What is chemo brain

Chemo brain is the mental cloudiness people with cancer sometimes notice before, during, and after their cancer treatment ¹. Even though chemo brain exact cause isn’t known, and chemo brain can happen at any time when you have cancer, this mental fog is commonly called chemo brain fog. Despite its name, chemo-brain may be caused by other treatments (that is other treatments instead of your chemotherapy for your caner) or happen at any time during a person’s cancer journey – note that chemo brain can happen before, during, and after their cancer treatment. Furthermore, people who do not receive chemotherapy also report similar symptoms.

Though the exact cause of chemo brain isn’t always known, this mental cloudiness (“chemo-brain”) has been linked with radiation treatment, chemotherapy and other cancer drugs. But research shows that these aren’t the only things that can cause thinking and memory problems in people with cancer. More research is needed to help prevent it when possible, and to cope with it when necessary.

Doctors and researchers call chemo brain many things, such as chemo brain fog, cancer treatment-related cognitive impairment, cancer-therapy associated cognitive change or post-chemotherapy cognitive impairment. Most define chemo brain as a decrease in mental “sharpness” – being unable to remember certain things and having trouble finishing tasks or learning new skills.

Many people with cancer experience trouble thinking, remembering, and concentrating before, during, and after their cancer treatment. These mental changes may last just a short time or go on for years. They can prevent you from returning to work or taking on the responsibilities you were used to before cancer.

What is chemotherapy

Chemotherapy (chemo) usually refers to the use of medicines or drugs to treat cancer. Chemotherapy drugs target cells at different phases of the process of forming new cells, called the cell cycle. Understanding how these drugs work helps doctors predict which drugs are likely to work well together. Doctors can also plan how often doses of each drug should be given based on the timing of the cell phases.

Cancer cells tend to form new cells more quickly than normal cells and this makes them a better target for chemotherapy drugs. However, chemo drugs can’t tell the difference between healthy cells and cancer cells. This means normal cells are damaged along with the cancer cells, and this causes side effects. Each time chemo is given, it means trying to find a balance between killing the cancer cells (in order to cure or control the disease) and sparing the normal cells (to lessen side effects).

What is radiation treatment

Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells.

Your cells normally grow and divide to form new cells. But cancer cells grow and divide faster than most normal cells. Radiation works by making small breaks in the DNA inside cells. These breaks keep cancer cells from growing and dividing and cause them to die. Nearby normal cells can also be affected by radiation, but most recover and go back to working the way they should.

Unlike chemotherapy, which usually exposes the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment. In most cases, it’s aimed at and affects only the part of the body being treated. Radiation treatment is planned to damage cancer cells, with as little harm as possible to nearby healthy cells.

Some radiation treatments (systemic radiation therapy) use radioactive substances that are given in a vein or by mouth. Even though this type of radiation does travel throughout the body, the radioactive substance mostly collects in the area of the tumor, so there’s little effect on the rest of the body.

How long does chemo brain last

How long chemo brain lasts is a major factor in how much it affects a person’s life. When chemo brain starts, how long it lasts, and how much trouble it causes can vary a lot.

For most people, chemo brain effects happen quickly and only last a short time. Others have long-term mental changes. Usually the changes that patients notice are very subtle, and others around them might not even notice any changes at all. Still, the people who are having problems are well aware of the differences in their thinking. Many people don’t tell their cancer care team about this problem until it affects their everyday life.

Here are just a few examples of what patients call chemo brain:

• Forgetting things that they usually have no trouble recalling (memory lapses)
• Trouble concentrating (they can’t focus on what they’re doing, have a short attention span, may “space out”)
• Trouble remembering details like names, dates, and sometimes larger events
• Trouble multi-tasking, like answering the phone while cooking, without losing track of one task (they’re less able to do more than one thing at a time)
• Taking longer to finish things (disorganized, slower thinking and processing)
• Trouble remembering common words (unable to find the right words to finish a sentence)

Chemo brain fog causes

Beyond the chemo brain symptoms that start during and just after treatment, there are some cases where brain symptoms start and even get worse after treatment is over. Many cancer treatments, including certain kinds of chemo and radiation, can cause short-term, long-term, and delayed problems.

Studies suggest that there may be more than one cause of chemo brain, especially for the short-term symptoms. Some people with cancer have very real brain problems even though they haven’t had chemo. Still others notice problems when getting hormone treatments, such as those used to treat breast or prostate cancers. For some, problems start after surgery. Along with chemo, many different things can worsen brain function.

For instance, brain function problems could be caused or worsened by any one or any combination of these factors:

• The cancer itself
• Brain cancer
• Other cancers that have spread to the brain
• Radiation treatment to the head and neck or total body irradiation
• Brain surgery, when areas of the brain are damaged during a biopsy or the removal of a tumor
• Other drugs used as part of treatment, such as steroids, anti-nausea, or pain medicines
• Hormone therapy, immunotherapy, and other medications, which may include:
  • Anti-nausea medicine
  • Antibiotics
  • Pain medicine
  • Immunosuppressants
  • Antidepressants
  • Anti-anxiety medications
  • Heart medicine
  • Sleep medicine
• Surgery and the drugs used during surgery (anesthesia)
• Other conditions related to cancer or its treatments. These include anemia, sleep problems, fatigue, high blood calcium, and electrolyte imbalances.
• Low blood counts
• Sleep problems
• Infections, especially those of the brain and spinal cord, and infections that cause a high fever
• Tiredness (fatigue)
• Hormone changes or hormone treatments
• Other illnesses, such as diabetes or high blood pressure
• Nutritional deficiencies
• Not having enough of certain vitamins and minerals, such as iron, vitamin B, or folic acid
• Patient age
• Depression
• Other brain or nervous system disorders not related to cancer
• Stress, anxiety, worry, or other emotional pressure

Anxiety

Anxiety may be described as feeling nervous, on edge, or worried. It is a normal emotion that alerts your body to respond to a threat. However, intense and prolonged anxiety is a disorder. And it may interfere with your daily activities and relationships.

Acute anxiety occurs in short episodes that end quickly. Chronic anxiety remains over time.

Anxiety symptoms may be mild or severe. And some of the symptoms may be similar to those of depression. Often, this is because depression occurs along with anxiety.

Anxiety and cancer

Many people with cancer experience symptoms of anxiety. A cancer diagnosis may trigger these feelings:

• Fear of treatment or treatment-related side effects
• Fear of cancer returning or spreading after treatment
• Uncertainty
• Worry over losing independence
• Concern about having relationships change
• Fear of death

Anxiety may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing anxiety are important parts of cancer treatment.

