You’re back at work after cancer treatment — or maybe you’re nearly done with treatment and working part-time. Either way, you’re likely eager to get back to “normal.” But if you’ve had chemotherapy (or even if you haven’t), you may notice your concentration, memory or other work skills aren’t quite up to par. This mental fog isn’t your imagination. It’s called “chemo brain.” Experts actually prefer the term “cognitive dysfunction associated with chemotherapy” or “post-chemo brain,” to more accurately describe it.

What Is Chemo Brain?

By whatever name, if you have it, you know it: memory lapses, difficulty remembering details, lack of concentration, inability to multi-task the way you once did, problems remembering names or spelling common words, inability to think as fast as you used to or difficulty remembering the steps of tasks you once performed easily.

Exactly how it occurs isn’t certain, but some experts suspect some chemotherapy drugs may slip past the “blood brain barrier,” which separates chemicals that belong in the brain from those that do not, and adversely affect cognitive skills.

While experts say they have a lot to learn about chemo brain, they do agree that it’s a real condition — and research suggests it may linger after treatment is completed. The treatment itself may impact nerve and brain function, and those effects may be complicated by the stress of coping with your cancer diagnosis and the fatigue from dealing with related issues and an overloaded schedule. Some people may be more genetically vulnerable to chemo brain than others.

Although research about chemo brain is still evolving, there are many steps you can take at work to help clear the “fog” and perform better. Below are some tips:

Chemo Brain: What to Do at Work

What you can do:

• Be aware of your stress level and work to reduce it. Excess stress by itself can impair your performance and thinking skills. Look to the source of the stress — a coworker playing a radio too loudly, constant chatter — and try to resolve it.
• Learn quick rescue techniques to combat stress during the day. One technique is deep abdominal breathing. Focus on breathing in deeply and exhaling deeply until you feel calmer and more in control.
• Minimize exposure to any toxins — whether it’s open windows that let in polluted air or workplace materials that are toxic. The aim is to keep your brain as healthy as possible.
• When you are feeling overwhelmed, write down a list of priorities. (A good idea even if you’re not feeling overwhelmed.)
• Once you’ve prioritized your to-dos, tell yourself you will focus on only the first task that needs to be accomplished. Don’t think about anything else. Otherwise, your concentration will suffer. As distractions decrease, concentration increases.
• While multi-tasking used to be viewed as an efficient way to approach things, experts say only 2% of people are actually good at it — regardless of their health, age, etc. So you’re better off working on one project — one task — at a time.
• Rely more than ever on “memory assist” tools, such as alerts, notifications and voice memos. Perhaps you have always used a computer-based calendar, for instance. Now, use the alerts built into it to remind you of an upcoming meeting, a project due date or other details. Learn about the features of your smart phone that can help you stay on track.
• Set up your work environment to boost concentration. That means clearing everything off your desk or your immediate work area, except what you are working on at the moment. Turn off your email notifications (or log out of your email entirely). If you have difficulty ignoring the world, create an auto-reply message that tells people you will respond at a specific time each day. Then, when you do turn your attention to email, stay completely focused on that task so you are able to get it done quickly. You can do the same with your voicemail message, choosing to return calls at a specific time.
• Rehearse to remember. Some research suggests that if you read something out loud, such as a name or a fact, you are less likely to forget it. The reasoning? Visual and aural input together help you remember. You can use this technique to talk yourself through challenging tasks at the computer. Maybe there is a word-processing technique you used to know by heart, but now you don’t remember it as easily. Print out the “help” instructions, then read them aloud and talk yourself through the process until it is second nature again.
• Get in a rut. Put your keys, ID, glasses and other items in the same place day after day. It will reduce the “Where is it?” stress when you are under fire and running late. At home, designate a “launching pad,” where you put everything you need to take to work the next day — ID/office access card, keys, phone, wallet, glasses, laptop. It will reduce that early-morning stress and allow you to concentrate and focus.

How coworkers can help:

• Ask for assistance from coworkers you know and trust. Tell them you could use some input to make sure your work projects are up to standards. For example, when you write a report, show the rough draft to one of your colleagues and ask for comments. Tell them to let you know if you’ve missed any important points or if you need to improve the grammar.
• Interact with coworkers. Being in a socially stimulating environment for at least part of the workday helps brain function. This “real world” connection is part of the recovery process. Somehow, the combination of thinking and talking is good for repairing the brain.
• Ask a coworker you trust to help retrain you on any tasks you’ve forgotten how to do. If you are the one responsible for ordering office supplies or scheduling staff meetings, ask someone to walk you through the steps if you’re having difficulty remembering. If a coworker offers to do the task for you, gently decline and emphasize that you are trying to relearn the process.
• Ask a coworker you trust to prompt you if/when they notice you need help remembering names, facts, schedules or other details.

How to Manage Your Lifestyle to Improve Focus

Our overall lifestyle habits can impact our ability to perform our jobs, regardless of whether we’ve gone through chemotherapy. Therefore, it’s not surprising that those same habits can help improve (or worsen) the symptoms of chemo brain. Take stock of how you’re doing on these basic lifestyle habits to keep cognitive-function challenges to a minimum.

• Get six to eight hours of sleep every night. Even if you feel that you don’t have the time — between doctor appointments, work, family obligations, etc., — make the time.
• Fit in some sort of physical activity nearly every day. It doesn’t have to be an hour workout at the gym, just focus on taking the stairs instead of the elevator or going for a 20-to-30-minute walk. Exercise is often the first thing people give up when pressed for time, and it should be the last. Getting regular exercise also helps you sleep better. It will improve your energy level, sense of well-being and thinking skills.
• Maintain a healthy diet.

For more tips on how to reduce cognitive challenges on the job, download a copy of our one-sheet on “Ways to Counteract ‘Chemo Brain’ at Work.”

Updated 2021