Treatment

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Wellbeing

Working with Chemo Brain

https://www.cancerandcareers.org/en/at-work/where-to-start/Managing-Tre…

You’re back at work after cancer treatment — or maybe nearly done with treatment and working at least part-time. You’re understandably eager to get back to “normal.” But if you’ve had chemotherapy (or even if you haven’t), you may notice your concentration, memory or other work skills aren’t up to par. This mental fog isn't your imagination. It’s called “chemo brain.” Experts actually prefer the term “cognitive dysfunction associated with chemotherapy” or “post-chemo brain,” to more accurately describe it.

What Is Chemo Brain?

By whatever name, if you have it, you know it: memory lapses, difficulty remembering details or concentration, inability to multi-task like the master you once were, problems remembering names or spelling common words, inability to think as fast as you once did, or difficulty remembering the steps of tasks you once performed easily.

Up to 30% of cancer patients who receive chemotherapy may experience chemo brain, according to the American Cancer Society. Exactly how it occurs isn’t certain, but some experts suspect some chemo drugs may slip past the “blood brain” barrier, which separates chemicals that belong in the brain from those that do not, and adversely affect cognitive skills.

While experts say they have a lot to learn about chemo brain, they do agree that it’s a real condition, not your imagination. Research suggests it may linger after treatment. The treatment itself may impact nerve and brain function, and those effects may be complicated by the stress of coping with the diagnosis and the fatigue from dealing with the stress and an overloaded schedule. Some people may be more genetically vulnerable to chemo brain than others.

Although research about chemo brain is still evolving, there are many steps you can take at work to improve the “fog” and perform better. Here, tips from the American Cancer Society, Mayo Clinic, and four experts:

Debra Barton, RN, PhD, AOCN, associate professor of oncology at Mayo Clinic, Rochester, MN
Grace Jackson, MD, psychiatrist, Wilmington, NC
Lori Hefner, cancer survivor, Pleasantville, CA, and founder of the website, chemobraininfo.org
Daniel Silverman, MD, PhD, associate professor of molecular and medical pharmacology, University of California Los Angeles David Geffen School of Medicine and head of neuronuclear imaging, UCLA Medical Center

Chemo Brain: What to Do at Work

What you can do:

Be aware of your stress level and work to reduce the stress. Excess stress by itself can impair your performance and thinking skills. Look to the source of the stress — a coworker playing a radio too loudly, constant chatter — and correct it.
Learn quick rescue techniques to combat stress during the day. One technique is deep abdominal breathing. Focus on breathing in deeply and exhaling deeply until you feel more in control.
Minimize exposure to any toxins — whether it’s open windows that let in polluted air or workplace materials that are toxic. The aim is to keep your brain as healthy as possible.
When you are feeling overwhelmed, write down a list of priorities. (A good idea even if you’re not feeling overwhelmed.)
Once you prioritize, tell yourself you will focus only on the first task that needs to be done. Don’t think about anything else. Otherwise, your concentration will suffer. As distractions decrease, concentration increases.
While multi-tasking is viewed as very efficient — and you may have been good at it before the cancer diagnosis — stop for a while, at least until you regain a better memory and other cognitive skills.
Rely more than ever on memory assists and take advantage of all the features. Perhaps you have always used a computer based calendar, for instance. Now, use the alerts built into them to remind you of an upcoming meeting, a project due date or other details. Learn the features of your smart phone that can help you stay on track.
Set up your work environment to boost concentration. That means clearing everything off your desk or your immediate work area except what you are working on first. Turn off your email. If you have difficulty ignoring the world, create an auto-reply message that tells people you will respond at a specific time each day. Then, when you do turn your attention to email, stay totally focused on that task so you get it done quickly. You can do the same with your voicemail message, choosing to return calls at a specific time.
Rehearse to remember. If you read something out loud, such as names or fact, some research suggests you are less likely to forget it. The reasoning? Visual and aural input together help you remember. You can use this technique to talk yourself through challenging tasks at the computer. Maybe there is a word-processing technique you used to know by heart, but now don't. Print out the “help” instructions, then read them aloud and talk yourself through it until it is second nature again.
Get in a rut. Put your keys, files, coat and other items in the same place day after day. It will reduced the “Where is it?” stress when you are under fire and running late. At home, designate a “launching pad” where you put everything you need to take to work the next day — keys, files, day planners, a jacket. It will reduce that early morning stress and allow you to concentrate and focus.

