Tips for Managing Chemobrain

00:00:00:00 – 00:00:25:08
Unknown
McClellan I’m H. McClellan. I’m the cervical cancer coordinator at Share. Before the presentation begins, I’d like to tell you a little bit about share. Share is a national nonprofit that supports, educates and empowers anyone who’s been diagnosed with breast or gynecologic cancers and provides outreach to the general public about signs and symptoms. Because no one should have to face breast, ovarian, uterine, cervical or metastatic breast cancer alone.

00:00:25:10 – 00:00:49:16
Unknown
For more information about upcoming webinars, support groups and our help lines, please visit our website at Share Cancer Support dot org. All participants will be muted during the presentation. Once Dennis finishes presenting, we’ll begin the Q&A discussion. Feel free to ask any questions through the Q&A section at the bottom of your screen. Remember that Dennis cannot give specific medical advice, so please keep your questions general in nature.

00:00:49:18 – 00:01:22:01
Unknown
We also have closed captioning available. You can enable this feature by clicking the live transcript button at the bottom of the screen and selecting the subtitle option. This webinar is being recorded and will be available on the Share website soon. Before we begin, I would like to start with two quick questions for our audience.

00:01:22:03 – 00:01:57:08
Unknown
Are you aware of strategies that can help manage chemo? Brain Not at all aware. Slightly aware. Moderately aware. Very aware. Extremely aware. Two Chemo brain affects my daily life and activities. Strongly agree. Disagree. Neither agree or disagree. Agree or strongly agree. Okay. So it looks like the majority of you are slightly aware and some at well, pretty close.

00:01:57:09 – 00:02:22:16
Unknown
Not at all aware. And in terms of chemo brain affecting your daily life and activities, it looks like the large majority say yes, it does affect their daily life and activities. Now, I’d like to hand it over to today’s speaker to introduce himself.

00:02:22:17 – 00:02:46:19
Unknown
You’re on mute. Hey, guys, My name is Dennis. I really appreciate you guys having me here. And I’m hoping that this presentation is going to be very helpful for you. I work at a major cancer center in Southern California, and for this particular topic, I actually do treat a lot of patients on the outpatient side who come in with complaints of chemo brain.

00:02:46:21 – 00:03:09:18
Unknown
Their doctors referred me to them, and I’ve been working with these types of patients for the last several years and just helping them manage these symptoms or to see symptoms and ultimately help them accomplish their goals. So I’ll go ahead and begin my presentation.

00:03:09:20 – 00:03:39:19
Unknown
Okay. So yeah, tips for managing chemo brain I’ll be going over is just a little bit about what is sharing outside. Just to double check out. Does everyone see that presentation? No. Okay.

00:03:39:21 – 00:04:08:01
Unknown
Okay. Sorry about that. So just to go over again. Yeah, I’ll be going over just what? Chemo brain is. You know what the impacts entail some strategies to manage chemo brain and just to kind of approaches to hopefully help you better live your life with it. So I’m sure you guys use this term chemo brain or chemo fog interchangeably when you share some of the lapses or the different kind of impacts it has on your life you’re sharing with your family.

00:04:08:02 – 00:04:32:00
Unknown
Maybe today I just feel like my chemo brain is really affecting me or I really feel foggy. But one thing I really want to emphasize is that it’s not just a symptom, it’s actually a real clinical symptom. And this is something that we as a medical professionals are aware of as a side effect of cancer, chemotherapy treatment. This is something that you can definitely bring up with your doctor.

00:04:32:00 – 00:04:51:05
Unknown
Many patients here at the hospital I work at bring up these side effects. Their doctors and their doctors guide them in terms of explaining to them what it is and how to address it, which is what I mentioned earlier, that they make a referral to an occupational therapist or someone else who can provide the support for addressing this issue.

00:04:51:07 – 00:05:21:14
Unknown
Within the medical field, we refer to this as chemotherapy induced cognitive impairment or cancer related cognitive impairment. And we mention those two things because these effects may actually present themselves even before someone is diagnosed, where the cancer itself can have an impact on on the person’s brain function and how they function in daily life. And then, of course, when a treatment is introduced, there’s a higher risk of experiencing these symptoms.