Acute anxiety symptoms

You may frequently experience short periods of the symptoms listed below. A panic attack is when a person has all of these symptoms at once:

• A feeling of intense fear or dread
• A feeling of detachment from yourself or your surroundings
• Heart palpitations or rapid heartbeat
• High blood pressure
• Chest pain
• Shortness of breath
• A feeling of suffocation
• Sweating
• Chills
• Dizziness or lightheadedness
• Trembling
• Nausea, diarrhea, heartburn, or a change in appetite
• Abdominal pain

Chronic anxiety symptoms

Chronic anxiety may include acute anxiety episodes, along with one or more of the following symptoms. They typically last for a longer time:

• Excessive worrying
• Restlessness
• Muscle tension
• Insomnia, which is the inability to fall asleep or stay asleep
• Irritability
• Fatigue
• Difficulty concentrating
• Indecision, which means having difficulty making decisions

It is important to tell your doctor or another member of your health care team if you experience any of these symptoms. However, such symptoms are not necessarily related to anxiety. Some may be side effects of the cancer or cancer treatment. For example, fatigue, insomnia, and difficulty concentrating are common side effects of cancer and cancer treatment.

Risk factors for anxiety

People with cancer are more likely to experience anxiety if they have these risk factors:

• Previous diagnosis of anxiety or depression
• Family history of anxiety or depression
• Lack of support of friends or family
• Financial burdens

Anger

Anger is a common feeling for many people living with cancer. It is often one of the first emotional reactions a person has to a cancer diagnosis. But it can develop at any time throughout treatment and survivorship.

A person living with cancer may feel anger about the way cancer has disrupted his or her life. He or she may be angry about the way family members and friends reacted to the diagnosis. Many people also wonder “Why me?”, which can lead to feeling angry and frustrated. Cancer symptoms and treatment-related side effects, such as trouble sleeping, fatigue, pain, and nausea, can make even the happiest person feel frustrated, irritable, and angry at times.

Depression

People with cancer may experience depression, which is a treatable mood disorder.

Depression may make it harder to cope with cancer treatment. It may also interfere with your ability to make choices about your care. As a result, identifying and managing depression are important parts of cancer treatment.

Talk with your doctor if you experience the following symptoms, especially if they last two weeks or longer.

The symptoms of depression may appear shortly after diagnosis or anytime during or after treatment.

These symptoms range from mild to severe. Severe depression interferes with a person’s relationships and day-to-day activities and responsibilities. This is also called major depressive disorder.

Mood-related symptoms

• Feeling down
• Feeling sad
• Feeling hopeless
• Feeling irritable
• Feeling numb
• Feeling worthless

Behavioral symptoms

• Loss of interest in activities that you previously enjoyed
• Frequent crying
• Withdrawal from friends or family
• Loss of motivation to do daily activities

Cognitive symptoms

• Decreased ability to concentrate
• Difficulty making decisions
• Memory problems
• Negative thoughts. In extreme situations, these may include thoughts that life is not worth living or thoughts of hurting yourself.

Physical symptoms

• Fatigue
• Appetite loss
• Insomnia, which is the inability to fall asleep and stay asleep
• Hypersomnia (excessive sleepiness)
• Sexual problems, such as decreased sexual desire

The cognitive and physical symptoms listed above may be side effects of the cancer or cancer treatment. As a result, doctors place more emphasis on mood-related and behavior symptoms when diagnosing depression in a person with cancer.

Risk factors for depression

• People with cancer are more likely to experience depression if they have these risk factors:
• Previous diagnosis of depression or anxiety
• Family history of depression or anxiety
• Lack of support of friends or family
• Financial burdens.

Guilt

Many people living with cancer experience guilt. Guilt is a feeling of blame and regret that is usually hard to acknowledge and express. Guilt often leads people to replay “what if” and “if only” scenarios in their minds to figure out what they could have done differently or how they could “right” a wrongdoing.

People with cancer may feel guilt at various times for different reasons. For example, you may feel guilty because:

• You could have noticed symptoms earlier or gone to the doctor sooner.
• You worry that you are a burden to your family or caregivers.
• The treatment you received did not work the way you had hoped.
• The cancer comes with financial costs or causes you to spend time away from work for treatment. Consider asking for help with managing the cost of your cancer care.
• You survived cancer while others did not. This is often referred to as “survivor’s guilt.”
• You blame yourself or feel embarrassed or ashamed of lifestyle choices and habits that may have increased your risk of developing cancer.

Family, friends, and caregivers of people with cancer may also experience guilt because they:

• Are healthy while someone they care about is ill
• Are not able to help more
• Cannot make the person with cancer healthier
• Feel stressed or sad themselves

Fear of Treatment-Related Side Effects

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. However, your health care team is focused on preventing and controlling your side effects. Don’t be afraid to talk with your doctor, nurse, or pharmacist about possible side effects and how you can manage them. This information can ease your mind and prepare you for what lies ahead.

Common fears

Some of the most common fears about side effects include:

• Losing control and/or not knowing what to expect
• Experiencing discomfort, pain, nausea, or tiredness
• Losing the ability to do daily activities, such as going to work, completing household tasks, and attending social events
• Undergoing appearance changes, such as hair loss or scars
• Developing sexual problems or struggling to become pregnant or have children after treatment
• Feeling anxious about a treatment or a procedure

Most of these cause short-term problems, and get better as the underlying problem is treated or goes away. A few, such as depression, can cause long-lasting brain problems unless the cause is treated.

No large-scale studies of routine screening for cognitive impairment have been published. One challenge is the lack of a brief measure of cognitive function that can accurately assess the multiple domains ². Patient-reported outcome scales (e.g., the Patient-Reported Outcomes Measurement Information System 8-item scale; and the Functional Assessment of Cancer Therapy—Cognitive) might prove valuable, but further study is required. An additional challenge is the timing of screening activities, given the variable time to onset and the resolution of concerns without intervention for many patients.

A group of researchers calculated effect sizes on the basis of data from 13 high-quality studies published in 2010 and earlier ³. Key criteria for study inclusion were reports with primary data, statistics to allow calculation of effect sizes, and a control group; studies with patients who had psychological distress were excluded.

Although several domains were affected, the effect sizes were small. The affected domains included executive function (effect size, –0.27), memory (effect size, –0.21), and verbal function and language skills (effect size, –0.17). Insignificant effect sizes were observed for construction (the ability to draw and build), concept formation, reasoning, perception, and orientation and attention.

The authors noted a consistent but not universal trend of worse performance by patients who received chemotherapy compared with groups who received other types of treatment, received no treatment, or were healthy. Furthermore, longer time in treatment was associated with increased impairment, and longer time since completion of treatment was associated with improvement ³.

Talk with your doctor or cancer care team

If brain problems cause trouble at work, talk with your doctor to try and pinpoint what’s causing your brain fog and what can be done about it. This is especially important for people with chemo brain that lasts more than a year and keeps causing trouble in their daily lives.

It helps a lot if you have a diary or log of the situations you have trouble with. It also helps to know some of the things that make the problem worse or better. For instance, are they worse in the morning or evening? Do you have more trouble when you are hungry or tired? Does it help to nap, walk, or have a snack? Your doctor will want to know when the problems started and how they affect your daily life.

• Write down questions about the problems you have. Take them to your appointment along with your memory tracking log to talk over with your doctor. Ask what may be causing the problems, and find out if there’s anything the doctor can offer to help you.
• Bring a list of all the medicines you take, including herbs, vitamins, supplements, and those you take on an “as needed” basis.
• Take a friend or family member with you to help you keep track of what’s said during the visit. They can also describe the changes they see if the doctor wants a different viewpoint of how your brain problems are affecting you.
• If your memory and thinking problems keep causing trouble in your daily life, ask your doctor if you might be helped by a specialist such as a neuropsychologist or a speech language pathologist. These professionals can test you and may recommend ways to help you better handle the problems. (You may hear this called cognitive rehabilitation.)

