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Cognitive challenges

Dr. Lori Bernstein, PhD, CPsych

Dr. Lori Bernstein is a licensed clinical neuropsychologist and works as a clinician investigator in the Department of Supportive Care at Princess Margaret Cancer Centre. She is an Assistant Professor in the Department of Psychiatry, University of Toronto, and holds a faculty position in the Graduate Psychology program at York University. Dr. Bernstein’s clinical practice includes neuropsychological assessment and psycho-educational interventions to teach patients self-management skills to better cope with cognitive impairment during and after cancer treatment. Her research focuses on understanding and characterizing cognitive changes that cancer and/or its treatment has on people and ways to help cancer survivors improve functioning so they can return to pre-cancer activities.

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Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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First author, Dr. Lori Bernstein, is part of the Cancer and Work core team member and is a neuropsychologist.

Many people report experiencing cognitive challenges during and after cancer treatment. Cognitive challenges may be influenced by the type and location of cancer, the type and duration of treatment, the presence of other disease and medical conditions, and mental health challenges such as depression, anxiety and stress.

People treated for cancer may notice changes in their cognitive abilities, including their concentration and ability to focus or multi-task. They may also find it harder to learn new information or recall previously learned information, and find words while speaking or writing. Gradual recovery usually happens after treatment is over, but it varies a lot between people. Some symptoms are minor, and others may be more bothersome. Persisting symptoms are more common in people who have had chemotherapy, hence, the terms “chemo brain” or “chemofog” even though symptoms can occur even in people who didn’t receive chemotherapy. The reasons why these changes occur are still unclear, but it is believed that there are many factors, and the problems are made worse in stressful environments.

Persistent symptoms may also occur when a tumour is located in the brain. Because the brain’s different parts are so highly specialized for particular functions, the location and the size of the tumour will cause specific types of deficits. Also, brain tumour treatments, the unique physiology of the individual and various medications can also alter cognitive functioning.

Vocational implications

You will need to consider how long you can concentrate on an activity, and if you require additional assistance to support (re)training. There may be periods during the day when you feel more or less mentally alert. Being aware of these patterns will help you identify work tasks and times when you need to employ strategies to maximize your performance.

For additional information see Pathways to Success for Youth Facing Neurocognitive Challenges (PDF, pages 9–12, Pediatric Oncology Group of Ontario).

Some potential problems that you might experience at work include:1

  • Difficulty answering questions quickly
  • Shifting from one task to another
  • Following step-by-step instructions when more than one given
  • Remembering the details of conversations and/or meetings
  • Organizing or assembling materials needed for a task
  • Remembering train of thought while speaking
  • Remembering specific words or names (“tip of the tongue”)
  • Following the flow of events

What you can do

There are strategies that both the employer and the employee can use to help an affected person manage cognitive deficiencies and reduce their impact in the workplace.

For instance, to cope with mental fatigue at work, take more frequent breaks. Also, be aware of your stress levels and work in such a manner to reduce distress. Distress can worsen weaknesses in thinking abilities, affecting performance. Notice factors that add unnecessarily to your stress levels, for example, too much talking in the workplace or other noise, and find ways to reduce them. If you cannot remove the trigger, engage in slow deep breathing and relaxation exercises.

When you are feeling overwhelmed, write down a short :”to do” list and order them in a way that makes sense given your priorities or constraints. Focus on the first one only. Don’t think about anything else. If you think of all the items on the list, it may be distracting or stressful, and your concentration will suffer. While you may have been able to multi-task before, it is mentally taxing and adds to feelings of being overwhelmed.

You may consider a formal cognitive assessment before returning to work. A cognitive assessment can help identify your challenges and tailor strategies to help you deal with cognitive difficulties.

For more on cancer-related brain fog, view the following video presentation by Dr. Lori Bernstein: Brain Fog: What is it & What can you Do About It?

Here are some other resources on brain fog and challenges with brain tumours, as well as cognitive problems:

Modify your work tasks and how you work:

  • Make modifications at your workplace that can help you be more productive.
  • Coach your workplace. Inform your colleagues and supervisor about challenges you are facing.
  • Enlist colleagues and ask trusted co-workers to prompt or remind you.
  • Rehearse if you have to make a presentation.
  • Develop or enhance your time management and organizing skills.
  • Reduce multi-tasking.
  • Make to-do lists and prioritize items; check the list throughout the day.
  • Use electronic calendar alerts.
  • Put your keys, files, coat and other items in the same place every day.
  • Conserve energy. Anticipate and work with your energy patterns.
  • Reduce distractions, such as noise or clutter in your workspace.
  • Learn stress management strategies.
  • Take more frequent breaks throughout the workday.
  • Practice self-acceptance. Don’t be hard on yourself if you notice you can’t remember something without a reminder.

View our Video on Returning to Work for Brain Tumour Patients.

Other Helpful Resources and Links


Changes in mood

Back to the list of common cancer treatment side effects