I defeated breast cancer, but am still battling the cognitive changes left behind after two years of intense treatment. Eight surgeries, six chemotherapy treatments, 25 radiation appointments, and two bouts of infection changed my body forever.
I’m OK with that, because everything was done to keep me alive. All signs point to these efforts succeeding. But one remnant of the battle didn’t get left behind with the wigs and empty medicine bottles: chemo brain. “Chemo brain” is a common term used for the attention and memory issues often caused by cancer treatment—although these issues are thought to come from multiple sources, not just chemotherapy.
I never imagined this ironic side effect of the cancer battle. I’ve worked as a speech-language pathologist in acute care and rehab for 30 years, and now I faced the same cognitive challenges I’d helped many of my patients overcome. I love my job, my patients, and my work family. Was I going to be able to continue to work full time? Or at all?
Gayla Poling seeks ways to prevent and treat hearing loss in patients receiving cisplatin treatment for cancer.
I first noticed my chemo brain when I lead meetings in my small department of four SLPs. We’ve been a team for years and communicate well. But in meetings, I experienced difficulty keeping a thought. I’d get lost in what I was saying and freeze mid-sentence. I couldn’t think of a word so would use another poor substitute. I also struggled to write patient notes, often sitting for prolonged lengths of time in front of my computer, trying to think of common terms.
I knew I was experiencing more than just typical lapses and I couldn’t brush it off as “senior moments.” I wish I could tell you how I applied a standard treatment plan for chemo brain and I’m functioning normally. But a standard treatment plan doesn’t exist and I’m not all better.
My self-designed treatment plan includes medicines provided by a cancer psychiatrist, advice from neuropsychology friends, counseling for adjustment, lots of reading about chemo brain, and figuring out effective organizational changes. The support of my work family gave me the biggest boost toward handling my cognitive challenges and helped prevent additional stress.
I’ve also learned so much more about my attention, executive functioning, and memory. I know what factors affect each of those cognitive domains in both positive and negative ways. It’s like a sliding scale each day, with my abilities changing in response to my inner and outer environments. My experience figuring out how to adjust and treat my own issues also made me a better SLP.
Here’s what I learned:
Take time to know your client. When working with a client with chemo brain—or any client with cognitive issues—get to know who they were before the illness that brought them to you. I really see how important it is to discover my patients’ strengths and goals before deciding on a treatment plan. Ask a lot of questions, including “What bothers you the most?” or “What are your strengths?” and “What’s a typical day for you?”
Define challenges and controllable influences. Help your clients put a name to their issues—attention, memory, executive function—so they can learn about these issues and understand their challenges. Work with them to create a list of positive and negative influences on their performance and teach them how to adjust and plan around those influences. This will empower your clients. Each day I think through my meetings, patient care, and home life. I consider how tired I am, how noisy it is, and how familiar I am with content. I control what I can and adjust for the rest.
Consider educating others. Teaching your patients to educate others about their situation is a powerful tool. If someone does not feel comfortable doing that, encourage them to find a trusted friend or a counselor who can support them. After many sleepless nights worrying if I could keep doing my job, I decided to open up to my coworkers. They responded with nothing but support and offers of assistance. Without this extra stress, I made fewer mistakes.
My chemo brain isn’t gone, but I am improving. Or maybe I’m just adapting. Either way, I feel more confident at work and at home. I know my strengths and challenges and take time each day to plan around them. Please get to know your clients, what scares them, and what motivates them. Teach them what affects their thinking and memory and how they can take control over some things. Finally, do your best to help them reach out to those around them.
I think evaluating and treating “chemo brain” will continue to grow in our professional scope of practice, and I hope to be part of the change.
Mary Ann Eller. MA, CCC-SLP, is the clinical services coordinator for speech-language pathology at Duke Regional Hospital, Durham, North Carolina. firstname.lastname@example.org