Key takeaways
- ‘Cancer Related Cognitive Impairment’ or CRCI can affect around three quarters of cancer patients, and have a negative impact on a person’s quality of life
- Eating a wide variety of plant foods can nourish gut microbes, which can have a positive impact on memory and concentration
- Regular physical activity can be both empowering and beneficial for brain function, as well as improve sleep and fatigue
- Working with a psychologist can help someone to explore the impact of CRCI on their life, and develop ways to adapt and cope
Changes to memory and concentration after cancer treatment is known as ‘Cancer Related Cognitive Impairment’ or CRCI. You might have also heard it called ‘chemo brain’. CRCI can be experienced in different ways, including memory loss, attention deficits – such as being unable to concentrate on work tasks or conversations – word finding difficulties and concentration issues, and can affect up to three quarters of cancer patients. Although symptoms usually get better after treatment, unfortunately, for some they can last longer, however they don’t tend to get worse. Changes to memory and concentration can make you apprehensive about returning to work, and affect relationships and everyday situations, leading to a sense of isolation, and have a negative impact on a person’s quality of life. In this article, three Perci professionals from the fields of physiotherapy, dietetics and psychology, share their approaches to supporting members through this frustrating and perhaps frightening side effect of cancer.
What causes Cancer Related Cognitive Impairment?
The causes of CRCI are not fully understood, but a combination of factors could contribute to the symptoms. These include cancer and cancer treatment, factors relating to the individual – such as genetics, lifestyle and other medical issues – and other cancer-related side-effects, including anxiety, cancer-related fatigue and pain.
Supporting Cancer Related Cognitive Impairment with diet and nutrition
Jo Cunningham, Registered Dietitian, Perci Health
People don’t necessarily make the link between changes to memory and concentration after cancer, and what they eat, but working with a dietitian can help. Brain fog, in particular, can be improved by working on digestion and addressing fatigue.
My general advice is to eat a diet rich in plants, with lots of colour and variety. Eating 30 plus plant foods each week helps to nourish the microorganisms that live in our gut lining. These gut microbes produce helpful by-products as they digest and ferment the food passing through. Some of these by-products, called short-chain fatty acids, have been shown to not only improve gut health, but also to play an important role in the gut-brain communication, and may be protective against CRCI.
I don’t like telling people to avoid things, as I believe what you do include in your diet is more important, but some studies have shown that diets high in ultra-processed foods may negatively affect cognition. These are foods that have been designed to stay on a shelf for a long period of time, like traditional packaged sliced bread, pastries, ready-meals, sausages and nuggets. I therefore suggest that we minimise these foods in the diet.
More specifically, a diet known as the ‘MIND Diet’, has been shown to improve cognition scores. The MIND Diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) is a combination of the well-known Mediterranean diet, which focuses on colourful vegetables and healthy fats, and the DASH diet, which was designed to treat high blood pressure. A study released in August 2023 showed that this diet can improve memory and concentration in the elderly in as little as 12 weeks.
One aspect of the MIND Diet that makes it ideal for people who have been through cancer treatment and are experiencing CRCI, is its high polyphenol content. These plant-based chemicals can nourish gut microbes, reduce inflammation and improve brain function. Berries – particularly blueberries – tomatoes, tofu, turmeric and onions are all really good sources of polyphenols. Including plenty of Omega 3-rich foods – like sardines, mackerel, salmon, sea bass, chia, flax and walnuts – each week may also reduce the risk of cognitive decline.
Ask Jo: Will taking a probiotic supplement help my memory and concentration?
If you’re looking after your gut microbes with food, that’s all that’s needed, although individual circumstances vary. If you’re interested in probiotics I recommend chatting to a dietitian experienced in this area because different strains do different things and there’s so many commercially available that it can drain the wallet quickly for little benefit!*
Supporting Cancer Related Cognitive Impairment with physical activity
Hannah Leach, Physiotherapist, Perci Health
While CRCI isn’t necessarily a physical issue, research shows that exercise can have a direct benefit on memory and concentration. Exercise has an anti-inflammatory effect on cells and increases the size of blood vessels around the brain, so we can use it to improve the health of brain cells. Indirectly, physical activity helps to improve mood and sleep, and reduce anxiety, which can all hinder cognitive function. This might be more personal to you, but if your mood is better and you are sleeping better, memory and concentration might feel less like a challenge.
