Cancer and its treatment can be stressful for people with cancer and their caregivers. Relaxation techniques and other mind/body practices can help calm your mind and sharpen your ability to focus. These techniques offer creative ways to reduce stress caused by cancer and to maintain inner peace. For example, some people with cancer and caregivers use these techniques to help them relax as they wait for treatments or test results.

Here are some techniques that can help you cope with the challenges of cancer:

DEEP BREATHING EXERCISES

At the core of life is breath. Laughing and sighing are the body’s natural ways of getting us to breathe deeply. That is why we often feel calmer or rejuvenated after these experiences. Anxiety and stress can make us take short, shallow breaths. Shallow breathing, which does not allow enough oxygen to enter our bodies, can make us even more anxious.

Try this four-step breathing exercise. It can be done anywhere, anytime:

1. Take in a deep breath from your diaphragm (this is the muscle between your lungs and abdomen).

2. Hold the breath for several seconds – however long is comfortable for you – and then exhale slowly.

3. Repeat steps 1 and 2 two more times.

4. Afterwards, relax for a moment and let yourself feel the experience of being calm.

MEDITATION

Repetitive prayers are a form of meditation. Two other traditional forms of meditation include “one-pointed” and “two-pointed” meditation:

One-pointed meditation focuses on a word or sound called a mantra.  Many people create their own mantra from an affirming word, such as “peace,” “love” or “hope.” Once you choose a mantra, find a safe, quiet place and repeat it to yourself during 15- to 20-minute sittings.

The goal is to relax the mind, which has a natural tendency to jump from one idea to the next – and from one worry to the next. Do not try to force your mind back to your mantra when you notice it has wandered. Simply guide it back gently, accepting that it will stray again.

Two-pointed meditation is also called “mindful” or “insight” meditation. With this technique, you relax your mind by focusing on your breath. As your mind jumps around, practice “non-judgmental awareness” – simply observe the pattern of your thoughts and gently guide them back to focus on your breath.

Non-judgmental awareness allows you to separate yourself from emotions and sensations rather than getting pulled into them.
One benefit of this type of meditation is that you can practice it while seated quietly or when doing daily activities.

GUIDED IMAGERY

This stress-reducing technique combines deep breathing and meditation. As you practice deep breathing, imagine a peaceful scene or setting, perhaps from a memory. Once you are relaxed, you can create a “wakeful dream” in which, for example, you envision pain being washed away or your body becoming stronger.

These exercises are often accompanied by “ambient” sounds, usually music or sounds from nature, such as waterfalls or ocean waves. Sometimes just listening to ambient sounds is enough to relax your mind and briefly transport you emotionally to a place in which you feel safer and more secure.

FINDING ADDITIONAL RESOURCES

Some cancer treatment centers have programs to teach people with cancer and caregivers the basics of relaxation or meditation.

There are also a number of easy-to-follow educational books and audio-recordings on this subject that provide step-by-step instructions.

Your nurse or oncology social worker may also be familiar with relaxation exercises and mind/body practices, or he or she may be able to refer you to others who can help you
learn these techniques.

CancerCare® Can Help

CancerCare’s professional oncology social workers are available to help you develop your own strategies for reducing stress and maintaining inner peace as you cope with cancer. We also provide education, support groups, financial help, and referrals – all completely free of charge. To learn more, call 1-800-813-HOPE (4673) or visit www.cancercare.org.

Many people going through cancer treatment notice changes in their memory and thinking abilities. Coping with symptoms of chemobrain involves finding ways to help you remember things better, and doing activities that keep your memory sharp. Below is a list of tips for combating chemobrain. Check off the ones that you think would be most helpful, and then give them a try to see which work best for you.

• Make lists. Carry a pad with you and write down the things you need to do.   For example, keep lists of things to buy, errands to run, phone calls to return, and even the times you need to take your medicines.  Cross items off as you finish them.

• Use a portable planner or personal organizer. These can help you stay on top of day-to-day tasks and keep track of appointments and special days like birthdays and anniversaries. Paper and electronic versions are available.

• Get a wall calendar. For some people, this works better than a portable planner because you can hang it up in a place that is easy for you to see everyday. Put it on your refrigerator or even on your bathroom mirror so you’ll be sure to look at it several times a day.

• Keep a “memory notebook.” For many people, a simple, ruled notebook works just as well as a planner. Use one to record everything you need to remember, such as:

• lists of things to do;
• the days, times and addresses for appointments;
• your medication schedule;
• important telephone numbers; and/or
• the names of people you meet and a little description of who they are.

