Nicole A:

So, at this point, I’m about seven years post-treatment, and I still have a lot of brain fog. Is there anything that I can do at this point to help?

Christina Pozo-Kaderman, PhD:

Hi, I’m Dr. Christina Pozo Kaderman. I am a clinical psychologist who’s worked in the area of psychosocial oncology for over 30 years. I’m the director of the young adult program at the Dana Farber Cancer Institute.

So, Nicole, thank you so much for asking your question. Yes, brain fog can continue for some people even years after completing all of their treatment. I think I wanted to start off by saying that there could be underlying medical factors that can be contributing to brain fog, and so I think it’s important to make sure that you’ve attended to those before moving forward.

So first of all, some young women, when they go through cancer treatment, go into premature menopause, and if they go into premature menopause, what happens is that they may then experience brain fog associated with premature menopause, and what we usually suggest is that you speak to your oncology team and get referred to a gynecologist that specializes in working with oncology patients about possibly, if indicated, starting you on hormone therapy, and that in and of itself, can help greatly with brain fog if that’s part of the underlying reason or some hormonal changes.

Sometimes, like being hypothyroid or hyperthyroid, that can also impact brain fog. So again, important to make sure that you follow up with your oncology team to see if there’s any underlying medical reasons. There’s also some medications that can contribute or cause brain fog. So again, making sure those types of possible reasons for the brain fog are addressed.

Now, I also want to talk a little bit about some other types of situations that can contribute or be part of the brain fog. So, it is not unusual that if somebody has untreated depression, that one of the symptoms of untreated depression are issues with cognition. So, people who are depressed may have difficulty focusing or concentrating short-term memory. The same thing goes along with anxiety or even just high levels of stress. We all know that if we are really anxious or stressed out, we sometimes really struggle with remembering things, thinking things clearly, multitasking. So, finding a way to manage your stress is critically important, and then also for some of our people that complete treatment, they are also dealing not only with brain fog, but they may also be dealing with treatment related fatigue. And if you look at fatigue as multi-dimensional, meaning that our energy has different components. It has a physical component. We obviously were active physically. We’re tired. There is an emotional component, and there is a cognitive component. So sometimes, given that our energy, once you go through treatment, maybe less than usual, you want to look and see how much fatigue is contributing to any cognitive changes.

With that being said, I think one of the main things, given that it’s been a while that you’ve been struggling with the fatigue, is to see a neuropsychologist who specializes in working with people who’ve been through cancer treatment. I think they can then give you very direct recommendations of ways to intervene. They may refer you to some type of cognitive rehab. They also may refer you to some types of software that’s there. Some apps that are specifically beneficial for patients who are struggling with brain fog, and those are like computerized cognitive training programs.

I also think it’s important to keep in mind that you need to be compassionate with yourself. There are these changes that happen post treatment, and being kind to yourself and giving yourself this opportunity to recover is critically important.

Exercise is also extremely helpful for, believe it or not, cancer related fatigue, but also for cognitive changes that may be the result of treatment. And then there’s obviously CBT strategies that a therapist can help you with. And then last. There may be medications that are indicated, particularly if there’s an underlying like ADHD or something else. So those are some of the recommendations. I hope that helps.