00:05:21:16 – 00:05:48:20
Unknown
So the cancer treatment itself, whether it be the surgical effects after surgery or other medications that are used to manage course complications, these may play a part in just this experience as well. So I do want to emphasize that this is a growing need as more and more people survive cancer with longer with cancer, you know, more and more people are actually reporting this as a as a big symptom.

00:05:48:22 – 00:06:21:15
Unknown
So as I mentioned earlier, some people actually experience some of these cognitive effects before treatment. So up to 40%, up to 75% experience difficulties during treatment. And some of you who may actually be have completed treatment, some people actually a lot of people report these symptoms persist for months or years after treatment. So, yeah, you know, I know many of you are coming in with a background of breast cancer, but this does affect every type of cancer.

00:06:21:17 – 00:06:55:05
Unknown
So as far as causes, don’t go too deeply into this, but I can generally say that we don’t fully understand why this happens, as there isn’t any one particular mechanism or one pinpointed answer. We do know that there is a constellation of symptoms that do impact how well your brain functions as you’re, again, going through treatment. So some of you, unfortunately, when you introduce your body to chemotherapy, it can really impact how well the brain functions in terms of how well brain cells work, how well they regenerate, how well they function in terms of their structure.

00:06:55:07 – 00:07:17:01
Unknown
And even the cancer itself can cause things like body inflammation or reduce oxygenation either to the or to spots. So and especially, as I said, with the background of breast cancer, the endocrine therapy treatment, the changes in hormone can have a huge impact in terms of how well the brain works. Other factors we consider would be things like age genetics.

00:07:17:01 – 00:07:40:12
Unknown
But the two things I really do want to go over today are the impact of depression and anxiety, as well as the different lifestyle factors that are impacted by cancer and chemotherapy. So some of the common complaints that you guys may may have shared with others or, you know, and this is kind of a compilation of the different types of things that patients do share with me.

00:07:40:12 – 00:08:07:11
Unknown
A lot of people will complain of work finding difficulties, that they have a hard time really expressing themselves in conversations. They forget where they’re going or there’s seems to be that always issue. If you walk into a room and you forget what you need to do there, or you forget why he needed to pick up. People also mentioned mental exhaustion or difficulty multitasking, decreased concentration of the task, or just a lot of trouble with with multitasking.

00:08:07:13 – 00:08:32:13
Unknown
And I do want to emphasize a lot of patients to really share with me the impact it has on their identity that really has a severe impact on their confidence. Feeling less confident, being able to do things at work or being able to perform roles with their family. And I really understand that this is something that when you don’t feel like the way you used to there, it’s just affects every part of your being.

00:08:32:13 – 00:08:55:14
Unknown
And there’s a sense of guilt, anger and frustration that I really try to help patients that are standing up. And this is a really hard thing to go through. And we understand it’s not easy. So as far as the different types of skills are impacted, just to be more specific, things like the ability to attend or concentrate on a task and verbal memory.

00:08:55:14 – 00:09:22:02
Unknown
If someone says something to you and you’re trying to remember, it just ends up being a lot harder for some reason to just really take it in visual memory. When you’re reading something, it’s harder to process what you’re reading or hard to remember later on what you read. Visual, spatial, for example, managing directions or managing procedures. So those are the kind of basic skills that are impacted by what I want to say is that what’s not impacted are things like open memory.

00:09:22:03 – 00:09:44:06
Unknown
So this is nothing like amnesia. A lot of people will ask me if, you know, there’s something concerning for stroke or Alzheimer’s or dementia, but I can safely tell them is that these things are actually two very different processes. So it’s not anything to do with dementia, It’s not anything to do with Alzheimer’s. It’s its own particular syndrome.

00:09:44:06 – 00:10:17:20
Unknown
And may try to alleviate people’s concerns or worries that this is something I think that would turn into something worse. So how do we address chemo brain? These are the four kind of major areas, and I always encourage patients to really take on different aspects of these areas when they helping them with their their sessions. So the first factor would be brain training and know a lot of people feel intuitively or naturally think if you train your brain enough that the skills will come back.