• Avoid distractions. Work, read, and do your thinking in an uncluttered, peaceful environment. This can help you stay focused for longer periods of time.

• Have conversations in quiet places. This minimizes distractions and lets you concentrate better on what the other person is saying.

• Repeat information aloud after someone gives it to you, and write down important points. For example, before you write down an appointment, you might say, “Okay, so we’re meeting at 2:00 p.m., Monday, June 3rd, at 503 Main Street.”

• Keep your mind active. Do crossword puzzles and word games, or go to a lecture on a subject that interests you.

• Proofread. Double-check the things you write to make sure you’ve used the right words and spelling.

• Train yourself to focus. We often do one thing while thinking about another, which increases our chances of forgetting something important. For example, if you keep misplacing your keys, take extra time to think about or picture what you’re doing every time you put them down. Also, say aloud to yourself, “I’m putting my keys on my dresser.” Then look at them again, and repeat: “Keys on dresser.” Auditory (hearing) cues give your memory an extra boost.

• Exercise, eat well and get plenty of rest and sleep. Research shows that these things help keep your memory working at its best.

• Consider telling loved ones what you’re going through. Depending on how private a person you are, you might tell your family, so that they’ll understand if you forget things you normally wouldn’t forget. They may be able to help and encourage you.

• Speak with an oncology social worker. If living with symptoms of chemobrain makes you anxious or sad, seek help. Oncology social workers, such as those at CancerCare, can work with you to help you find ways to cope.

CancerCare® Can Help

CancerCare has a staff of professional oncology social workers who understand the challenges of cancer. We are available to help you address any concerns you may have
about chemobrain or memory loss. We also provide education, counseling, financial help, and practical help, and all our services are completely free of charge. To learn more,
call us at 1-800-813-HOPE (4673) or visit www.cancercare.org.

Concentration is your ability to work without letting people, feelings or activities get in the way. There are three steps to developing your concentration abilities:

• Establishing concentration
• Increasing concentration
• Developing the concentration habit

This fact sheet provides tips on how to develop each of these abilities.

ESTABLISHING CONCENTRATION

Be aware of external distractions and separate yourself from them. For example, give yourself permission to let your answering machine pick up calls and not to check your email while you’re working on a task. Or, ask your family for an hour of uninterrupted quiet time.

Try to recognize these distractions and take care of them. Internal distractions such as thoughts, emotions, physical feelings, hunger and tiredness can interrupt your ability to focus. Do something about the things that are bothering you before you start the task at hand. For instance, if you know that you are hungry, eat before you start a task.

Stop distracting thoughts that pop into your mind as soon as you are aware of them. You can do this by “noticing” the thought, and then consciously bringing your attention back to the task at hand.

Keep a reminder pad handy. If something that you have to do pops into your head, jot it down to get it off your mind.

INCREASING CONCENTRATION

Plan to concentrate. How interested are you in what you are doing?  If the answer is “not much,” then try to come up with reasons for developing an interest. Will the project give you a chance to learn a new skill? Or might finishing it give you a sense of accomplishment?

Use a pencil or highlighter. Taking notes or highlighting key points are ways to keep yourself actively involved in a task such as reading.

Divide tasks into manageable parts. You will feel a sense of accomplishment more often, which can help you stay motivated and on task longer.

Plan breaks according to your concentration span. You are not a machine. Taking a walk or a lunch break will help clear your head.

If you find yourself losing focus, stand up. The physical act of standing up brings your attention to the fact that you’re losing focus. It lets you stop the process and bring your thinking back to the task at hand.

Vary your activities. Change is often as good as a taking a break.

DEVELOPING THE CONCENTRATION HABIT

Like any other skill, concentration must be learned, practiced and developed. Here are some questions to help you get in a regular pattern of concentrating.

How long is your concentration span? Find out by recording your start time for a task like reading, and as soon as your mind begins to drift, record this time. Try this several times until you can gauge your average concentration span.

When is your concentration level at its best? Find a consistent time during the day when you know that you won’t be interrupted and that your energy level meets the demands of the particular task. Then, try to use that time slot each day to work on that task.

What are the conditions that best allow you to concentrate? Allow yourself to be removed from distractions for set periods of time to try and accomplish work. A clearedoff desk, good lighting, some light music in the background – figure out what works for you. Make the atmosphere as inviting as possible for you to concentrate better.

