side effects. These might include:

• Using a memory system 
entering important information into a single, portable system such as a smartphone or day planner, with alerts programmed to give you reminders of important events and tasks
• Storing frequently used items in a convenient location 
placing important possessions (for example, your keys, phone, and wallet) in the same place every time
• Minimizing distractions 
seeking out or creating a quiet environment, and focusing on a single task at a time

Fatigue, sleep disturbance, and distress can worsen cognitive weaknesses, so it is important to get them under control. The following strategies can help:

• Practice good sleep hygiene.  
Establish a consistent sleep and wake time. Limit daytime naps. Avoid screens (such as television, tablet, or phone) in bed. And optimize your sleep environment. Try to make sure your bedroom is dark, quiet, and a comfortable temperature so you can fall asleep more easily.
• Participate in regular physical, cognitive, and social activities. 
Regular activity can reduce fatigue, boost your mood, and enhance your overall well-being.
• Prioritize. 
Practice energy conservation by spending your energy only on those activities that are most important to you. Delegate or let go of the rest.
• Manage depression and anxiety. 
Talk to your doctor if you’re experiencing symptoms of depression, anxiety, or another mood disorder. Treatment options might include medications, talk therapy, taking part in support groups, and learning relaxation strategies.

Communication with your care team is key. Cancer-related cognitive changes can be subtle and may not be obvious to others. If you are experiencing cognitive changes or have noticed such symptoms in a family member, it is important to alert your healthcare providers. You may want to request a referral for a neuropsychological evaluation. A neuropsychologist can provide a formal assessment of your symptoms and work with you to develop a personalized management plan. 


Dr. Jeffrey WefelDr. Mariana BradshawDr. Jeffrey Wefel (left) and Dr. Mariana Bradshaw (right) are board-certified clinical neuropsychologists at the University of Texas MD Anderson Cancer Center in Houston, TX. Their practice focuses on the neuropsychological effects of cancer and cancer therapy in adult cancer survivors. 

To find a board-certified neuropsychologist near you, visit
TheAACN.org/directory.

This article was published in Coping® with Cancer magazine, March/April 2019.