You may need to visit a larger hospital or cancer care center to find experts on testing brain function, including chemo brain. Ask if you can get a referral to one of these specialists who can help you learn the scope of your problem and work with you on ways to manage it. You’ll want to find out what your insurance will cover before you start.

Questions to ask your doctor

These are just some of the questions you may want to ask your doctor about chemo brain.

• Are there other medical problems that could be causing my symptoms?
• Is there treatment for my symptoms?
• What can I do to manage chemo brain?
• Is there anything I can do to help prevent chemo brain?
• Should I see a specialist? Can you recommend one?

Risk factors for chemo brain

Factors that may increase the risk of memory problems in cancer survivors include:

• Brain cancer
• Chemotherapy given directly to the central nervous system
• Chemotherapy combined with whole-brain radiation
• Higher doses of chemotherapy or radiation
• Radiation therapy to the brain
• Younger age at time of cancer diagnosis and treatment
• Increasing age

Chemo brain signs and symptoms

Whether you have memory or concentration problems depends on the type of treatment you receive, your age, and other health-related factors. Cancer treatments such as chemotherapy may cause difficulty with thinking, concentrating, or remembering things. So can some types of biological therapies and radiation therapy to the brain.

These cognitive problems may start during or after cancer treatment. Some people notice very small changes, such as a bit more difficulty remembering things, whereas others have much greater memory or concentration problems.

Cancer patients may experience the following difficulties:

The level of these symptoms often depends on several factors. These can include:

• Your age
• Stress level
• History of depression or anxiety
• Coping skills
• Access to psychological resources
• Types of cancer treatment you are receiving

Managing symptoms of cognitive problems is an important part of cancer care and treatment. Talk with your health care team if you develop any of these symptoms or changes.

Your doctor will assess your symptoms and advise you about ways to manage or treat these problems. Treating conditions such as poor nutrition, anxiety, depression, fatigue, and insomnia may also help.

Chemo brain prevention

So far, there is no known way to prevent chemo brain. For some people, treating their cancer will mean trouble with thinking, memory, planning, and finding the right words.

The causes of brain problems related to cancer and its treatment are still being studied. Chemo brain seems to happen more often with high doses of chemo, and is more likely if the brain is also treated with radiation. But because chemo brain is usually mild and most often goes away in time, chemo that’s proven to work against the cancer should not be changed to try to prevent this side effect.

Chemo brain complications

The severity and duration of the symptoms sometimes described as chemo brain differ from person to person. Some cancer survivors may return to work, but find tasks take extra concentration or time. Others will be unable to return to work.

If you experience severe memory or concentration problems that make it difficult to do your job, tell your doctor. You may be referred to an occupational therapist, who can help you adjust to your current job or identify your strengths so that you may find a new job.

In rare cases, people with memory and concentration problems are unable to work and must apply for disability benefits. Ask your health care team for a referral to an oncology social worker or a similar professional who can help you understand your options.

Chemo brain diagnosis

There’s no clear definition of chemo brain, so no tests exist to diagnose this condition. Cancer survivors who experience these symptoms often score in normal ranges on memory tests.

Your doctor may recommend blood tests, brain scans or other tests to rule out other causes of memory problems. But if no apparent cause can be found for your symptoms, your doctor may refer you to a specialist who can help you cope with memory changes.

Chemo brain treatment

It’s not clear what causes chemo brain, and no cure has been identified. In most cases, cancer-related memory problems are temporary, so treatment focuses on coping with symptoms.

No standard treatment has been developed for cancer-related memory problems. Because symptoms and severity differ from person to person, your doctor can work with you to develop an individualized approach to coping.

Managing cognitive problems

Cognitive problems often get better after taking care of a treatable condition, such as anemia or an electrolyte imbalance. Likewise, problems caused by a medication generally go away after stopping the drug. Problems related to cancer in the brain often improve with treatment, but some symptoms may continue.

Cognitive problems related to chemotherapy, radiation therapy, or other cancer treatments may be long term. Ways to manage these lasting cognitive problems include:

• Medications, including stimulants, cognition-enhancing drugs, and antidepressants
• Occupational therapy and vocational rehabilitation, to help people with daily tasks and job-related skills
• Cognitive rehabilitation and cognitive training, to help patients improve their cognitive skills and find ways to cope with cognitive problems

Day-to-day coping

Experts have been studying memory for a long time. There are many things that you can do to help you sharpen your mental abilities and manage chemo brain.

Some examples are:

• Use a detailed daily planner or your smart phone. Keeping everything in one place makes it easier to find the reminders you may need. You might want to keep track of appointments and schedules, “to do” lists, important dates, websites, phone numbers and addresses, meeting notes, and even movies you’d like to see or books you’d like to read.
• Do one task at a time and avoid distractions.
• Get rid of clutter.
• Exercise your brain. Take a class, do word puzzles, or learn a new language.
• Get enough rest and sleep.
• Talk with your employer if you are having problems at work. Discuss ways your employer could support you, such as changing your workload or deadlines.
• Move your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert, and decreases tiredness (fatigue). However, if you’ve never exercised before or you have balance problems or muscle weakness, you should check with your doctor to determine a safe exercise program before adding physical activity to your routine. You may need physical therapy or another medically supervised conditioning program.

Get Effective Exercise

• The key is to keep your exercise program simple and fun. Exercise and relaxation techniques are great ways to relieve stress. Reducing stress is an important part of getting well and staying well.
• Everyone’s exercise program will be different. Your goal should be to exercise for at least 10 minutes at a time. Some people may need guidance to make an appropriate exercise plan.
• An exercise plan may include different types of exercise: 1) aerobic exercise, 2) exercise that increases your flexibility and range of motion, and 3) muscle-strengthening exercise.
• Start slowly. Don’t work too hard or for too long. Build up intensity and exercise for longer periods slowly over time.
• Include a warm up for at least 2 to 3 minutes and a cool down.

Add physical activity to your daily routine

Here are some ways to add physical activity to the things you do every day. Remember, only do what you feel up to doing.

• Walk around your neighborhood after dinner.
• Ride your bike.
• Mow the grass, or rake the leaves instead of using a blower.
• Scrub your bathroom.
• Wash and wax your car.
• Play active games with kids, like freeze tag, jump rope, and the games you played when you were a kid.
• Walk a dog (one that can be controlled so that you don’t trip or get pulled off balance).
• Weed your garden.
• Take a friend dancing, or dance in your own living room.
• Use an exercise bike or treadmill, or do arm curls, squats, lunges, and crunches while watching TV.
• Walk to lunch.
• Park your car in the farthest parking space at work and walk to the building.
• Use the stairs instead of the elevator or escalator.
• Get off the bus several stops early and walk the rest of the way to work.
• Make appointments for yourself in your daily planner for 10-minute walking breaks.
• Form a walking club of co-workers to help you stay motivated to walk during the workday.
• Wear a pedometer every day and try to increase your daily steps.