CancerCare® Can Help

CancerCare’s professional oncology social workers are available to help you with any concerns you may have about chemobrain. We also provide free education, counseling, financial assistance, and practical help. To learn more, call 1-800-813-HOPE (4673) or visit www.cancercare.org.

Talking to your doctor can be difficult, especially about symptoms of chemobrain. Not all health care professionals know how to evaluate chemobrain, and many may be unfamiliar with the resources that are available to help. If you have problems with memory and attention, or other difficulties related to chemobrain, speaking with your doctor is an important first step in getting the care you need.

These are CancerCare’s tips for communicating with your doctor about chemobrain:

• When you use the word “chemobrain,” your doctor may not be familiar with it. Tell him or her that chemobrain refers to cognitive problems after chemotherapy.

• Bring someone with you. It is always helpful to have a second set of ears, especially if you have trouble remembering information.

• Write a list of the specific problems you are having and try to keep the descriptions short. For example: “I can’t remember words,” or “It’s very hard for me to concentrate.”

• Keep a journal to help you remember your symptoms. Come prepared with information about when your symptoms started and if they are getting better or worse.

• I can’t remember words

• Write down the answers you get. This way, you can go over the information later when you have time to research and concentrate.

• If possible, bring a tape recorder. It is OK to ask your doctor if you can record your visit.

• Get a second opinion if your doctor doesn’t seem to take your thinking and memory problems seriously. Your difficulties might go away, but if they persist, these symptoms should be evaluated by a neuropsychologist.

Here are some questions you may want to ask your health care team to help you understand your difficulties:

• How long do chemobrain symptoms usually last?

• Can you evaluate me to see if my chemobrain symptoms are related to anything that could be more easily treated, such as low blood count or other medications I am taking?

• Can you refer me to a neuropsychologist to be evaluated?

• If you don’t believe I need an evaluation now, when should I come back for follow-up if these symptoms persist?

• How might cognitive remediation* and/or medication help me with these difficulties?

• Do you know a professional who might help me develop some strategies to make up for my problems with memory, attention and new learning?

• Is there anything else I should know? Is there anything I can read for more information on chemobrain?

• Show your doctor CancerCare’s fact sheet, “Cognitive Problems after Chemotherapy.” Ask your doctor about what he or she knows about resources in your community.

*Cognitive remediation: working with a trained professional to address problems related to thought processes.

CancerCare Can Help

CancerCare’s staff of professional oncology social workers can help you address individual issues you may have when communicating with your doctor about chemobrain. We understand the importance of this relationship, and our social workers offer you detailed advice on the telephone, online, or in person to help you foster the best possible relationship with your health care team. CancerCare also offers education, information and referrals to other resources to help you improve communication with your health care team.

If you have questions about chemobrain or need more information, call CancerCare at 1-800-813-HOPE (4673) or visit us at www.cancercare.org.

CancerCare’s Chemobrain Information Series was made possible through a grant from the Lance Armstrong Foundation.

Problems with memory and concentration, along with a general feeling of not functioning mentally as well as usual, are informally referred to by patients as chemobrain.  Health care professionals call these symptoms cognitive deficits, from the word cognition, which means thought, and the word deficit, which means falling short of.

If you are experiencing these types of problems, you may be experiencing chemobrain, and you are not alone:
• Memory loss
• Trouble paying attention
• Trouble finding the right word
• Difficulty with new learning
• Difficulty managing daily activities

People often notice these problems during chemotherapy treatment. Within one year of treatment, many people find these difficulties greatly improve or no longer exist. However, for some people, chemobrain can continue for years following completion of treatment.

Causes of Chemobrain

Researchers are uncertain of the exact causes of these difficulties, but they are currently studying this problem in order to find ways to both treat and prevent it.

The causes of long-lasting chemobrain (more than one year after treatment) are not known.   However, there are a number of very treatable factors that can cause temporary but similar problems in people undergoing chemotherapy. These include:
• Low blood counts
• Stress
• Depression
• Anxiety
• Fatigue and sleep disturbances
• Medication to treat side effects
• Hormonal changes resulting from some cancer treatments

So tell your doctor if you’re having trouble with your memory or notice any other symptoms of chemobrain. He or she can help eliminate some of the factors that can also cause cognitive problems. For example, medication that treats nausea can make you less alert and affect your ability to think clearly. A simple change to your prescription may make a real difference in how you feel.

What Can You Do?