00:10:17:20 – 00:10:37:13
Unknown
But what I do want to say is there is some mixed evidence with that. So while brain exercises may help your brain be active, it doesn’t necessarily translate into real life skills. Unfortunately, the brain doesn’t work the same way as a muscle. If you were to go to the gym and you were to work out that muscle, that muscle would get stronger.

00:10:37:13 – 00:11:09:02
Unknown
But the brain is actually quite more complex, does a lot more different things. So what I can say about this is this doesn’t necessarily need to be the entire focus of trying to help you reduce symptoms. Rather, I think it’s good to just keep your brain active if you find something that a type of brain training activity that’s really relates to an activity that you do in everyday life, I think it’s good to use as a way of practicing a certain strategy, building your confidence and being able to do something more efficiently or faster.

00:11:09:02 – 00:11:39:12
Unknown
And that in of itself, I think helps with overall input performance. The next three approaches are what I actually do most with my patients, so I help them learn compensatory strategies such as learning how to use or implement calendars, alarms and reminders so that we don’t have to completely rely on their brain. And while that may seem like a simple solution, it’s actually the way you use it and how you use it and how consistently you use it, that ultimately leads to better results.

00:11:39:12 – 00:12:05:19
Unknown
I also tell them to create a supportive environment around them, to be able to tell their family members or people who work around them the kind of struggles that they have so that people are aware and they can actually support a much more better environment for them to work in the lifestyle management. There are actually a lot of healthy habits that support good brain health and it’s actually those things that have a much more direct impact on the brain.

00:12:05:21 – 00:12:28:23
Unknown
So some of those areas could be helping the person manage fatigue, helping them manage their pain and a big part would be helping manage stress to really reduce anxiety that comes with chemo brain. And ultimately I help people find different ways to still accomplish their goals. You know, a lot of people tell me this feels like a new normal, but that doesn’t necessarily mean that people can’t adapt.

00:12:29:00 – 00:12:47:15
Unknown
So as long as we have a clear goal in mind and we learn a different way to ultimately accomplish that goal, it may not be the same as what it used to be, but at the end of the day, if they feel like they’re still doing what they want to do just in a different way, that still leads to better quality of life.

00:12:47:17 – 00:13:17:14
Unknown
So I’ll be going over first with lifestyle management. So the main point of this slide is there’s a lot of different things that actually contribute to chemo brain. It’s a combination of these effects. So when I ask a patient kind of what is going on their lives, I think key and on the specific areas, because if any of these areas can actually be improved, you’ll see direct beneficial effects towards how well the brain function, how well the brain feels.

00:13:17:16 – 00:13:38:16
Unknown
So for example, some of the focal areas I tell people is, you know, if you’re feeling very inactive, I always encourage patients to start exercise more. I really want to highlight exercise as one of the main things that they can do, because a lot of people ask me, is there some sort of magic pill or magic procedure that can actually help reverse human brain?

00:13:38:16 – 00:14:03:07
Unknown
And fortunately, there isn’t. But of all the research that we’ve looked at, exercise actually has one of the most beneficial effects. I understand, especially with cancer treatment in the cancer itself, people may feel really inactive. They’re not doing the things that they would normally do to get up, move around or exercise, but starting to increase your level of exercise and being able to be more active, that actually has a lot of benefits towards the brain.

00:14:03:07 – 00:14:24:09
Unknown
So I’ll kind of go over that a little bit more in depth in our next slide. But as you can see, these are a lot of different types of helpful solutions or strategies that people can implement in their lives to ultimately reduce the symptom burden know their cancer. So, for example, as I mentioned, exercise, I think it’s a good goal.

00:14:24:13 – 00:14:57:19
Unknown
Like I said, just to start being more active. One of the best benefits with exercise is that it reduces fatigue. So imagine with the feet you have right now, if it gets better, if you’re able to have more energy to do things, that goes a long ways and being better able to focus or better able to remember. And in fact, exercise has a lot of direct physical benefits, such as improving circulation or managing mood and things like sleep hygiene, getting more consistent sleep routine.

00:14:57:19 – 00:15:17:07
Unknown
So that way you have better rest. So that way your brain has better rest. So I always encourage patients, you know, try to reduce some of the level of activity, have a wind down process before they go to sleep, try to avoid looking at their phones or looking at screens. So that way their brain doesn’t think that it’s still light outside and protecting their sleep environment.

