As a survivor, when you notice changes or feel that something is off with your thinking, attention, or memory, it is important to address concerns with your oncologist. You know yourself better than anyone else and if you are concerned or worried about cognitive issues or “fogginess,” it is important that you let your doctor know.
During cancer treatment, up to 75% of patients can experience some type of cognitive dysfunction. Although most issues resolve after treatment, almost a third of survivors continue to experience long-term deficits known as “Chemo Brain” or “Chemo Fog.” (1) Survivors may notice changes in cognitive processes such as memory – both visual and verbal, attention, executive function, and language. (2) These issues can range from subtle to severe and unfortunately most survivors to not talk to their physicians until it greatly impacts their day-to-day functioning. The medical community has been trying to understand “Chemo Brain” for several decades and is still working hard on it today. Unfortunately, there are no medications available that can alleviate these deficits. The current recommendations for treatment are cognitive rehabilitation, exercise, and meditation. (3) Given the decades of life years ahead for many survivors, particularly those of childhood, adolescent, and young adult cancers, it is imperative cognitive issues are addressed as soon as they arise.
Cognitive rehabilitation therapy (CRT) is a systematic and functional approach focused on inducing changes in cognitive functioning by either reestablishing or strengthening previously learned patterns of behavior or 2) establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological pathways. (4) The overall goal of cognitive rehabilitation is to induce neuronal growth via plasticity. In 2011, the Institute of Medicine (IOM) published a report on cognitive rehabilitation where they described two general approaches for rehabilitation: (5)
1) Restorative treatment, whose goal is to improve the cognitive system to function in a wide range of activities;
2) Compensatory treatment, which trains solutions to specific problem areas such as using memory notebooks or learning selfl-cuing strategies.
How these approaches are implemented by a psychologist, social worker, occupational therapist, or any other health provider depends on the individual practitioner. Many methods of CRT involve the patient to work independently on strategies or skill assessments. However, over five decades ago, Reuven Feuerstein developed a cognitive rehabilitation system where the client works through training tools with a mediator. This approach is based on structural cognitive modifiability and mediated learning experience. It consists of three application systems;
1) a dynamic-interactive assessment of learning capacity and processes of learning, the LPAD (Learning Propensity Assessment Device);
2) a cognitive intervention program called “Instrumental Enrichment Program”, which trains cognitive, metacognitive and executive functions; and
3) a program, which is oriented at working directly within the context, Shaping Modifying Environments. (6)
Unlike other CRTs, the Feuerstein approach has been utilized in individuals with cognitive functioning issues due to many different causes across the entire age spectrum, such as congenital neurological impairment, autism, and dementia.
Regardless of approach taken, the most important part of any therapy begins when you let someone know you need help.
- Palmer C. Cognition and cancer treatment. Monitor on Psychology. 2020;51(2):42.
- Pendergrass JC, Targum SD, Harrison JE. Cognitive Impairment Associated with Cancer: A Brief Review. Innov Clin Neurosci. 2018;15(1-2):36-44.
- Society AC. Chemo Brain. 2020; https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/changes-in-mood-or-thinking/chemo-brain.html.
- Harley JP, Allen C, Braciszewski TL, et al. Guidelines for cognitive rehabilitation. . NeuroRehabilitation. 1992;2(3):62-67.
- Medicine Io. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence. Washington, DC: The National Academies Press; 2011.
- Lebeer J. Significance of the Feuerstein approach in neurocognitive rehabilitation. NeuroRehabilitation. 2016;39(1):19-35.