Treatment Side Effects – Cognitive Difficulties

Treatments like chemotherapy, certain immunotherapy, and hormone therapy for advanced breast cancer can cause cognitive difficulties as a short-term or long-term side effect. Also, sometimes referred to as mental fog, brain fog, or “chemo brain,” cognitive difficulties can cause challenges in thinking, processing, remembering, or focusing.1,2

Similar to other side effects, the cognitive difficulties experienced with breast cancer treatment can range from mild changes to more significant issues.1 For some people, cognitive abilities improve after treatment is finished. Others may experience long-term effects. Most people (75-80%) report that their cognitive function is back to normal approximately a year after treatment.3

When cognitive difficulties occur, they can cause a negative impact in a person’s quality of life. Those who experience long-term deficits may be unable to return to work or studies and 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:

  • Having difficulty concentrating
  • Experiencing trouble remembering words or concepts
  • Feeling confused
  • Forgetting details
  • Having trouble with planning, organizing, or multitasking – called executive functioning
  • Thinking slower
  • Having difficulty learning new things
  • Experiencing 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. Any person receiving treatment for breast cancer that is experiencing any challenges with thinking, remembering, or concentrating should talk to their doctor about their symptoms. 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, with older adults being potentially more vulnerable to these potential side effects from breast cancer treatment. Aging is associated with a variety of changes in the body, including DNA damage, increased inflammation, and oxidative stress. Chemotherapy can also cause these changes, and hormone therapy can also potentially cause DNA damage. The research suggests that the same biologic processes that occur in aging, and which put a person at increased risk of developing breast cancer, also are linked with the processes involved in cancer treatments and cognitive decline. Cancer treatments may accelerate the aging process, or the effects of treatment may cause a cascade of biologic changes that can affect a person’s cognitive abilities.2

Managing cognitive difficulties

There are several ways to manage cognitive difficulties associated with breast cancer treatment, including:

  • Medications – Some research has found that certain people may benefit from treatment with stimulant medications, such as Ritalin® (methylphenidate) or Provigil® (modafinil). Antidepressants may also help in people who are experiencing depression, which can worsen cognitive difficulties.3,4
  • Cognitive-behavioral therapy – Researchers have found that women with breast cancer treatment-related cognitive difficulties can benefit from learning self-awareness, relaxation, and cognitive strategy exercises.5
  • Lifestyle approaches – Maintaining a healthy diet, engaging in regular exercise (check with your doctor if you have an exercise restriction), and getting enough sleep are some of the ways a person can help support healthy cognition.1
View References
  1. Memory or concentration problems and cancer treatment. National Cancer Institute. Available at https://www.cancer.gov/about-cancer/treatment/side-effects/memory. Accessed 8/15/18.
  2. Ahles TA, Root JC, Ryan EL. Cancer- and Cancer Treatment–Associated Cognitive Change: An Update on the State of the Science. Journal of Clinical Oncology. 2012;30(30):3675-3686. doi:10.1200/JCO.2012.43.0116.
  3. Grisham J. Behavioral psychologist Tim Ahles discusses cognitive changes associated with cancer treatment. Memorial Sloan Kettering Cancer Center. Available at https://www.mskcc.org/blog/behavioral-psychologist-tim-ahles-discusses-cognitive-changes-associated-treatment. Accessed 8/15/18.
  4. Central neurotoxicity, memory loss, and their relationship to chemotherapy. Chemocare. Available at http://www.chemocare.com/chemotherapy/side-effects/central-neurotoxicity-memory-loss.aspx. Accessed 8/15/18.
  5. Ferguson RJ, Ahles TA, Saykin AJ, et al. Cognitive-behavioral management of chemotherapy-related cognitive change. Psycho-oncology. 2007;16(8):772-777. doi:10.1002/pon.1133.