There are things you can do to help yourself. Please see CancerCare’s fact sheet “Combating Chemobrain: Keeping your Memory Sharp” for helpful tips.

Neuropsychologists

If one year has passed since you completed chemotherapy, and you have tried self-help techniques to cope but are still troubled by memory and related problems, you will need a professional evaluation. Professionals who are skilled at assessing and treating the symptoms of chemobrain are called neuropsychologists.

Neuropsychologists are psychologists with special training that prepares them to help people experiencing trouble in areas such as attention, new learning, organization and memory. These doctors will do a complete evaluation and determine if there are any treatable problems such as depression, anxiety, medication and fatigue. They also identify the areas in which you need assistance, as well as your areas of strength.  After their evaluation is complete, neuropsychologists may suggest cognitive remediation or cognitive rehabilitation. This process involves working with a professional on problem areas and developing a plan that helps improve your functioning so you can better manage your daily life.
Remediation should also include practical ways to address your specific
areas of concern.

How Do I Find a Neuropsychologist?

Professional organizations can refer you to a qualified neuropsychologist. These are listed in the resource section of this handout. You can also ask your physician for a referral.  Once you have found a neuropsychologist, work with him or her to determine your insurance coverage for an evaluation and cognitive remediation. Some Medicare and Medicaid plans and private insurers pay for these services, but coverage varies, so it is important to have this information before deciding on a treatment plan.

What is The Role of Oncology Social Workers?

Talking with a social worker who understands cancer issues can be very helpful. Oncology (cancer) social workers are trained to help individuals cope with the emotional impact of these types of problems. CancerCare’s staff of professionally trained oncology social workers can work with you develop a plan to address these difficulties, including referrals to important resources. We offer detailed advice on the telephone, online, or in person to help you improve your functioning on many levels. CancerCare also offers free counseling, education and financial assistance.

Resources for Patients with Cognitive Difficulties

CancerCare

www.cancercare.org
CancerCare programs—including counseling, education, financial assistance and practical help— are provided by trained oncology social workers and are completely free of charge. We offer an
online archive of Telephone Education Workshops on topics such as chemobrain and improving memory, along with a series chemobrain fact sheets.

American Board of Professional Psychology

www.abpp.org
Best website to obtain the name of a highly qualified psychologist who is an expert in neuropsychology and in providing both evaluation and treatment to people experiencing problems in areas such as memory, concentration, new learning, prioritizing, and other difficulties associated with chemobrain.

American Psychological Association

www.apa.org
Has consumer section on how to reach each state’s psychological association. Every state has a referral service and can help you locate professionals with neuropsychology or rehabilitation medicine experience.

Neuropsychology Central

www.neuropsychologycentral.com
Provides information on neuropsychology evaluation, online support, rehabilitation literature, and treatment.

CARF: The Rehabilitation Accreditation Commission

www.carf.org
Lists an accredited rehabilitation program in each state and qualifies programs in outpatient medical rehabilitation, occupational rehabilitation, and brain injury rehabilitation, all of which may be helpful to patients with chemotherapy-related cognitive deficits. These programs are also likely to have a rehabilitation specialist or neuropsychologist associated with them.

CancerCare’s Chemobrain Information Series was made possible through a grant from the Lance Armstrong Foundation.

Cancer can be a life-changing experience, both physically and mentally. And when cancer treatment delivers a knockout punch to cognitive abilities, patients with the resulting “chemo brain” often face major challenges trying to get their lives back on track.

But those who recognize the cognitive effects of toxic cancer drugs, adjust their schedules and learn to compensate for what are usually temporary limitations have an easier time returning to a productive life.

Barbara D. Wick of Chicago, for example, was working part time as an insurance consultant and serving on several not-for-profit boards while receiving chemotherapy for ovarian cancer. It was suddenly a challenge for her to deal with the complex problems presented by her professional and volunteer activities.

“I found it difficult to deal with more than one factor at a time and scary to have to think on my feet,” she said. “And I couldn’t trust my memory.”

She continued working but stopped taking new clients and transferred a difficult account to someone else. Helped by a support group, Mrs. Wick adopted new ways to handle professional and personal demands.

“I learned coping techniques that are not really different from those that would be used for people with memory loss,” she said in an interview. “I write everything down immediately, including appointments, doctors’ comments, ideas of things to do, plans and promises I’ve made. This gives me something to go back to, and using more than one modality — listening and writing — reinforces my ability to remember the information.”

