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:
- Ask the Expert: Brain Tumours and Cognition (Brain Tumour Foundation of Canada)
- Ask the Expert: Communication and Cognition (Brain Tumour Foundation of Canada)
- Side Effects and Their Management: Memory and Cognitive Changes (American Brain Tumor Association)
- Returning To Work After a Brain Tumor Diagnosis (American Brain Tumor Association)
- Video on Returning to Work for Brain Tumour Patients (BC Cancer Agency)
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
- Pathways for Success: A guide for educators, counsellors and families for survivors of childhood cancer
- Macmillan Cancer Support: Side Effects and Symptoms
