Brain Fog and Advanced Breast Cancer Treatment

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Treatments like chemotherapy, immunotherapy, and hormone therapy for advanced breast cancer can cause cognitive difficulties. This can include problems with thinking, processing, remembering, or focusing. This is sometimes called mental fog, brain fog, or "chemo brain."1,2

The cognitive difficulties caused by breast cancer treatment can range from mild changes to more significant issues. Talk to your doctor about what to expect with your specific treatment. For some people, cognitive abilities improve after treatment is finished. Others may experience long-term effects. Around 75 to 80 percent of people report that their cognitive function is back to normal about 1 year after treatment.1,3

When cognitive difficulties occur, they can cause a negative impact on quality of life. Those who experience long-term deficits may be unable to return to work or studies. Adapting to cognitive changes can be stressful and disheartening.

Symptoms of cognitive difficulties with breast cancer treatment

Cognitive difficulties may appear differently in each person who experiences them. Symptoms may include1:

  • Difficulty concentrating
  • Trouble remembering words or concepts
  • Confusion
  • Forgetfulness
  • Trouble planning, organizing, or multitasking (executive functioning)
  • Slower thinking
  • Difficulty learning new things
  • Challenges with visuospatial abilities, like reading a map or avoiding obstacles in a room

These are not all the ways cognitive difficulties may be experienced. If you have challenges with thinking, remembering, or concentrating while undergoing treatment for breast cancer, talk to your doctor. There are several ways to help treat or manage cognitive challenges.

Aging, treatment for breast cancer, and cognitive difficulties

Age is a risk factor for developing cognitive difficulties. In most cases, older adults are more likely to experience these side effects from breast cancer treatment. Aging is linked to a variety of changes in the body. This includes DNA damage, increased inflammation, and oxidative stress. Chemotherapy can also cause these changes. Hormone therapy may also cause DNA damage.2

Research suggests that cancer treatments may speed up the aging process. Plus, the effects of treatment may cause biological changes that can affect a person’s cognitive abilities.2

Managing cognitive difficulties

There are several ways to manage cognitive difficulties linked to breast cancer treatment, including:1,3-5

  • Medicines – Some research has found that certain people may benefit from treatment with stimulant drugs, such as Ritalin® (methylphenidate) or Provigil® (modafinil). Antidepressants may also help people who are experiencing depression, which can worsen cognitive difficulties.
  • Cognitive-behavioral therapy – Researchers have found that women with breast cancer treatment-related cognitive difficulties can benefit from cognitive-behavioral methods. This includes self-awareness, relaxation, and cognitive strategy exercises.
  • Lifestyle approaches – Maintaining a healthy diet, getting in regular exercise, and getting enough sleep can help support healthy cognition.

Talk to your doctor about the best ways to manage cognitive issues for your specific needs.

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