Professional Management : BC Cancer Agency

Reviewed: December 2006

The first and most important strategy in managing memory/thinking dysfunction in people with cancer is to be alerted to this disturbing symptom and evaluate its affect of quality living. Once memory/thinking dysfunction is recognized there are many treatment and management options that can make a huge difference in how you feel and function daily.

An important first step is to consider reversible causes of memory/thinking dysfunction such as anemia (low red blood cell count), nutritional deficiencies, depression, pain or other unmanaged symptoms, such as fluid and electrolyte imbalances and infection.

Management with Physical, Occupational, and Speech Therapy
Physical and occupational therapy can be of tremendous benefit for people who have developed weakness, generalized deconditioning, sensory neuropathy, or other nerve or musculoskeletal impairments from cancer and its treatment. Both of these treatment options can improve mobility and general physical stamina.

People with cancer who have developed impaired use of their upper extremities due to peripheral neuropathy, either from radiation to the area, lesions located in the spinal cord or brain, or chemotherapy or biologic therapy, may benefit from occupational therapy. Difficulties with swallowing, speaking normally, or even primary language problems may be helped by speech therapy.

Memory/ Thinking and Vocational Rehabilitation
If given the appropriate type of support, many people with cancer who experience neurocognitive impairments can improve their function at home , work, and play, and enjoy an improved level of independence and quality of life. Since people with cancer generally have fairly mild, limited cognitive problems, they tend to respond very well to focused rehabilitation efforts.

Memory/ thinking rehabilitation is designed to improve independence level, while vocational rehabilitation is designed to improve productivity, which may include volunteer work, performing household activities, going back to school, working at a modified job, or maintaining your current employment. A preliminary study found that brain tumor patients who underwent memory/ thinking and vocational therapy required shorter length of treatment, needed fewer rehabilitation sessions, and had better overall outcome in terms of independence and productivity, as compared with patients who have traumatic brain injuries.

Physical and Mental Activity
Daily mental and physical activity can help preserve memory and other mental functions. Mental activity increases the connections between brain cells and keeps the connections active. If brain cells aren't used regularly their connections will weaken. Brain-strengthening mental activities include reading, doing puzzles, playing a musical instrument, painting, cooking, redecorating, woodwork, knitting or crocheting, needlework, writing journals or articles, and some computer games to name a few. Taking up a new hobby is one way to stimulate your brain through learning. Regular physical activity can also protect the brain. Brain-protecting physical activities include walking, going up and down stairs, hiking, cycling, driving, and gardening.

Education, Counseling, and Support Groups
Healthcare providers may not discuss potential neurobehavioral symptoms with people living with cancer, in part, because these clinicians are not aware of the impact that even subtle symptoms can have on functioning. People who experience neurobehavioral symptoms and their families may feel isolated and alone.

This is why education is extremely important. The more knowledge you and your family members have about the disease, treatment, and expected problems, the more effectively you can cope. Even simple strategies, such as taking intermittent naps, writing notes, and taking special care to plan and organize activities, may be sufficient to effectively cope with symptoms.

Support groups and counseling can also reassure you and you family that your experiences are not unusual, and can help you deal with the grief, anger, frustration, and other problems that frequently arise over the course of the disease.

Behavioral Approaches
Recognizing the challenges of cognitive impairment and putting in place compensatory strategies, or methods to compensate for it, demonstrates a very high level of coping. These strategies include list making, developing a system of reminders, keeping a calendar, journaling, and many more activities that keep track of time and events that are apt to be forgotten.

Stress has long been associated with difficulties in memory/ thinking performance. Creating methods of stress management and incorporating them into your daily routine is essential, particularly for those living with cancer. Methods of reducing stress are self-defined, that is, what works for one person may not work for another. Take time to investigate what calms and soothes you, and try to incorporate these activities into your daily life.

Memory/ thinking behavior therapy addresses the role of unresolved stressors or issues in your life. During memory/thinking-behavioral therapy, your therapist takes an active role in modeling and mentoring the reshaping of new perceptions and empowers new behaviors for you to practice and make part of your life.

The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.