How coworkers can help:

Ask for input from coworkers you know and trust. Tell them you need input to see if your work projects are up to standards. For instance, when you write a report, show one of your helpers the rough draft and ask for comments. Ask if you’ve missed any important points or if you need to improve the grammar.
Interact with coworkers. Being in a socially stimulating environment for some of the workday helps brain function. This “real world” connection is part of the recovery process. Somehow, the combination of thinking and talking is good for repairing the brain.
Ask a coworker you trust to help retrain you on the tasks you’ve forgotten. If you generally distribute the mail in the morning, or organize an office party, ask someone to walk you through the steps if you are having difficulty. If a coworker offers to do the task for you, gently decline and stress that you are trying to relearn.
Ask a coworker you trust to prompt you when he or she notices you need help remembering names, facts, schedules or other details.

How to Manage Your Lifestyle to Improve Focus

Just as your overall lifestyle habits affect your ability to perform when you haven’t had chemo, they can improve or worsen your chemo brain symptoms. Take stock of how you’re doing on the basic lifestyle habits to keep chemo brain problems to a minimum.

Get six to eight hours of sleep. Even if you feel you don’t have time between doctor appointments and work, make the time.
Fit in activity nearly every day. It doesn’t have to be an hour workout at the gym, just focus on taking the stairs instead of the elevator or going for a 20-to-30-minute walk. Exercise is often the first thing people give up when stressed for time, and it should be the last. Getting regular exercise also helps you sleep better. It will improve your energy level, sense of well-being and thinking skills.
Improve your diet or maintain a healthy one.

Work and Your Diagnosis and Treatment

Before you approach colleagues, talk to your doctor specifically about how your illness can affect your career. Here are a few helpful tips to smooth the process:

Tell your doctor exactly what your job is and any unique circumstances you'll be coping with.
Let your doctor know that it's important to you to make decisions that are good for your health and your job whenever possible.
Ask for general ideas of how your diagnosis, medication or treatment could affect your job.
Know the specific details on all treatments and medicine. What are common reactions? What can you do to manage them? Know what each medicine is and how it will affect you. See if you can be flexible with the time you take your meds, in order to minimize any side effects at work. Ask about oral chemotherapy and other options that might be less disruptive to your work schedule.
Ask your doctor for advice on working during treatment.

Working Through It

If you plan to continue working while undergoing treatment, you can make the process easier for yourself - as well as your employer and co-workers - through planning, preparation and communication.

Communication

Regular communication will help prevent your coworkers and supervisors from questioning your value and productivity as a staff member. Everyone will need reassurance that you're still part of the team. A lack of communication can give rise to confusion and anxiety – or even mistrust and suspicion – whereas clear and constant communication can help build a world of reassurance.

Pointers & Ideas

Communicate regularly with supervisors and coworkers to let them know how you intend to stay on top of your work responsibilities.
Initiate regular meetings with supervisors – and colleagues, if appropriate – to review expectations and productivity.
Inform supervisors and coworkers if there's any change in your condition or treatment that will affect your performance. If you need to take time off, stay in touch with one or two people by phone or e-mail to keep your lines of communication open during your absence.
If you need help, ask. It doesn't convey weakness. It shows that you're invested in ensuring the best outcome for any given project.
If colleagues handled some of your responsibilities during your absence or while you transition back to work, let them know that you truly appreciate their support.
If you think you are eligible for a reasonable accommodation, talk to your supervisor.

Keep A Work Diary

Use It To:

Map Out Your Work Week

Keeping careful notes about the way you feel throughout each day and week should reveal important patterns about the effects of your treatments and medications. If your hours are flexible, work during as many of your peak-performance hours as possible. You can also schedule important meetings and presentations for the mornings or afternoons when you know you're likely to feel your best.

Find Optimal Times For Treatments

Your work diary can help you determine whether it makes sense to schedule doctor appointments before work, during your lunch hour or at the end of the day. If you feel exhausted three or four hours after treatments, for example, schedule 2 p.m. appointments, so you'll be off work when that fatigue hits. Or if your body needs a few days to recover from treatment, try to schedule sessions for Friday afternoons.

Document Your Work Schedule

By tracking your hours and reactions to treatment, your notes could prove valuable if problems arise at work. What if your worst-case scenario presents itself and you suspect that your rights are being violated? You'll already have a detailed first-person account, describing your daily and weekly schedules.

Nutrition and a Proper Diet

A proper diet is your ally for cancer patients undergoing treatment, although you may not always feel like eating. The right food can go a long way toward alleviating treatment-related symptoms such as fatigue and weight loss and will help your body bounce back once treatment is over.

Unfortunately, the side effects of chemotherapy and radiation sometimes make it difficult to get excited about dining. In addition to leaving you weak and nauseated, these treatments tend to damage the delicate cells that line your mouth and gastrointestinal tract, altering the taste of food and making eating uncomfortable even when you are hungry. But changes in your food choices and eating patterns can help.