Ways regular exercise may help you during cancer treatment

• Keep or improve your physical abilities (how well you can use your body to do things)
• Improve balance, lower risk of falls and broken bones
• Keep muscles from wasting due to inactivity
• Lower the risk of heart disease
• Lessen the risk of osteoporosis (weak bones that are more likely to break)
• Improve blood flow to your legs and lower the risk of blood clots
• Make you less dependent on others for help with normal activities of daily living
• Improve your self-esteem
• Lower the risk of being anxious and depressed
• Lessen nausea
• Improve your ability to keep social contacts
• Lessen symptoms of tiredness (fatigue)
• Help you control your weight
• Improve your quality of life

Scientists still don’t know a lot about how exercise and physical activity affect your recovery from cancer, or their effects on the immune system. But regular moderate exercise has been found to have health benefits for the person with cancer.

A growing number of studies have looked at the impact of physical activity on cancer recurrence and long-term survival. (Cancer recurrence is cancer that comes back after treatment.) Exercise has been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem, happiness, and several quality of life factors in cancer survivors. At least 20 studies of people with breast, colorectal, prostate, and ovarian cancer have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive. Randomized clinical trials are still needed to better define the impact of exercise on such outcomes.

Those who are overweight or obese after treatment should limit high-calorie foods and drinks, and increase physical activity to promote weight loss. Those who have been treated for digestive or lung cancers may be underweight. They may need to increase their body weight to a healthier range, but exercise and nutrition are still important. Both groups should emphasize vegetables, fruits, and whole grains. It’s well known that obesity is linked with a higher risk of developing some cancers. It’s also linked with breast cancer recurrence, and it might be related to the recurrence of other types of cancer, too. Exercise can help you get to and stay at a healthy weight.

Cancer and fatigue

Most people with cancer notice that they have a lot less energy. During chemotherapy and radiation, most patients have fatigue. Fatigue is when your body and brain feel tired. This tiredness does not get better with rest. For many, fatigue is severe and limits their activity. But inactivity leads to muscle wasting and loss of function.

An aerobic training program can help break this cycle. In research studies, regular exercise has been linked to reduced fatigue. It’s also linked to being able to do normal daily activities without major problems. An aerobic exercise program can be prescribed as treatment for fatigue in cancer patients. Talk with your doctor about this.

Tips to reduce fatigue:

• Set up a daily routine that lets you be active when you feel your best.
• Get regular, light-to-moderate intensity exercise.
• Get fresh air.
• Unless you are told otherwise, eat a balanced diet that includes protein (meat, milk, eggs, and legumes such as peas or beans).
• Drink about 8 to 10 glasses of water a day unless your doctor tells you not to. Even more fluids are needed to prevent dehydration if you’re exercising
• intensely, sweating, or in a hot environment.
• Control your symptoms, like pain, nausea, or depression.
• Keep things you use often within easy reach to save energy.
• Enjoy your hobbies and other activities that give you pleasure.
• Use relaxation and visualization techniques to reduce stress.
• Balance activity with rest that does not interfere with nighttime sleep.
• Ask for help when you need it.

To make your exercise effort most effective (give you the best results), it’s important that you work your heart. Notice your heart rate, your breathing, and how tired your muscles get. If you get short of breath or very tired, rest for a few seconds, and start exercising again as you are able. When you first start, the goal is to exercise for at least 10 minutes at a time. Go slow at first, and over the next few weeks, increase the length of time you exercise. Be careful if you’re taking blood pressure medicine that controls your heart rate. Your heart rate will not go up, but your blood pressure can get high. Ask your doctor, nurse, or pharmacist about this if you’re not sure about your medicines.

Scientists don’t know the best level of exercise for someone with cancer. The goal is to have your exercise program help you keep up your muscle strength and keep you able to do the things you want and need to do. The more you exercise, the better you’ll be able to exercise and function. But even if planned exercise stops, it’s good to keep being active by doing your normal activities as much as you can.

• Eat vegetables. Studies have shown that eating more vegetables is linked to keeping brain power as people age.
• Set up and follow routines. Try to keep the same daily schedule.
• Pick a certain place for commonly lost objects (like keys) and put them there each time.
• Don’t try to multi-task. Focus on one thing at a time.
• Ask for help when you need it. Friends and loved ones can help with daily tasks to cut down on distractions and help you save mental energy.
• Track your memory problems. Keep a diary of when you notice problems and what’s going on at the time. Medicines taken, time of day, and the situation you’re in might help you figure out what affects your memory. Keeping track of when the problems are most noticeable can also help you prepare. You’ll know to avoid planning important conversations or appointments during those times. This record will also be useful when you talk with your doctor about these problems.
• Try not to focus on how much these symptoms bother you. Accepting the problem will help you deal with it. As many patients have noted, being able to laugh about things you can’t control can help you cope. And remember, you probably notice your problems much more than others do. Sometimes we all have to laugh about forgetting to take the grocery list with us to the store.

Reduce Stress

You can’t control everything in life. But you can control how you react to life’s stresses. Set aside about 5 to 10 minutes a day, if possible, to practice one or more of these relaxation exercises.

Connect with Your Body’s Relaxation Response

1. Lie comfortably on your back or find a comfortable and quiet place to sit.
2. Close your eyes and breathe gently and naturally through your nose.
3. Relax all your muscles, starting at your toes and moving up to the top of your head.
4. Focus on your breathing.
5. Continue for 5 to 20 minutes.
6. When you are done, sit quietly for several minutes, at first with your eyes closed and then with your eyes open. Wait a few minutes before standing up.

Practice Deep Conscious Breathing

1. Find a comfortable and quiet place to sit or lie down.
2. Relax your face, jaw, neck, and shoulders. Gently place one hand on your chest and the other hand on your belly button.
3. As you breathe in, allow the breath to expand your belly, chest, and lungs. As you breathe out, gently press your hands against your chest and belly to let out more air.
4. Focus on steady breathing.
5. Take your time.

Try Progressive Muscle Relaxation

1. Plan to take about 15 minutes to do the exercise.
2. Find a quiet place where no one will disturb you.
3. First, apply muscle tension to a specific part of the body. Take a slow, deep breath and squeeze the muscles as hard as you can for about 5 seconds.
4. After about 5 seconds, quickly relax the tensed muscles. Exhale as you let all the tightness flow out of the tensed muscles. The muscles should feel loose as you relax them. It’s very important for you to notice and focus on the difference between the tension and relaxation.
5. Stay relaxed for about 15 seconds, and then do the same thing for the next muscle group. Once you’ve gone through all of the muscle groups, take a moment to enjoy the relaxation.

Tell others

Another thing you can do to better manage chemo brain is tell family, friends, and your cancer care team about it. Let them know what you’re going through. You may feel relieved once you tell people about the problems you sometimes have with your memory or thinking.

• Talk with your employer if you are having problems at work. Discuss ways your employer could support you, such as changing your workload or deadlines.

You’re not stupid or crazy – chemo brain is a side effect you can learn to manage. Even though this isn’t a change that’s easy to see, like hair loss or skin changes, your family and friends might have noticed some things and may even have some helpful suggestions. For instance, your partner might notice that when you’re rushed, you have more trouble finding things.