00:15:17:07 – 00:15:39:23
Unknown
So that way, you know, sleep is the place where they sleep rather than doing a bunch of other things that would keep in mind active managing mood. That’s one of the biggest things I help with patients. And when someone’s anxious, someone is really distracted by the stresses in their life. That’s already a big piece of the pie that takes up their attention span.

00:15:40:01 – 00:16:08:04
Unknown
So what I tell people is that before they embark on any type of call, I think it’s really important for them to address any of those major stressors that cause impact impacting things like anxiety or depression. So I tell them, you know, doing things like having a consistent routine, a deep breathing meditation, doing journaling to take any scattered thoughts and putting it down on paper so that we can have as much control over you.

00:16:08:06 – 00:16:33:10
Unknown
Those are all really helpful things for reducing anxiety, especially when you’re trying to perform something and you’re distracted by anxiety, that distraction can become much less. Similarly, I also tell people, you know, if there’s things that you need to receive counseling for, that goes a long ways in terms of really, you know, reducing some of those mood symptoms, lifestyle balance.

00:16:33:12 – 00:16:54:11
Unknown
So one thing I want to say for the next slide would be, you know, I understand a lot of people, their their lives just revolve around their cancer and having to go to health care appointments. I think it’s good to kind of take a look and see, you know, when we see how we can balance lifestyle better, why don’t we have enough leisure enough rest times that way?

00:16:54:11 – 00:17:33:20
Unknown
Your life isn’t just completely controlled by your cancer. So I show this patient showing my patients this list, this little circle here, and we look work on ways to making sure that there’s a much better balance. And that ultimately leads to a better mood and a lot better rest for being able to manage everyday activities. So the other thing that is really helpful for patients is really helping them understand how their their memory works, how ultimately attention leads into memory, which leads them to being able to manage their daily functions.

00:17:33:23 – 00:18:07:08
Unknown
So this is a common hierarchy which once patients are better able to understand, they’re more aware of why their lapses occur, why they forget things. So, for example, if you’re already feeling very fatigued by having a long day or just by the side effects of treatment, you’re already functioning at a much lower level. You know, how can you expect to pay attention to something to be able to multitask and ultimately remember something from what you’re paying attention to if you’re already very tired?

00:18:07:08 – 00:18:26:05
Unknown
So like I said, exercise is really important to be able to better manage that fatigue, but also being able to control your environment. Know if you’re about to embark on a specific activity, maybe it’s better to do it when you have a lot more energy. Maybe it’s harder to do it when you have better sleep or you’ve been able to rest before.

00:18:26:05 – 00:18:53:22
Unknown
Really taxing yourself. So as you can see with these slides, there’s a lot of different types of things that go into forming a memory. How long can you sustain your attention for If you feel like you have a short attention span, maybe it’s best to kind of, again, pace yourself, take a break, ask for clarification before you zone out or start dreaming, daydreaming or again, you feel the distraction and anxiety.

00:18:53:22 – 00:19:15:16
Unknown
I think it’s really good to be much more in control of, you know, a conversation with a doctor or conversation with a family member by telling them, hey, I’m not I don’t have the best attention right now. Maybe we should slow things down. And if that helps and ultimately allows you to tend to that information, then you can take that information and store into your short term memory.

00:19:15:16 – 00:19:37:12
Unknown
Much more effectively, create a much more organized memories. That way you can actually stick much better to your long term memory. So I just want to go over that briefly, but just for the sake of time, I’ll go over some more different types of strategies that are helpful. So there are times where, of course, you feel time pressure managing, where you feel the clock ticking.

00:19:37:12 – 00:19:53:17
Unknown
I think it’s best to have this approach where you take a look at what are some of the anticipated challenges, what are some of the things that make you feel very anxious when you feel that time pressure and learn how to prioritize your time? So I’ll deal with a lot of patients is I’ll help them break down the task.

00:19:53:19 – 00:20:22:10
Unknown
I know what to prioritize. Priority hours, see what they can take out first so that way they can focus on one thing. So as a tip, I think it’s always good to kind of analyze the activity, figure out how things can be done better and have a much more stronger approach to going into to engaging in an activity As far as memory strategies go, we kind of differentiate between internal memory shows and external memory strategies.

