Dealing with Cognitive Side Effects

Ovarian Cancer Cognitive Side Effects

Women who have undergone treatment for ovarian cancer sometimes report a decline in their cognitive abilities. Most often noticed are changes in multitasking, attention and learning/memory abilities. Though not everyone experiences this, both chemotherapy and a drop in sex hormone levels can have a negative effect on brain function.

Stress, fatigue and depression also impair some aspects of cognition as well as the ability to cope with everyday life/work. Unfortunately, a good understanding of the relative impact of these multiple factors (or their remediation) is currently lacking, though research is underway in several centres.

As a Neuropsychologist, I would recommend the following if, after an initial recovery period from surgery, chemotherapy or hormone inhibition, you notice longer term problems with your level of functioning.

Addressing Mood, Fatigue & Psychological Factors

First, it is best to try to deal with any mood/psychological/fatigue factors that might be playing a role. A discussion with your family physician and/or referral to a Clinical, Counselling or Health Psychologist for advice and treatment should help to address these issues. Larger, urban cancer treatment centres often include such specialised personnel.

In regional and remote areas, Clinical Psychologists in private practice can often be accessed for either face-to-face or (increasingly) web-based psychotherapy. If more severe cognitive problems persist, then referral to a Clinical Neuropsychologist for assessment and advice might be an option.

Strategies to Assist with Cognition

To help you cope with cognitive issues, I offer the following suggestions:

How to Multitask Better

Problems with multitasking and attention are best dealt with by minimising intrusive distractions, focussing on one thing at a time and improving your own routine.

For example:

Set aside two or three specific times per day to check emails or social media rather than allowing these to interrupt the flow of your work.
Keep a note pad with you and write down the things you need to return to in order to finish or use post-it notes to leave yourself messages in places you will find them when appropriate.
Try to do repeated tasks always at the same time of day or always on the same day of the week. For example, link activities such as your medication-taking, lunch-packing and gym-bag readying and do them in a particular order and at a specific time (make a list if necessary).
Remember that some activities, though normally done in the morning before heading out might better by accomplished during a quieter time such as in the previous evening.

Helping learning and concentration

If you are finding it difficult to concentrate or learn something new:

Reduce background noise
Reduce the chances of interruption (e.g., by closing your office door or forwarding your phone to an answering machine)
Move to a quiet space (or don headphones or earplugs)
Engage in mental tasks when you are at your brightest (for most this would be relatively early in the day or soon after a coffee!)
Remember that it is always easiest to learn something new if one is first shown what to do and then is given the chance to try and do it oneself a few times under supervision/guidance.
Repeatedly practice new things a few times soon after learning them.

Supporting Memory

To support your memory:

Ask people to remind you by sending emails with information or sending you calendar reminders. Or even send yourself an email, if it’s appropriate.
Use a diary or phone calendar with reminder alarms to record upcoming commitments, appointments and deadlines. Write in reminders for performing tasks as well. Of course, it’s also important to keep these devices with you!
If trying to remember something specific that you’ve forgotten (e.g., What was it you were supposed to order?), try to imagine the context in which it was learned: (e.g., Who told you? Where were you when it was told to you? How did you react emotionally? How long ago was it?)
Rely on physical reminders to remember to do things (e.g., place the item you want to remember to take with you on top of your purse, establish a tray on the desk (or a file on your computer desktop) where you place items that need your attention (e.g., bills, invitations, etc)
Keep record of what has happened/what you’ve done. This may be relevant for things like medical records, bills paid, gifts given, or more general life events. You might find that physical files in a filing cabinet, computer files or a journal are helpful for such things.
Things are remembered better when you are trying to recall something in the same place that the learning took place, so try to do similar work in the same spot each time. On the other hand, it might also be wise to work in different places if tasks are separate. Before you begin, give yourself a minute to orient and settle into your workspace.

Prioritise Yourself

Finally, in general, focus on what is most important. It’s probably better to do fewer things well than many things poorly. If you are not able to keep on top everything that you used to do, try to eliminate the nonessential or less enjoyable activities, say “no” more often, delegate, and ask for help.

About Author:

Laurie Miller is a respected Clinical Neuropsychologist and Clinical Associate Professor at the University of Sydney, Sydney NSW, Australia.

She has published numerous research studies on the topic of memory, including a randomised controlled trial evaluating the effectiveness of a group-based, memory strategy training course for neurological patients called: ‘Making the Most of Your Memory: An Everyday Memory Skills Program’.

Published: June, 2021