28 April 2014

Ian Gawler blog: Chemo-brain - a problem in need of a solution

Imagine feeling as if someone has turned a washing machine on in your head. This is what it felt like for me when I had 2 ½ months of chemo in 1976. I had expected the bad feeling, but there was no preparation for the memory loss that went with it.

Know anyone who has experienced a similar problem?

Over many years helping others deal with cancer, I have been faced with continual reports from people suffering “chemo-brain”. What to do?

Common symptoms include a wide range of cognitive problems. Loss of ability to pay attention, find words, remember things, think clearly, and perform daily activities in both the short and long term seem to be frequent side-effects.

So this week we go Out on a Limb once more, report on new research that is finally beginning to look into this vexed area, suggest antidotes (there are no significant medical solutions offered) and the request is there to share experiences you or people you may have know that were affected by chemo-brain via the comments section below

Also, if you have not seen them, I am having heaps of fun each week on Facebook linking some of my photos (yes, I do love photography) to meditation, with the caption "meditation delivers". You might like to check it out at www.facebook.com/driangawler, but first

Thought for the day

If a person is beset with mental pain,
He can relieve his suffering
By learning how to meditate
And then practicing it.

The turmoil gradually goes from his mind,
And the hurt of the mental pain is no longer there.
I have seen this happen with many, many people,
So I know beyond all doubt that it is effective.
         Dr. Ainslie Meares

Dr Meares published the world's first book on therapeutic meditation in 1967 - Relief Without Drugs. It sold over one million copies all around the world.

My take on chemo-brain is that it is a widespread, under-acknowledged, under-reported, under-treated problem that creates significant problems for a large number of people treated with chemotherapy. In extreme cases, I have had some people tell me the effects were so bad and so long-lasting that if they had known how badly their minds would be affected, they would not have had the chemotherapy.

Happily, at last months annual meeting of the National Comprehensive Cancer Network (NCCN) in the USA, cognitive dysfunction, commonly known as chemo brain, was reported to be a new "area of intense research".

In my view this cannot come too soon as the problem has been overlooked or neglected for many years.

In fact, one of the presenters at the meeting, Elizabeth Kvale, MD, medical director of the Supportive Care and Survivorship Clinic, at the University of Alabama, Birmingham commented that there is "limited" evidence to guide the management of this condition, and that "It is anticipated our understanding will expand substantially," with the benefit of new research.

What is known from research is that cancer-associated cognitive dysfunction impacts about 20% to 30% of all cancer survivors. In my experience, supported again by the research, effects last from months to a few years. In some there seems to be a life long affect.

Studies include a 2012 meta-analysis of 17 longitudinal breast cancer trials that found patients treated with chemotherapy performed worse than those who did not receive it in terms of verbal ability and visuo-spatial ability (J Clin Oncol. 2012;34:3578-3587).

One of the difficulties in this area is that research has shown a poor relationship between patient symptoms and objective measures that have attempted to quantify them. For example, the correlation between patient reports of cognitive decline and the results of investigative neuropsychological testing are "modest" according to the NCCN guideline on survivorship.

At present, there is no effective screening tool for the problem. The Mini-Mental State Examination (MMSE) and other tools lack "adequate sensitivity for subtle decline in cognitive performance," according to the NCCN.

However, among 189 breast cancer survivors who complained about memory, there was a significant association between results of neuropsychological tests and the complaints.

The NCCN guidelines do advise clinicians working with patients who complain of cognitive problems to inquire about their ability to pay attention, find words, remember things, think clearly, and perform daily activities.

Patients appreciate having their symptoms "validated," says the NCCN. “Validated”? Maybe we could hope for something more!

The NCCN does suggest people at risk can be screened for other factors such as depression that may contribute to cognitive impairment, while imaging studies are not recommended.

“Aside from giving a patient a neuropsychological evaluation and optimizing management of depression or other problems such as sleep disturbance, the only other first-line intervention for these patients is occupational therapy”, said Dr. Kvale. In the second line, clinicians can consider use of psychostimulants, according to the NCCN guide.

Suggested antidotes - from experience!

1. Be prepared

Chemotherapy varies in its intensity and side-effects, but clearly does commonly knock people around. Ideally, before starting treatment, during and after, adopt a anti-inflammatory, regenerative lifestyle - details are in You Can Conquer Cancer.

In my experience, this approach will minimize side-effects, optimize results and minimize chemo-brain.

How to do it? Eat good food and meditate – and exercise regularly. Keep this up throughout treatment.

2. Detox during chemo
If on 3 weekly cycles of chemo, many people have reported benefited from having a juice day or simple fast 2 weeks after each treatment.

3. Detox after chemo
Once a treatment cycle is completed, many report feeling significant benefit from doing a longer, more thorough detox. In my experience, a mono-diet works best in this situation, and all the details are set out in You Can Conquer Cancer.

4. Live to live
Once cancer free, it makes logical sense to look after yourself - look after your life - by continuing to live an anti-inflammatory, regenerative lifestyle. For me, it is worth enjoying being thorough. A long, happy life post cancer is possible!!!

The Cancer Council, the survivors and the book

Book: You Can Conquer Cancer

CDs / Downloads : The Gawler Cancer Program

Eating for Recovery

Cancer, Healing and Wellbeing 
Only 3 weeks to go before this 8 day cancer residential Ruth and I will present personally in Auckland and spaces are still available to join us.

We will cover the full range of Integrative Medicine options, – therapeutic nutrition, exercise and meditation, emotional health, positive psychology, pain management, the search for meaning and so on.

I will personally present the majority of the content but along with Ruth, participants will have the additional support and experience of Liz Maluschnig and Stew Burt; two very experienced and committed New Zealanders.

For details on this and the other cancer related residential programs for 2014 CLICK HERE 


  1. Hi All
    I experienced brain fog after months of chemo. I use the diet & meditation as recommended by Ian. I also have a positive mental attitude towards life.
    What I believe has given me an edge is treatments from an excellent Kiniesologist over the past 4 years since finishing chemo. She has been able to increase my cognitive function greatly - I can really notice the difference. Just research the practitioner well before spending your money. I live in Qld.

  2. This is really quite devastating to find out. I can only hope that some of these side effects stay in a box in storage deeply buried never to surface. I'd hate to think of the dilemma of having to decide between life-saving treatment and the possible consequences for these patients that need the chemotherapy...