00:20:22:12 – 00:20:45:17
Unknown
So what I’ve found to be most helpful with my patients is to really encourage things like mental imagery, creating diagrams and structure, because the main thing I want to emphasize is that while we have thoughts in mind, they tend to be scattered. They tend not to really hold as much of our attention if it’s just their mind. But if we put things down on paper, we create things that are really nice and organized and create structure around it.

00:20:45:19 – 00:21:15:20
Unknown
It’s only going to make things easier to remember. And so some of that can be based on categorizing, based on importance or categorizing based on a procedure that you’re are used to. And again, just spending the extra time to make it much more meaningful for yourself, I’ll skip this slide. So as far as it goes, for people who have trouble reading things, remembering what they’ve read later, there’s a simple technique you can use.

00:21:15:20 – 00:21:36:12
Unknown
You can kind of preview the information first after previewing it and seeing what the main themes are. Then you create your questions over what is it that you’re trying to understand or was it you’re trying to read? And then as you read through it, you try to answer those questions, you review the information, you summarize that information with somebody else and then or yourself.

00:21:36:12 – 00:22:05:05
Unknown
And then you test yourself to see if you really understand what you just read. So again, this is for something that in case you read something, you forget later. This is a nice little method or strategy to support that. So again, just for the sake of time, I’ll just briefly go over it. So like I said earlier, having things like calendars, reminders and journals are very helpful.

00:22:05:05 – 00:22:31:14
Unknown
But I always work with in terms of patients is having them develop a very consistent routine where they use it very effectively. So being consistent with when you set those reminders, being consistent with information that you write down, so that way, you know, it’s a lot more efficient towards helping you remember things that are important. So I’ll just actually I’ll just focus on the questions now for the sake of time.

00:22:31:16 – 00:22:51:13
Unknown
But in case anyone needs any more resources, again, if you guys feel like you’re dealing or struggling with this a lot, you can actually just bring this up with your doctor. And what they may actually do is only refer you to a neurologist or a neuropsychologist who can then eventually or directly refer you to an occupational therapist or speech therapist.

00:22:51:13 – 00:23:16:06
Unknown
You can provide weekly sessions to address these issues in case anyone is interested in brain training programs. There’s two that I found to be very helpful. I’m not necessarily promoting these, but if you are interested, these are ones that I’ve found to be very relevant to everyday activities. And in case anyone is interested in reading books, I actually use this book a lot with patients as memory and attention adaptation training.

00:23:16:08 – 00:23:42:05
Unknown
It’s something worth checking out where it actually goes through step by step processes of how to address this issue. Okay. So I’ll go ahead and take questions now. Thank you so much. That was very informative and we appreciate it. We’re going to start the Q&A. You can still submit questions at the Q&A section at the bottom of the screen.

00:23:42:07 – 00:24:12:14
Unknown
We will try to get through all of the submitted questions, but we may not be able to, due to time constraints. So question one how do you communicate? You have chemo brain at work. So yeah, this is something where you can explain to an employer that, you know, due to your treatment, due to the cancer itself, there are a lot of symptoms.

00:24:12:15 – 00:24:53:00
Unknown
It has a really big symptom burden and this impacts, you know, any specific task that you do at work. It is something where you can actually get work accommodation for it because like I said, it is recognized in the mental community as something that is a pretty serious side effect. So I know it’s hard for other people to understand, but if you bring it up with your doctor and they are able to write in their academic accommodation and specify why that might be really helpful to our work accommodation on this very academic conversation, But that might actually be really helpful towards helping explain to them how serious this is.

00:24:53:02 – 00:25:24:22
Unknown
Okay. How long does chemo brain last after completing treatment? So that’s I know that’s an important question to ask and really it’s different for everybody. So I can’t really necessarily giving you a pinpoint answer, but it can last for a while depending on, you know, how much treatment you’ve got. And again, we looked at the risk factors of things like age, other symptoms that you’re dealing with.