She said she also became a “list addict.”“At night, I make a list of what I have to do and where I have to be the next day,” she said. “I’ve become religious about always putting things back in the same place — keys, cellphone, scissors, bills, everything. I pay bills on the same date and I double-check and proof everything, sometimes twice.”

Strategies for Staying on Track

The symptoms of chemo brain — commonly mental fogginess that can cause problems with memory, concentration, word retrieval, number processing, following instructions and multitasking — are widely known. And the effects, the causes of which are still unclear, are sometimes long-lasting.

In an excellent new book, “Your Brain After Chemo,” Dr. Daniel H. Silverman and Idelle Davidson quote a 52-year-old woman who was treated four years ago with drugs and radiation for breast cancer:

“Ever since I got lost in the shopping mall garage and couldn’t find my car, I always write down the level number and color code, etc., on the back of my parking ticket,” she told the authors. “And I always place parking tickets in the same section of my purse so I know where to find them. For extra measure, I’ll play a word game. If I’m parked on B1, for example, I’ll make up a cue like: Be one with the universe.”

Dr. Silverman, a leading researcher in the field, and Ms. Davidson, a health journalist and former cancer patient, offer a long list of suggestions to help people who are struggling with the cognitive effects of chemotherapy. Even though I don’t have chemo brain, several of their tips already help me keep track of a complex life despite an aging memory. And while I’m not yet ready to buy a personal digital assistant, I plan to adopt several other strategies.

•

Prioritize. Because multitasking can be overwhelming to people with chemo brain, it helps to list tasks in order of their priority and concentrate on one at a time.

•

Develop routines. Prepare the night before for the next day. Review your calendar, lay out clothes, pack your briefcase, perhaps even set up breakfast and prepare a brown-bag lunch. Take medications and exercise at the same time each day.

•

Rehearse. On the way to a meeting where you will have to be on top of your game, visualize the room or the people who will be there and practice what you will say.

•

Use word associations or rhymes. Maybe Harry has lots of hair and Mrs. Gold lots of money. Perhaps your daughter-in-law’s birth date is 2-4-68 or the combination on your gym lock is 2 (times) 6 (equals) 12.

•

Rely on more than one sense. Try to link people and places with their scents, tastes, textures or unusual characteristics. Maybe Henry always wears a hat, or Rose’s front door is red.

•

Use a notebook to record information. My surroundings are covered with sticky notes, and I search frantically for something I know I wrote down somewhere. The authors suggest a single notebook so that everything is in one place, and dating the pages as you use them. They say, “This frees your desk and your mind from clutter.”

Post a checklist by the front door. Leave yourself a note of things to remember when you are going out — keys, wallet, walk the dog, close the windows, turn off the hose, check the faucets, lock the door.

•

Write phone numbers on your phones. It doesn’t take chemo brain to forget a phone number, and I’ve noticed that many people don’t know their own cellphone number. Program as many contacts as you can into your cellphone, and keep a list of frequently dialed numbers next to your landline.

•

Use a day planner. Write down all appointments immediately, with times, places and contact phone numbers. If you spend most of the day at a computer, you can use the calendar feature that alerts you to appointments. As a backup, I record things on a wall calendar and keep a paper tickle file, but this works well only if you check it regularly.

•

Leave messages for yourself. If you have voice mail or an answering machine, you can use it to remind yourself of appointments or tasks you have to do. But again, this works only if you check it regularly.

•

Timers can be lifesavers. I never put anything on the stove, in the oven or on the grill without setting a timer to warn me when to turn the heat down or off. I also have several 24-hour timers that I use as a wake-up alarm and to remind me when to move the car, pick up the grandchildren at school or put the laundry in the dryer.

•

Get adequate rest. Even without chemo brain, fatigue is a memory destroyer. Don’t skimp on sleep, and when you feel your brain dragging, take a 20-minute nap. Stress impairs brain function, so practicing relaxation techniques like meditation and yoga can be very helpful as well.

Let Others Help

Finally, don’t bite off more than you can chew. Until and unless your brain recovers fully, simplify your life. Follow Mrs. Wick’s example if you can and reduce your workload or your hours. Perhaps even take a vacation or a leave of absence. Less work done well is better than a lot done poorly.

If those options seem like luxuries you cannot afford because you need to work, this is the time to rely on friends and family. Delegate chores. Say yes to people who offer to cook meals. Tell family members, especially, what coping tips you’re using so they don’t inadvertently derail your efforts. In as many ways as possible, give yourself a break.