Most treatment centers now offer nutritional counseling to help patients cope with side effects and maintain a healthy diet while undergoing chemo or radiation. If you haven't already done so, ask your doctor for a nutrition referral so you can get individual guidance. The following will help you get started.

Be kind to your mouth.

Chemotherapy and radiation can leave your mouth dry and prone to sores and infection. You can preempt some of these problems by keeping your mouth well-lubricated and taking extra care of your teeth and gums.

Brush your teeth with a soft toothbrush every time you eat. Periodic rinses with mouthwash are a good idea as well - just avoid products that contain alcohol, which will further dry your mouth.
Keep a water bottle with you at all times and take a sip every few minutes.
If you like gum, consider trying Biotene's dry mouth gum (available at Drugstore.com), which is designed to reduce mouth sugars and stimulate saliva production.
If liquids alone don't help, try a mouth-moisturizing gel such as Oralbalance (available at DentalDepot.com), which can keep your mouth moist for up to eight hours.

Forget the food pyramid.

Standard nutritional advice doesn't necessarily apply when you're undergoing chemotherapy or radiation treatments. Yes, you should eat plenty of fresh fruits, vegetables and whole grains - but if you want to maintain a healthy weight in the face of nausea, taste changes and loss of appetite, rich, high-calorie foods are your new best friends.

Follow your internal clock.

You may find that your appetite is better at some times of day than others. Many cancer patients find that their appetite is best in the morning. So if you feel like having a burger and a milkshake for breakfast - go ahead. And if you don't feel like eating, don't force it.

Let others do the cooking.

Food odors trigger nausea in many cancer patients. Dining out, ordering in, or letting other family members cook is a good way to protect yourself (and enjoy some well-deserved pampering). When you do cook your own meals, stick to foods that aren't particularly pungent and be sure to eat in a room other than the kitchen.

Pour on the sauces!

Butter, salad dressings, gravies and rich sauces that you might have avoided before your diagnosis are the ideal condiments now. The added moisture is soothing to dry, sore mucus membranes, and the added calories can help you maintain a healthy weight.

Avoid extremes.

Very hot or very cold foods will irritate sensitive tissues in your mouth and throat. Opt for cool or warm foods, such as salads, vichyssoise or gazpacho, whenever you can.

Keep your favorite foods on hand.

There are sure to be times when you simply don't feel up to cooking or going out to eat. Prepare for these occasions by stocking your home and office with snacks and ready-to-eat foods that you can grab when necessary. Include some bland items that will help quell nausea, such as saltine crackers, as well as calorie-rich favorites like ice cream.

Following nutritional diets for cancer patients may lower the effect chemotherapy has on the taste buds.

Recipe: Cayenne Taffy

Capsaicin, the active ingredient in cayenne pepper, has long been used as a topical pain reliever. In 1994, a medical student at Yale University developed this recipe for a cayenne pepper taffy, which kills the pain of mouth sores and increases the flow of saliva without the "burn" normally associated with hot peppers.

1 cup sugar
3/4 cup light corn syrup
1 tablespoon cornstarch
2 tablespoons butter
1 teaspoon salt
2 teaspoons vanilla
1/2 teaspoon cayenne pepper

Heat all ingredients except the vanilla and cayenne over medium heat, stirring constantly until the mixture reaches 265 degrees F. Remove from heat and stir in the vanilla and cayenne. When the mixture is cool enough to handle, butter your hands and pull the mixture until it is satiny and stiff. Pull into long strips, cut into 1-inch pieces, and wrap with waxed paper.

Nutrition: Practical Tips to Cope with Treatment Side Effects

The side effects of chemotherapy and radiation treatment can cause a number of eating problems that can prevent patients from getting the nutrition they need to fight infection and aid their recovery. In addition to a lack of appetite and nausea, complications include sores or pain in the mouth and throat, dry mouth and changes in the taste buds that make many foods unappealing.

Most treatment centers now offer nutritional counseling to help patients cope with side effects and maintain a healthy diet while undergoing chemo or radiation. Some types of cancer (esophageal, intestinal, etc.) have very specific guidelines for nutrition. In some cases where eating is impossible, nutritional therapy may help, in the form of nutritional supplement drinks, alternative feeding methods (by tube or bloodstream) and medication.

The following are some practical tips for dealing with the most common problems associated with eating and cancer treatment Be sure to check with your doctor or nutritional counselor first to see if you have any specific concerns.

Lack of Appetite

It's common to feel no desire to eat, but it's essential to your health. Become committed to eating as well as you can.

Eat small meals throughout the day, rather than trying to consume three large ones.
Listen to your internal clock. If you know your appetite's strongest in the morning, make the most of it with a large breakfast.