00:25:24:22 – 00:26:09:06
Unknown
So again, I can’t really give a clear answer, but if you’re still feeling like it’s lasting for a long time, it it can last for quite a bit of time. Again, for, like I said, 60% of patients. You say, are there any specific types of chemo that have more of a negative impact on cognitive function? So again, this is something that I would not not to cop out on this answer, but yes, this is something that you would want to bring up with your doctors because they can actually say based on the evidence, the body of research, that this particular chemo, a certain percentage, would report more side effects.

00:26:09:06 – 00:26:36:21
Unknown
But what I can say generally, especially with the endocrine therapy, you know, things that are suppressing your hormones, those are they call them aromatase inhibitors, those tend to have a very well known side effect for chemo brain, and especially if you’ve gone through radiation or, you know, you’ve gone through any other type of systemic chemo, like things like taxane.

00:26:37:02 – 00:27:13:09
Unknown
Yeah, those are known to also cause chemo brain as well. Okay. Should we see an ecologist to better understand the extent of our memory issues? So here at our hospital, we actually have a neuropsychologist who does a lot of specific cognitive testing. So hopefully you or Julia would look like is that you mentioned to your doctor and then they would refer you to a neuropsychologist and then they would do a battery of tests to really pinpoint the specific degree of impact it has on your function in your brain.

00:27:13:09 – 00:27:39:13
Unknown
So they would actually give you a very specific picture. So I would say you bring it up with your doctor so that way they can refer you to a professional who can test you for it. Okay. See, how do you differentiate between chemo brain, old age and the beginning of dementia? So that that the same thing applies to what I just mentioned.

00:27:39:13 – 00:28:09:17
Unknown
So if you do have that concern, a neuropsychologist neurologist would actually be able to differentiate between those two. They would do tests specifically for dementia or Alzheimer’s. They would again do a battery of cognitive tests and then they can, based on that data, tell you whether, you know, dementia is actually something that you should be concerned about. But there are many cases where I’ve had where they say, no, it’s just this chemo brain and there are no other indications for things like dementia or Alzheimer’s.

00:28:09:19 – 00:28:48:18
Unknown
I think try to break through a couple more. Are there any methods available to predict protect the brain during treatment? So, yeah, that’s a good question and that’s something I actually tell my patients to. I see for their you’re actually going to go to like chemo or something. Policy like habits can prevent factors like being very active, having robust exercise routine, being able to manage mood and prevent a high degree of depression or anxiety.

00:28:48:18 – 00:29:08:10
Unknown
Those are actually protective factors as far as it goes. With anything more specific than that, I can say you can go ahead and just see how you can test yourself in terms of your cognitive function. If someone does have a history of ADHD, I would actually bring that up with with their providers. That way, you know, they’re more aware of it.

00:29:08:10 – 00:29:39:14
Unknown
They can better prepare for it. And if there needs to be actually introduction of other type of medications, that’s something that’s worth worth considering. Okay. Are there any specific diet and nutrition supplements that could help? So I can’t give specific recommendations. I always just say if you’re struggling to eat, I think it’s really good to to see a dietitian who can help you develop a plan to have more balanced diet throughout your day.

00:29:39:14 – 00:29:58:21
Unknown
I know a lot of patients I work with, they actually struggle to eat. They’re not eating enough or they’re not drinking enough because of whether it be nausea or or they just don’t have any appetite. So if that’s something that impacts you, I really encourage, you know, developing routines that where you’re able to have more healthy eating habits, more consistent habits.

00:29:58:21 – 00:30:21:06
Unknown
And again, if you want specific recommendations, a dietitian will actually tell you more specifically the nutrients that you need to eat. But in general, people always say it’s better to have balanced, healthy diet than one that’s not as healthy. Right. Well, thank you, Dennis, for an informative program and thank you to all of you for participating in so many questions.

00:30:21:06 – 00:31:07:05
Unknown
Before we wrap up, I’d like to ask our audience one more question. Are you aware of strategies that can help manage chemo? BRAIN Not at all. Aware. Slightly aware. Moderately aware. Very aware. Extremely aware. All right. So 42% are moderately aware and 27% are very aware. So it looks like people have come out of this and learned some new skills on how they can help manage chemo brain, which is wonderful.

00:31:07:07 – 00:31:25:20
Unknown
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00:31:25:22 – 00:31:33:22
Unknown
Thank you again, Dennis. Thank you everyone.