CHEMO BRAIN – WHAT it is and HOW to DEAL with IT

“Chemo brain” is a popular term to describe the brain fog and memory loss that can happen after chemotherapy treatments for cancer. Chemo brain is a real phenomenon and there are things that you, the patient, can do about it.

While updating my book on chemotherapy, Making the Chemotherapy Decision, this year, I encountered an interesting book on this topic aimed at people looking at or recovering from chemotherapy treatment- Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus, by Dan Silverman, MD, PhD, and Idelle Davidson.

The 284-page book, written for a general audience, includes a survey of recent research in this area, a look at the symptoms and signs of brain fog, and tips and suggestions for getting your brain back in shape if it has been adversely affected by treatment.

Dr. Silverman is a professor of molecular and medical pharmacology at UCLA and a noted researcher in this area. He was one of the first to quantify the phenomenon of brain fog. Co-author Davidson is an award-winning health journalist who experienced brain fog for several months after cancer treatment and writes with an assured, experienced voice.

For years, chemo brain was dismissed by many doctors as “all in your head.” That is changing.


Studies that compared brain function of patients who underwent chemotherapy with patients who had not began in 2004 at the MD Anderson Cancer Center in Houston. An early study at the University of Rochester Medical Center in New York showed that three chemotherapy drugs — carmustine, cisplatin, and cytarabine — may be more toxic to brain cells than cancer cells. Since then several studies have turned up evidence to support the thesis that certain chemotherapy drugs or drug combinations can adversely affect brain function.

Hormones are used to treat women with breast cancer and men with prostate cancer. These treatments can send women into a premature menopause, and men into a corresponding physical crisis and cognitive decline. In one study of breast cancer patients, women who received chemotherapy and women who received chemotherapy both with and without the hormone tamoxifen registered declines in verbal memory performance, while women who received no adjuvant chemotherapy actually registered cognitive improvements.

At this point, according to Dr. Silverman, one of the worst chemotherapy drugs may be cyclophosphamide. This is often used in combination chemotherapy treatments, whose effects may come from interactions with the drugs it’s used in combination therapy with – methotrexate, 5-fluoruracil or doxorubicin. For breast cancer patients, the CMF regimen of cyclophosphamide, methotrexate and 5-FU showed less adverse mental effects when the methotrexate was replaced by doxorubicin or epirubicin.

In addition to particular drugs listed above, Dr. Silverman writes that researchers are now studying other compounds including cisplatin, vincristine, etoposide, vinblastine, and steroids dexamethasone and prednisone for cognitive ability lapses in such areas as language and memory.

What is to be done? Before making the decision to undergo chemotherapy, when choices are available, patients and their doctors may want to weigh the potential for cognitive effects into the treatment equation. For some people, a chemotherapy regimen with fewer mental side effects may be preferable, even if efficacy of the chemotherapy agents is a bit higher.


Silverman and Davidson have developed a 9-step program for recovering from brain fog. Their program includes the practice of good nutrition. Among their recommendations are the inclusion of at least five portions of fruits and vegetables every day, especially those with dark colors, as well as adequate protein, and no more than 60 grams of fat per day. They also advise drinking a little milk and coffee every day.

Regular exercise and keeping engaged mentally, socially and intellectually are also recommended by the authors as is sexual activity. “Sexual stimulation is much more potent stimulus of our neurological reward pathways than even a runner’s high,” Dr. Silverman observes.

The authors suggest that recovering cancer patients get examined regularly as recommended, but their program suggests that they avoid unnecessary medical tests and stay away from hospitals unless emergency or hospital treatment is needed.

While research continues in this area, Your Brain after Chemo provides useful information to consider when you have cancer, and you are making the chemotherapy decision.

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