Tell your friends and family members what they can do to help. Their support and understanding can help you relax and make it easier for you to focus and process information.

Managing Emotions

Cancer disrupts so many parts of a person’s life, from relationships to work and hobbies. Depending on the seriousness of the illness and the chance of recovery, it may also force you to make changes to your future and deal with the chance of dying. During this time, you may experience many different emotions, such as:

• Sadness
• Anxiety
• Loneliness or a sense of being different from others
• Fear
• Anger
• Frustration
• Guilt
• Feeling out of control
• A change in the way you think about yourself and the future.

However, many people with cancer have also reported positive changes, including:

• Appreciation for the strength of their bodies
• Peace
• Gratitude
• New important relationships with caregivers and other patients
• Awareness and appreciation that life is short and special
• A shift in priorities
• Clarity about meaning in life and personal goals.

Coping with anger

In general, people consider anger to be bad. But, like any other emotion, it is something people just need to feel sometimes. Many people living with cancer feel guilty for being angry or simply don’t know how to express their feelings. As a result, the person may keep his or her feelings inside. Some people try to cope with anger by abusing alcohol and drugs. Others express their anger in ways that put both themselves and others at risk of harm. Continued anger and not feeling able to express it in healthy ways can lead to depression. Although depression is more common among people with cancer, it should not be considered a normal part of living with cancer. Learn more about the signs and symptoms of depression and how to find help.

When expressed in a safe, positive way, anger can help you change things for the better. For example, anger about cancer may provide a person with the energy and strength needed to overcome the challenges of treatment.

Healthy ways to express anger

The best way to deal with anger is to identify it and find a healthy way to express it. Consider the following tips when you find yourself feeling angry:

• Recognize your anger. Sometimes people act on their anger before they fully know that they are struggling with the emotion.
• Avoid taking out your anger on others. Direct your anger at the cause of the feelings, rather than other people.
• Don’t let anger mask other feelings. People sometimes use anger to hide painful feelings that are difficult or uncomfortable to express, such as sadness or hopelessness.
• Don’t wait for anger to build up. Express your feelings as soon as you recognize them. If you hold them in, you are more likely to express anger in an unhealthy way.
• Find a safe way to express your anger. You can express and release your anger in a number of healthy ways, including:
  • Discussing the reasons for your anger with a trusted family member or friend
  • Doing a physical activity while feeling your anger at its full intensity
  • Beating on a pillow with your fists or a plastic bat
  • Yelling out loud in a car or private room
  • Exploring therapies, such as massage, relaxation techniques, or music or art therapy

Consider counseling

If you find it hard to manage and express your anger in healthy ways, you could benefit from counseling, either one-on-one or in a group setting. A mental health counselor can help you identify what triggers your anger, avoid destructive responses, find healthy ways to express your feelings, and learn valuable coping skills. A counselor can also help evaluate whether chronic anger is contributing to clinical depression and help you address other related problems such as addiction and relationship issues.

Depression treatment

People with depression usually benefit from specialized treatment. For people with moderate or severe depression, a combination of psychological treatment and medication is often the most effective approach. For some people with mild depression, talking with a mental health professional may be enough to alleviate the depressive symptoms.

Psychological treatment. Mental health professionals include licensed counselors, psychologists, and psychiatrists. They provide tools to improve coping skills, develop a support system, and reshape negative thoughts. Options include individual therapy, couples or family therapy, and group therapy. Additionally, psychiatrists are the mental health professionals who can prescribe medications (see below) and evaluate medical causes of depression.

Medications. Different types of antidepressant medications are available. Your doctor will select the most appropriate antidepressant based on these factors:

• Your needs
• Potential side effects
• Other medications you take
• Your medical history

Tell your doctor about all cancer-related medications and supplements you take. Some may interfere with types of antidepressants.

Some people experience improvement 2 weeks after starting an antidepressant medication. However, it often takes up to 6 to 8 weeks for the medication to have full effect.

Medication may not sufficiently treat depression unless it is combined with psychological treatment.

Follow-up

After a referral to a mental health professional, your oncologist will likely follow up with you about your treatment’s effectiveness and side effects.

If depression symptoms have not decreased after 8 weeks of treatment:

• Consider other treatment options
• Consider adding counseling to your treatment plan, if you haven’t already

You and your doctor can address these options earlier, if necessary.

Coping with guilt

Although feelings of guilt are common, it is not healthy to dwell on them. Feeling very guilty about events outside of your control and the inability to let go of guilt can lead to depression. Although depression is more common among people with cancer, it should not be considered a normal part of living with cancer. Learn more about the signs and symptoms of depression and how to find help.

Letting go of guilt

• Letting go of guilt can help improve your well-being and your ability to cope with cancer. To reduce guilty feelings:
• Remember that cancer is not your fault—or anyone else’s. Experts do not fully understand why most types of cancer develop. Sometimes people with cancer feel guilty about specific lifestyle choices they made, such as cigarette smoking. But it is important to let go of any mistakes you think you made in the past and to forgive yourself and others.
• Know that your feelings of guilt will come and go. Just like all difficult emotions triggered by a diagnosis of cancer, your feelings of guilt will change over time.
• Share your feelings. Talk about the guilt you are feeling with someone you trust or with a counselor or social worker. Learn more about the benefits of counseling and how an oncology social worker can help.
• Join a support group. It helps most people to know that others have been in their situation and have experienced similar feelings of guilt. Learn more about support groups and how to find the right one for you. Also read about online communities for support.
• Focus on positive things in your life for which you are thankful. Find activities that are soothing or help you relax. Do things that you enjoy, such as seeing a friend or watching a funny movie. Read more about coping with cancer through humor.
• Find other healthy ways to express your emotions. Consider expressing how you feel through creative activities you enjoy, such as music or art. Or write down your thoughts and feelings in a journal. Learn more about finding comfort through journaling.

Coping with self-image changes

You may view yourself and your body differently after cancer. These tips may help you cope:

• Allow time to adjust. Accepting a cancer diagnosis and undergoing treatment may change your life. It takes time to adapt so treat yourself with compassion and kindness.
• Talk with others who have been in similar situations. Many times, having one-on-one conversations or attending support groups with people who have been in the same situation can provide understanding and hope.
• Build a network of friends and family who can support you and help you feel positive.
• Ask for and accept help. Pass off tasks that take up your energy and aren’t pleasing to you. Asking friends to babysit, hiring a housekeeper, or buying prepared meals helps free up time to focus on healing.
• Stay calm and, if you are able, embrace humor. Laughter has many positive effects on the mind and body. And it may help you relax during an uncomfortable time.
• Let your health care team know your worries and concerns. For instance, if you are worried about losing your hair during treatment, you may consider cutting it very short or even shaving it. Taking control over the process may help you feel less scared.
• As much as possible, remain active. Physical activity creates energy and may help you feel better during treatment. Social activities can also help you focus on something other than cancer.
• Seek counseling if you need professional support. A professional can help you cope with and understand confusing feelings and deal with physical changes.

Coping With Uncertainty

Many people with cancer may feel a lack of certainty about what the future holds. After a cancer diagnosis, you may feel that your life is less secure than it once was. It is important to ask for support when you are feeling this way. Talk with your health care team about the resources available to help you.