Dry Mouth

This is one of the most common side-effects of treatment. Fortunately, there are ways to help you combat it.

Brush your teeth with a soft toothbrush at least four times a day, and always after you eat. Floss gently daily.
Rinse your mouth, avoiding products with alcohol.
Keep your lips moisturized as well.
Consider trying Biotene's dry mouth gum or a mouth-moisturizing gel such as Oralbalance.
Choose foods that are moist or add extra sauce, dressing or gravy.
Keep hard candy and ice chips handy, and carry water with you throughout the day.
Drink liquids through a straw.

Mouth and/or Throat Pain

In addition to dry mouth, you may experience throat pain or mouth sores that make eating painful and difficult.

Again, brush your teeth and rinse your mouth throughout the day.
Keep water with you and sip often.
Eat soft, tender foods that have been cooked well, making them easier to chew and swallow. Think: soft fruits, cottage cheese, yogurt, eggs, soups, mashed potatoes, oatmeal or pudding.
Avoid foods that are dry or coarse, such as crackers, cold cereal, raw vegetables and hard fruits.
Steer clear of foods that are spicy, salty or acidic, including citrus fruits, all of which may irritate your mouth or throat.

Changes in Taste

Patients often find, after treatment, that nothing tastes the same. These tips may help you cope.

Rinse your mouth out with water before each meal.
If you're experiencing a metallic taste in your mouth, using plastic silverware may help.
Citrus fruits can be refreshing - unless you have mouth sores that make them prohibitive.
Mints or gum can help keep your mouth feeling fresh.
Use more sugar in your foods to make them more palatable. (Note: If you are suffering from thrush because of your treatments, sugar can aggravate this condition.)
It may seem obvious, but indulge in your favorite foods.

Nausea

Food odors can trigger nausea, so let others cook for you or get takeout.
Notice which foods cause the most nausea and avoid them.
Sip fluids and eat small meals throughout the day, especially bland, dry items like toast or crackers.
Don't lie down within an hour after eating to help minimize reflux.

Hats For Cancer Patients

A number of stores, catalogs and web sites specialize in hats, caps and turbans for people experiencing hair loss due to cancer treatment. But don't limit yourself to these suppliers. Any hat will do, whether it's from a big department store or a resort boutique. A few tips on buying and wearing hats:

Look for deep hats that fit down over your head. 1920s-style cloche ones work well, as do many men's-style hats a la Annie Hall. Avoid any hats that you can see through -- they won't protect you from the sun or mask your hair loss.
Think about where you'll be wearing the hat. Wide-brimmed hats can be fun for outdoors and do a great job shading UV rays, but they also block overhead lighting at the office and can be awkward in crowded spaces like elevators, trains and restaurants. A wide brim may also be difficult to wear while driving if it hits the back of your seat.
Baseball caps are popular because they're adjustable, widely available and have a nice, casual look. Regular caps may expose part of your scalp, so be sure to apply sunscreen to the back or your head. You may want to buy a cap that is specifically designed to cover the lower part of your scalp. (These are available online, at specialty stores and through catalogs like the American Cancer Society's TLC, www.tlcdirect.org.)
The comfortable turban comes in a wide range of colors and is usually made of soft stretch fabrics. Look Good...Feel Better, a national public service program for women with cancer, teaches various beauty techniques and will show you how to make quick-and-easy turbans out of t-shirts. Adding a broach to a turban can spice it up, but be careful not to venture into 'Madam Zorba the Fortune-Teller' territory. If you want a little extra height to give the appearance of hair underneath, add a shoulder pad or two.
All hats should fit snuggly but not be so restrictive that they give you a headache. Loose-fitting hats can easily be tightened by adding a layer of foam, about one-quarter-inch to one-half-inch thick, to the inside of the hat. The foam sold in hardware stores for insulation around windows and air conditioners works well. If there's an inner hatband, you can slip the padding between the hat and band. Otherwise, buy foam with an adhesive backing and attach it directly to the hat. Adjustable hat-sizers are available from online e-tailers and specialty shops. Camping and travel stores like EMS sometimes carry hats with elasticized inner bands that adjust to the size of your head.

Unless the hat is made of extremely soft materials, you'll need to wear a wig cap, sleeping cap or scarf underneath to protect your scalp from irritation. Sleep caps and wig caps can be bought through a number of retailers and online. If you use a scarf under your hat, choose cotton, because silks can be too slippery.

Online Resources:

http://www.lookgoodfeelbetter.org
http://www.tlcdirect.org/ (American Cancer Society catalog)
http://www.headcovers.com
http://www.softhats.com
http://www.hatsscarvesandmore.com

Chemo hats come in all kinds of shapes, styles and fabrics. You may need to buy several of them to wear for different occasions.