Cancer-related cognitive impairment (CRCI) refers to changes or challenges in memory, concentration, attention and executive functioning (like planning, organizing, or emotional regulation) because of cancer treatment. Commonly referred to as “chemo brain” or “chemo fog,” CRCI can result from chemotherapy, along with other cancer treatments like radiation, hormone therapy, surgery, immunotherapy or other targeted  therapies. (1)

CRCI is highly prevalent for cancer patients who have undergone treatment, with between 60-70% of patients reporting challenges with  memory or cognitive processes. (2)

Vatsala Kirtani, MD, is a hematologist and oncologist at Rochester Regional Health. She recently spoke with the Breast Cancer Coalition to help us better understand cancer-related cognitive impairment, how to address it with your provider and ways to manage symptoms to maximize quality of life.

Focus on Validation

When it comes to CRCI, validating patients’ symptoms as real concerns is key, says Dr. Kirtani. She speaks openly with her patients to acknowledge their challenges in memory or executive functioning, reassuring them that CRCI is not a progressive condition that will lead to dementia. Talking through these concerns can provide great relief to patients and affirms that CRCI is a real condition.

While up to 75% of cancer patients will experience symptoms related to CRCI, most patients will see those symptoms dissipate following treatment. However, Dr. Kirtani reports that approximately 35% of patients will have persistent symptoms months or even years after finishing treatment. (3) Acknowledging and discussing this with patients allows for informed decision making and management of symptoms.

Helpful Management Strategies

CRCI is common for those undergoing cancer treatment, but there are ways to help manage the symptoms. Dr. Kirtani recommends organizational strategies or memory aids like utilizing notebooks and alarms on your phone. She also recommends keeping items in consistent locations and performing more cognitively demanding tasks when you have the most energy in your day.

Additionally, Dr. Kirtani says physical activity is indicated to help address CRCI symptoms and may help with improving memory and reducing sleep disturbances and stress. (4,5) Whether this is aerobic exercise, yoga or a mindfulness practice, staying active and reducing stress can help those experiencing cognitive symptoms following cancer treatment.

Aromatase Inhibitors and CRCI

Breast cancer, along with some gynecologic cancers, is often estrogen receptor positive (ER+). (6,7) This means that the cancer feeds off estrogen to grow. A common treatment for ER+ breast cancer is an aromatase inhibitor (AI), an oral medication that lowers estrogen levels in the body to reduce the risk of cancer recurrence.

Dr. Kirtani reports that in her own practice, her patients prescribed an aromatase inhibitor commonly report some symptoms of memory loss or issues with memory; mild brain fog is extremely common. With a significant percentage of patients undergoing treatment for breast cancer prescribed an AI, this reiterates the importance of open dialogue between patients and providers to ensure any memory issues are addressed, validated and properly managed to optimize quality of life.

Our Unique Experience

As more treatment options become available, it is likely that cancer-related cognitive impairment will also become more prevalent. Dr. Kirtani recommends that each patient experiencing CRCI-related symptoms review their concerns with their provider.

When it comes to diagnosis, treatment and survivorship, every person’s experience is unique. As Dr. Kirtani says, “Every cancer treatment and every cancer is so individual.”

There is not a “one size fits all” model in cancer treatment. If you feel you have noticed changes in memory, concentration or attention following chemotherapy or other cancer treatments, you are not alone. Speak with your provider about any concerns related to your treatment. Know that the Breast Cancer Coalition is here to validate and support you through treatment and beyond.