Causes of uncertainty

Both newly diagnosed patients and long-term survivors have common worries:

• Having to put plans on hold. You may feel like you are unable to look to the future. Making plans is difficult for many practical reasons. For instance, it can be hard to plan a family vacation when you may not know exactly when you will have treatment. You may not be able to commit to a lunch date because you cannot predict how you will be feeling. Some people feel unable to make any plans. One approach that works well for many people with cancer is to remain flexible and accept that plans may change.
• Fear about cancer treatment and side effects. You may be apprehensive or scared of the possible side effects of treatment, such as pain, nausea, or fatigue. Or you may fear becoming dependent on others during cancer treatment or missing activities that you enjoy. Learn more about coping with the fear of treatment side effects.
• Long-term cancer survivors may worry about having late effects. These are side effects of cancer treatment that occur months or years after treatment ends. Talk with your health care team about possible late effects and how they can be managed. There are resources available if you need help.
• The treatment won’t work. No treatment works the same for every patient, even those with the same type of cancer. Some treatments are more effective for some people. Other treatments may work but cause side effects. Understanding what your treatment options are today and in the future may help you know what to expect next.
• The treatment will stop working. Many times, people continue to receive a treatment until it stops working. This is especially true for those with cancer that has spread or those with cancer that is controlled with drugs for a long time. It is scary to think the drug could stop working, even if you know that there are other treatments you can take.
• The cancer will come back. A cancer recurrence is when the cancer returns after treatment. It is a top fear of many cancer survivors. If you worry about this, you may find yourself paying attention to every potential symptom you have. In turn, this can increase your general level of anxiety. Learn more about coping with the fear of recurrence.
• Fear of dying or losing someone you love. Confronting the idea of dying can be difficult. Feeling fear is natural when you face the prospect of dying or losing someone you love. It’s normal to struggle with a fear of death. Yet, if these feelings become severe, talk with your health care team about resources to help you cope.

Dealing with the “what ifs” of cancer

• Acknowledging the unknowns of cancer may make you feel anxious, angry, sad, or afraid. You may even have physical symptoms from these feelings. For instance, it may interrupt sleep or make it harder to concentrate at work. Learning to manage the uncertainty is an important part of staying healthy. These tips may help you cope:
• Recognize that there are situations you can control and those you can’t. As hard as it sounds, many people find it helpful to let go of those things that they can’t change and focus on their reaction to events.
• Talk with your health care team if your feelings of uncertainty are affecting your daily life. They can help you find the resources you need to feel better.
• Talk with a counselor or social worker at the hospital. They may recommend a support group in your area. A group may help you share with others who are going through a similar cancer experience. There are also support communities online.
• Talk with friends and family members. Tell them how you are feeling and how they can help.
• Learn as much as you can about the cancer and its treatment. Having the right information can help you know what to expect.

Managing Stress

A disease such as cancer is often one of the most stressful experiences of a person’s life. Coping with cancer can be more challenging with added stress from work, family, or financial concerns. Usual, everyday stress can also make coping with a cancer diagnosis more difficult.

Stress has not been shown to cause cancer. But chronic stress may weaken the immune system, causing other health problems and decreasing feelings of well-being.

Tips for reducing stress

“Stressors” are sources of stress. Some stressors are predictable and, therefore, sometimes avoidable. You can often lower the amount of stress in your life by making small changes. Consider the following tips for reducing stress:

• Avoid scheduling conflicts. Use a day planner or your phone or online calendar to keep track of appointments and activities. When you schedule activities, allow plenty of time to finish 1 activity before starting the next. Don’t schedule too many activities for the same day or week, especially activities you need to prepare for. If managing your schedule is exhausting, ask someone you trust to help review your appointments.
• Be aware of your limits. If you don’t have the time, energy, or interest, it’s ok to politely decline when people ask you to take on tasks. And, don’t feel guilty over saying no. A cancer diagnosis is life-changing, and focusing on the things that matter most makes good sense. At work, don’t volunteer for projects that would make your workload unmanageable. If saying “no” feels difficult, tell the person asking what you can do instead. This could be doing a smaller part of the task or having more time to complete the task.
• Ask for help. It’s also good sense to ask family, friends, and coworkers for help. People are likely to offer their support, so think about particular tasks you need help with beforehand. People appreciate being able to help in specific ways. For example, family or friends may be able to help with shopping, meal preparations, pet-sitting, or picking up a child from school.
• Prioritize your tasks. Make a list of the things you routinely do, such as work and household chores. Rank these things by importance, considering the things you must do and the things that are most important to you. If you don’t have time to do everything, concentrate on the tasks and activities at the top of your list.
• Break down tasks into smaller steps. Sometimes large tasks can be accomplished in smaller steps to take on 1 at a time. This process can make seemingly overwhelming problems easier to handle. For example, instead of spending an afternoon cleaning your entire house, tackle 1 or 2 rooms each day.
• Concentrate your efforts on things you can control. A stressor may be something you cannot change or control, even with the best planning. Traffic is one example. People who can remain flexible keep their stress low. Sometimes the only aspect of a problem you can control is how you react to it. If it helps, think of it as saving your energy to spend on things more important to you.
• Get help with financial problems. Talk with an oncology social worker or a financial advisor familiar with cancer-related insurance and financial matters. Do not wait to seek financial help. Late bills and debt can quickly become overwhelming. Learn more about managing the cost of cancer care.

Stress management strategies

Although you can try to reduce the number of stressors in your life, you can’t completely avoid stress. However, stress management strategies can help you feel more relaxed and less anxious. The following are tips to help reduce stress:

• Exercise regularly. Moderate exercise such as a 30-minute walk several times a week can help lower stress. Talk with your doctor before starting an exercise schedule. Learn suggestions and tips for physical activity.
• Spend time outside. If possible, take a walk outside in a park or other natural setting. Sunlight, fresh air, and the sounds of nature can help brighten a person’s day.
• Schedule social activities. Make time to socialize with family or friends, as it is a good way to reduce stress.
• Eat well. Maintaining a healthy diet and getting enough rest will give you more energy to deal with daily stressors. Learn more about nutrition during treatment.
• Get plenty of sleep. Life is busy and some people may think that sleep is indulgent. But sleep is essential to help the body stay healthy and heal. Try to get 7 or more hours of sleep each night. Naps during the day can also help. If you are having difficulty sleeping, talk with your health care team about ways to manage sleeping problems.
• Join a support group. Support groups offer you the chance to talk about your feelings and fears with others who share and understand your experiences. You can also talk with a trusted friend, a counselor, or a social worker. Learn more about support groups.
• Schedule daily relaxing time. Spend time doing an activity you find relaxing, such as reading a book, gardening, or listening to music.
• Do things you enjoy. Eat at your favorite restaurant, or watch your favorite television show. Laughter reduces stress; see a funny movie or read a humorous book.
• Write in a journal. Writing about the stresses and events in your life provides a private way to express your feelings. Learn more about the power of writing.
• Learn a new hobby. Engaging in a new and challenging activity gives you a sense of accomplishment and provides distraction from daily worries. Examples include taking an art class or playing a musical instrument.

