Chemo Brain & Fatigue

As cancer treatments improve, more and more people are either being cured or are living with cancer as a chronic illness. As a result, treatment aftereffects and the challenges they present are becoming increasingly apparent. Two of the more common aftereffects are cancer-related fatigue (CRF) and cognitive impairment, also known as "chemo brain."

The National Comprehensive Cancer Network defines CRF as "a persistent sense of tiredness related to cancer or cancer treatment that interferes with usual functioning." It is different from the everyday tiredness that can affect anyone, and is not readily relieved by rest or sleep.

Chemo brain may occur after chemotherapy and can include difficulties with memory, concentration, language, attention, reaction time, organizational skills and other mental functions.

"Many patients experience excessive fatigue or cognitive difficulties following their cancer treatments," says Swedish Cancer Institute rehabilitation physician David Zucker, M.D., Ph.D. "This can be very distressing.

"Fatigue," explains Dr. Zucker, "is the most common side effect of cancer and cancer treatment. And we know that cancer-related fatigue can compound the effect of chemo brain and, likewise, that chemo brain can increase cancer-related fatigue." 


Cancer-related fatigue can happen with all types of cancer and treatments.  Surgery, chemotherapy and radiation therapy, as well as combined therapies, can all contribute. CRF can last from a few days to a year or more, depending on the patient and the type of treatment the patient receives.

Dr. Zucker notes, however, that factors other than cancer treatment often play a role in CRF as well. Examples include pain, depression, anxiety, lack of exercise and poor nutrition. Medications used to treat conditions other than cancer can contribute to fatigue, too. 

The first step in combating cancer-related fatigue is to look for reversible causes, such as anemia, that can be treated medically. If none can be found — and this is sometimes the case — Dr. Zucker recommends that you:

  • Conserve energy by planning ahead, scheduling rest, pacing yourself, practicing proper body mechanics and avoiding extremes in temperature.
  • Eat a well-balanced diet and keep well hydrated by drinking plenty of fluids. If necessary, meet with a registered dietitian for guidance.
  • Begin an exercise program — after first consulting with a physician — that's based around low- to moderate-intensity aerobic activity such as walking, swimming or cycling. Stretching and light weight training can also be helpful. 
  • Manage stress, which for many cancer survivors includes finding activities or techniques that help you relax, exercising regularly, joining a support group, talking with friends and family, or talking with a counselor.

Chemo Brain

Although the problems that cancer-related cognitive impairments can create are well established, the causes are not fully understood. The good news is that there are a number of strategies to lessen the cognitive impacts of chemotherapy, and that do it without the use of medication. Dr. Zucker offers these tips to help patients with chemo brain cope (experiment to find what works for you):

  • Ask for help, because letting people know you have a problem will remove much of the pressure and help reduce stress.
  • Get enough sleep and establish a regular wake-up time and bedtime. Sleep is vital and regular sleep hours help your brain stay on track. Beware of anything that degrades the quality of sleep, including caffeine and alcohol.
  • Exercise regularly, since even short periods of simple exercise several times a day revitalize the brain and sharpen your thinking.
  • Eat well to ensure that your body and your brain are getting high-quality nourishment and plenty of fluids.
  • Exercise your mind. Discuss current events, work a crossword puzzle or start a new hobby.
  • Avoid multitasking and take your tasks one at a time instead of trying to do too much at once.
  • Create a "memory notebook" — take notes and keep a day-by-day record of upcoming appointments, important phone numbers and even your medication schedule. Consider keeping a personal diary of this challenging time in your life.
  • Reduce stress by giving yourself plenty of time to get to appointments and social events, and let people know that you are sometimes late.
  • Consider learning to meditate, since it can help you relax, strengthen your mind and help improve concentration.

"Notice that many of the suggestions for lessening the impact of chemo brain also can help with cancer-related fatigue," says Dr. Zucker. "By using these strategies, you can help reduce both."

Talk It Out 

If you think you are experiencing cancer-related fatigue or chemo brain, don't hesitate to talk to your physician or other health-care providers. For one, you don't want to carry this burden alone. Nor do you want to overlook the possibility that your problem or problems may be caused by a condition that's unrelated to your cancer or your cancer treatment.

And, finally, remember that physicians and researchers are studying cancer-related fatigue and chemo brain on an ongoing basis. If your physician knows that you are suffering from one or both of these conditions, then you will be well positioned to benefit from any medical advances when they become available.