Exercise can feel daunting, especially if you’re also experiencing cancer-related fatigue, so one of my first questions will be about what activities you’re already doing. A lot of the research is focused on walking, so if we’re starting from scratch, we’ll look at getting into a walking routine. From there, you can start to build up to 150 mins of moderate exercise a week. Walking is a great way to train your memory and concentration. You can challenge yourself by walking different routes, trying to remember a specific route, or walking the route backwards.
If you’re already doing quite a lot of activity, we’re looking to build a well-rounded routine with cardiovascular and strength elements. Activities like tai chi and dance, which require coordination and attention, as well as memorising steps and routines, can be really helpful to add in. These are accessible ways to exercise, which you can do at home by watching a video online.
If you’re struggling with your memory and concentration after cancer treatment, and feeling a bit stuck, scared, or out of your control, it can be empowering to do things with your body and feel like you’re achieving something. Doing things you like and having goals can have a positive impact on your mood and help you to feel more in control after treatment.
Ask Hannah: How can I stick to an exercise routine when I’m struggling to concentrate?
When focusing on specific routines feels difficult, it can be helpful to use ‘intuitive movement’. This means tuning into your body, how it feels and what it needs at that time. You can try this by putting on your favourite music and starting to move your body in any way that feels good for you, whether that’s gently stretching, dancing or walking outdoors. This may look different every time you try it.
Coping with the psychological impact of Cancer Related Cognitive Impairment
Dr Lucy Davidson, Psychologist, Perci Health
While working with a psychologist can’t cure CRCI it can help you to understand the impact it’s having on your life and to cope better with it. It’s a significant issue, especially for people who might have led very busy lives or had a high-powered job, and are now struggling to remember people’s names and what they were doing five minutes ago. Just like so many other aspects of cancer, there is loss attached; in this case, the loss of who you were before your treatment.
We’ll look at your experience of these challenges in some depth, and also work through expectations you might have about getting back to a pre-cancer version of yourself, or even operating as you did during treatment. Lots of people struggle with being too hard on themselves. The anxiety can drive you to overdo it, push yourself too much or set unrealistic goals, which can cause another level of distress. As a society, we’ve become too relaxed about the impact of illness and the need to properly recover, so I’ll help patients think about what recovery looks like, and how they can be more tolerant of where they are right now.
The time when our bodies recover the most is during sleep. If you’re not sleeping well, it’s likely you’ll have a day when concentration is difficult. What’s known as ‘sleep hygiene’ is really important. Do you have a good nighttime routine? Can you cut down screen time? Can you have a warm bath? Can you read before bed or listen to an audiobook? Winding down before bed, as well as setting a regular sleep pattern and sleep hours, can help. And if you’re sleeping better, you might find that memory and concentration are improved, or at least less of an issue. This aspect of psychology is more behavioural; it’s about adapting to your new reality and finding strategies to cope.
Ask Lucy: Do you have any advice for managing at work when you find it difficult to concentrate?
Sometimes, with the limitations cancer has put on you, you might have to manage the tasks you have to do in a different way. For example, if you’re sitting down to prepare for a meeting, work you previously could have done over a couple of hours solidly, you might need to break up into smaller chunks over the day or even a couple of days, taking regular breaks.
Cancer Related Cognitive Impairment can have a significant impact on someone’s life, especially after the challenges of cancer diagnosis and treatment. Our professionals are here to help. Start by talking with one of our expert Cancer Nurse Specialists, who will offer guidance, and can refer you to the professionals you need to work through CRCI and other challenges.
*Always discuss any supplements you might want to try with your oncology dietitian and pharmacist as some cancer drugs interact with supplements
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
Gomes Gonçalves et al., ‘Association Between Consumption of Ultraprocessed Foods and Cognitive Decline’, National Library of Medicine, Feb 2023, https://pubmed.ncbi.nlm.nih.gov/36469335/
Kühn et al., ‘Twelve Weeks of Additional Fish Intake Improves the Cognition of Cognitively Intact, Resource-Limited Elderly People: A Randomized Control Trial’, National Library of Medicine, 2022. https://pubmed.ncbi.nlm.nih.gov/35166302/