Relaxation techniques

Many people learn and practice relaxation techniques to lower stress. You can learn most of them in a few sessions with a counselor. And, many hospitals and cancer centers have classes to teach patients relaxation techniques. You can do these techniques daily or at specific stressful times, such as during a medical procedure.

• Relaxed or deep breathing. This technique involves deep, slow breathing while concentrating on filling the lungs and relaxing muscles.
• Mental imagery or visualization. This helps you create peaceful and relaxing images in your mind.
• Progressive muscle relaxation. This technique involves tightening and then relaxing muscles. Most people start at either the toes or the head and progressively relax all the muscles across the body.
• Meditation. With this technique, you can learn to relax your mind and concentrate on an inner sense of calm.
• Biofeedback. This technique can teach you to relax and control your body’s response to stress by paying attention to signals from the body.
• Yoga. Yoga focuses the mind on breathing and posture to promote relaxation and reduce fatigue.

Treatment types to cope with anxiety

There are a variety of ways to cope with anxiety. Many are used together. Talk with your doctor or a professional counselor to find the best options for you.

Relaxation techniques. Relaxation techniques may be used alone or to supplement other types of treatment. Some of the following methods may be done with little guidance. Others may require the help of an instructor.

• Deep breathing
• Progressive muscle relaxation. This is a technique that involves tightening and then relaxing muscles. You begin at the toes or the head and progressively relax the muscles across the body.
• Guided imagery. This is the use of words and sounds to help you imagine positive settings, experiences, and feelings.
• Meditation. This is a practice of focusing attention in one direction to achieve a sense of grounding in the present moment and reduce stress.
• Hypnosis
• Biofeedback. This involves paying attention to and controlling signals from the body, such as heart rate. Signals from the body are measured with painless electrical sensors, called electrodes.
• Yoga. This is the use of breathing and posture exercises to promote relaxation.

Psychological Treatment. Mental health professionals include licensed counselors, psychologists, and psychiatrists. They provide tools to improve coping skills, develop a support system, and reshape negative thoughts. Options include individual therapy, couples or family therapy, and group therapy. Additionally, psychiatrists are the mental health professionals who can prescribe medications (see below).

Medication. If your anxiety symptoms are moderate to severe, you may benefit from medication. Different types of medications are available. Your doctor will select the most appropriate medication based on these factors:

• Your needs
• Potential side effects
• Other medications you take
• Your medical history

Tell your doctor about all cancer-related medications and supplements you take. Some may interfere with types of anti-anxiety medications.

Some people experience improvement 2 weeks after starting medication. However, it often takes up to 6 to 8 weeks for the medication to have full effect.

Medication may not sufficiently treat anxiety unless it is combined with psychological treatment.

Follow-up

After a referral to a mental health professional, your oncologist will likely want to talk with you about your treatment’s effectiveness and side effects.

If anxiety symptoms have not decreased after 8 weeks of treatment:

• Consider other treatment options, such as trying medication or switching to a different type of medication
• Consider adding counseling to your treatment plan, if you haven’t already

You and your doctor can address these options earlier, if necessary.

Coping with your fears

The following suggestions can help you cope with the fear of treatment-related side effects:

• Remember that the long-term goal of treatment is to help you, not hurt you.
• Know that many cancer treatments used today are less intense and take less time than previous treatments.
• You can often manage side effects with medication. And most side effects go away after treatment.
• Ask your doctor, nurse, or pharmacist about managing the common side effects for each treatment. Often, many side effects can be anticipated and/or prevented before treatment starts.
• Ask your social worker for counseling or referrals to community support partners.
• Ask how to reach the doctor’s office after hours and for a list of symptoms that may require immediate care.
• Stay involved in your care and express your thoughts in the treatment decision-making process.
• Learn how you can preserve fertility, and ask your doctor about seeing a fertility specialist before treatment begins.
• Talk with your family and loved ones about your expectations and concerns. Their support can ease your fears about experiencing side effects from treatment.
• Find others who have recently gone through the same treatments. You may find support groups in your local community or online. It can help to talk with others and know that you are not alone. But remember that each person’s experiences with side effects may be different from your own.
• Talk with your employer about what you will be going through. Discuss adjusting your schedule while you undergo treatment. Learn more about going back to work after cancer.
• Stay focused on the present. Dwelling on things that may or may not happen will only worsen negative feelings.
• Keep a journal to record your feelings and your experiences.
• Try relaxing techniques, such as deep breathing, music, yoga, and meditation. When you are less anxious, you can focus better and make more educated decisions.
• Give yourself time to grieve physical losses and adjust to your new body.

Coping with Grief

Grieving the death of a person close to you often involves very painful feelings. Waves of grief may come and go over months or years. Sometimes, it may feel like the pain will never end. But most people find that over the course of a year or more the intensity of grief lessens. As hard as it may seem, people find ways to adjust to life without the person they loved and lost. Although working through grief can be a long and difficult process, there are things you can do to help yourself heal.

Ways to cope with loss

Just as each person’s experience of grief is unique, coping strategies work differently for each person. It may help to think about how you’ve coped with difficult situations in the past and use similar strategies. Here are some tips for coping with loss:

• Allow yourself to experience the pain of loss. As much as it hurts, it is natural and normal to grieve. Sometimes people feel guilty about the way they feel, thinking they should “get over it.” Let yourself grieve and fully experience the feelings of grief, such as shock, sadness, anger, and loneliness. Don’t judge yourself for having feelings that seem wrong. Let yourself react in ways that help you process and release intense emotions, even if it means crying or screaming. Some people set aside private time every day to think about their loved one and experience the feelings that arise. This approach is especially helpful for those who have difficulty showing their feelings to others.
• Talk with others. Talking about your loss and sadness with others may help you process and release your feelings. Let family and friends know how important it is for you to share your feelings with them. Reassure them that you don’t expect them to have answers, you just need them to listen.
• Find creative outlets. Consider expressing your feelings through creative activities you enjoy, such as music or art. Or, write your thoughts, feelings, and memories in a journal. Looking back through your journal will allow you to see how your grief changes over time.
• Engage in physical activity. Find a physical activity—such as walking, running, or riding a bicycle—to help you cope with your feelings. Exercise and activities like hitting a punching bag or hitting golf balls at a driving range may help release frustration or anger.
• Give yourself a break from grieving. It is important to take breaks from grieving with pleasant activities and interactions with supportive family members and friends. For example, you may choose to go to dinner with friends, take a relaxing bath, watch a movie, start a new hobby, or enjoy the outdoors. Remember that it is good for you to enjoy yourself. It is okay to laugh and feel happy, despite your loss.
• Maintain a routine. Keeping a basic routine of daily activities helps you structure your time and keeps you connected to familiar people and places. If possible, avoid making major decisions, such as changing jobs or moving within the first year after a loss. This will help you maintain a sense of normalcy and security and lessen additional stress.
• Forgive yourself. Forgive yourself for the things you regret doing or saying to your loved one. Also forgive yourself for the things you regret not doing or saying. Letting go of regrets and the pain that comes with them will allow you to focus on the good memories.
• Be patient. Allow your grief to unfold at a pace that is natural for you. Don’t judge or criticize yourself for not coping as well or healing as quickly as you think you should. Each person needs to grieve in ways that feel right.
• Take care of yourself. It is important to attend to your physical needs during the period after a loss. Grieving is both emotionally and physically exhausting. Care for yourself by trying to get enough sleep at night, eating a healthy diet, and exercising.
• Join a support group. Support groups offer you the chance to talk with others who have similar experiences. Group members can offer encouragement, comfort, guidance, and practical suggestions. And, they can reassure you that your experiences are normal. You may want to join a general loss support group. Or, you may prefer a group that is specific to your situation, such as a group for those who have lost a spouse to cancer.

