Mental Fatigue Worries Chemotherapy Patients

NEW YORK—More than 500 cancer patients across the country participated in a Cancer Care, Inc. teleconference addressing a little-discussed concern literally on the mind of many chemotherapy patients: forgetfulness during and after chemotherapy.

Cancer patients sometime refer to the condition jokingly as "chemo-brain" or "chemo-head," but it can be frightening if not understood, said Stewart Fleishman, MD, director of cancer supportive services, Beth Israel Cancer Center, New York.

Many worry about Alzheimer’s disease, he said, and need to be reassured that the sudden appearance of memory gaps during treatment is not a sign of dementia. Alzheimer’s is slow to develop, not sudden, he stressed.

Although mental fatigue is often associated with breast cancer treatment, it also occurs in men receiving chemotherapy, Dr. Fleishman said. "Female patients are much more likely to speak up about this. Men don’t want to admit they are not up to their usual level of activity or function," he said. He noted that men undergoing prostate cancer treatment often have similar problems in remembering where they put their keys and getting lost when driving.

People become tired and forgetful during chemotherapy because most of the drugs are designed to seep into the brain, Dr. Fleishman explained. Because these drugs are potent, patients also receive therapies that act on the brain to control nausea, vomiting, and dizziness.

A patient who is concerned about mental changes should discuss the problem with an oncologist or oncology nurse, he advised. The practitioner can make sure the patient is not anemic, developing an infection, or severely depressed. These can be treated, but some fatigue, mentally as well as physically, is to be expected, Dr. Fleishman said.

He offered several practical suggestions for coping with mental fatigue.

• Exercise seems to be one of the best antidotes, Dr. Fleishman said, because it releases stress-relieving endorphins.

• Eating small meals throughout the day helps keep blood sugar levels relatively stable. Despite advocacy for phytoestrogens and certain "smart foods" with lots of protein, he warned that "the jury is out" on the former, and the latter have not been tested. Similarly, he said multiple vitamins can be good, but megadoses of individual vitamins may be harmful, and patients should avoid folic acid during chemotherapy.

• Memory exercises should help the brain, he said, suggesting that patients read more and join a book club or try to learn something new, such as how to use a computer. "Learning something new forces you to use the brain," he said.

• Patients should practice defensive strategies such as making lists, always putting one’s keys and purse in the same place, and writing down where the car is parked in the mall. Leaving early when driving and having a contingency plan in case a familiar route is blocked is also a good idea, he said.