Seeking additional support

Many people find counseling and therapy helpful when coping with grief.

Grief counseling

Most of the support that people receive after a loss comes from family and friends. Sometimes a person’s grief may be so severe that it interferes with their ability to perform daily responsibilities. If you feel that you need more help coping with your grief, you may want to talk with a counselor. A counselor can help people work through the grief process in a one-on-one or group setting.

Grief therapy

Grief therapy is for people who have extreme or complicated grief. A person with complicated grief is often unable to work through their grief without help.

The following are four common types of complicated grief:

• Exaggerated grief. Grief reactions are extreme and overwhelming. And, they may worsen over time.
• Chronic grief. Feelings of intense grief continue and do not improve over time.
• Masked grief. Grief reactions are absent or indirect, taking the form of an illness or abnormal behavior.
• Delayed grief. Grief reactions are triggered months or years later by another loss or distressing event, rather than at the time of the initial loss.

Grief therapy can help a person understand why he or she is having a difficult time coping with the loss. It can also help a person identify barriers that are preventing him or her from resolving the grief. A mental health professional, such as a psychologist or clinical social worker, provides grief therapy in an individual or group setting.

Because each person grieves differently, decisions about the need for grief therapy are made on a case-by-case basis. However, the following signs suggest that you may need additional help coping with your grief:

• Ongoing difficulty with eating
• Difficulty sleeping
• Inability to work or complete regular daily activities six months after your loss
• Inability to care for yourself
• Feelings of worthlessness
• Thoughts of suicide

Finding help

To find help dealing with grief, start by talking with your primary health care provider. He or she can help you determine the type of support that will work best and can often provide a referral. You can also check with a local hospital or cancer treatment center, a community hospice service, your health insurance company, or your employer’s employee assistance program.

Coping with Metastatic Cancer

To understand your situation, you may want to get a second opinion. Many people find that it helps to get an opinion from another oncologist, and many doctors encourage it.

Your doctor can help you cope with cancer symptoms and treatment side effects. For example, if you have pain, your treatment might include surgery to remove a tumor in a painful area. Your doctor might also prescribe pain medication or anti-nausea medication.

Deal with emotions and lifestyle changes

Coping with emotions and lifestyle challenges is an important part of living with metastatic cancer. Ways of coping include:

• Learning about the metastasis—You might want to know everything possible, or just basic information.
• Talking with a counselor about your situation – For example, a psychologist, psychiatrist, or oncology social worker.
• Managing stress—From planning ahead to trying meditation and yoga, there are many options to help lower your stress level.
• Finding meaning—Talking with a hospital chaplain, a counselor, or your religious leader can help.

Recognize your feelings and concerns

Talking about fears and concerns is important, even when treatment is working well. Tell your doctor and health care team about emotional symptoms. People may live for years with metastatic cancer. Your doctor can help you have the best quality of life possible during this time. Hospitals and medical centers have many resources for you and your family.

Family members need help, too

Your loved ones might also need help coping. Having a family member or friend with metastatic cancer is challenging, especially for people who help care for you. They can try the ways of coping above. Your doctor and health care team can suggest more help for family members. For example, support groups for family members meet in person and online.

Alternative medicine

No alternative treatments have been found to prevent or cure chemo brain. If you’re interested in trying alternative treatments for your symptoms, discuss the risks and benefits with your doctor.

Alternative treatments for other types of memory problems are also touted as helpful for chemo brain, such as:

• Ginkgo. Supplements containing ginkgo leaves have shown some promise in treating age-related memory changes in older adults, but more study is needed. Ginkgo supplements are generally safe, but they can interfere with some common medications, including blood thinners. Talk to your doctor before beginning ginkgo supplements.
• Vitamin E. Vitamin E may be beneficial for brain cells, but more study is needed. Vitamin E supplements are generally safe when taken in recommended doses, but they can interfere with common medications, including blood thinners and chemotherapy drugs. It may be easier and safer to choose foods that are high in vitamin E, such as vegetable oils and eggs.

Coping and support

Chemo brain symptoms can be frustrating and debilitating. With time, you’ll find ways to adapt so that concentration will become easier and memory problems may fade. Until then, there are ways to cope. Try to:

• Understand that memory problems happen to everyone. Despite your best strategies for dealing with your memory changes, you’ll still have the occasional lapse. It happens to everyone. While you may have little control over the cancer-treatment-related memory changes, you can control other causes of memory lapses that are common to everyone, such as being overly tired, distracted or disorganized.
• Take time each day to relax. Stress can contribute to memory and concentration problems. Devote time each day to stress-relief activities, such as exercise, listening to music, meditation or writing in a journal.
• Be honest with others about your symptoms. Be open and honest with the people who are close to you about your chemo brain symptoms. Explain your symptoms and also suggest ways friends and family can help. For instance, you might ask a friend to remind you of plans by both phone and email.

Cognitive problems in children

Young children (age 5 and younger) are more likely to have long-term cognitive problems. These cognitive problems can occur months or years after treatment ends and can continue into adulthood. The following treatments are more likely to cause cognitive problems:

• Radiation therapy directed at the head, neck, or spinal cord
• Total body radiation
• Chemotherapy delivered directly into the spine or brain

Some of the possible cognitive problems include:

• Decreased overall intelligence
• Learning disabilities
• Decreased attention span and attention deficit disorders
• Delayed development, including delayed social, emotional, and behavioral development
• Lower academic achievement, especially in reading, language, and math
• Decreased ability to understand language or to put thoughts together in a way that makes sense
• Decreased nonverbal and verbal memory skills

There are many ways to manage cognitive problems for children. These may include occupational therapy, speech therapy, behavior therapy, social skills training, cognitive rehabilitation, and medications for attention deficit disorders. Some children may need to change how they learn in school or pay attention.

Additional in-school options such as specialized reading and math instruction and special education programs are also helpful. Because early intervention seems to offer the most benefit, parents must be aware of possible cognitive problems. They should talk with their child’s health care team as soon as they suspect a problem.

1. Chemo Brain. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/changes-in-mood-or-thinking/chemo-brain.html[↩]
2. Wefel JS, Vardy J, Ahles T, et al.: International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 12 (7): 703-8, 2011. http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70294-1/fulltext[↩]
3. Hodgson KD, Hutchinson AD, Wilson CJ, et al.: A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer Treat Rev 39 (3): 297-304, 2013. http://www.cancertreatmentreviews.com/article/S0305-7372(12)00219-8/fulltext[↩][↩]