In "Helping Patients Cope With Losing Things" (Oncology Times 2019;41(4):12), I discuss a common symptom of cancer-related cognitive impairment (CRCI). As a physician-survivor dealing with this challenge, I believe you play a central role in helping patients who report, "I keep losing things." You can determine if further evaluation for other medical problems, including early dementia, is indicated. If not, you can reassure patients. Either way, you can review their medications and make adjustments, if appropriate. And with just a few words, you can encourage patients to learn how to deal with the challenge in healthy ways. Feel free to use this handout whichever way is useful in your practice.
Coping With losing Things
Dear Patient,
This handout offers insights and tips for dealing with the common symptom of losing things more than usual. The goals are to help you think and talk about the challenge in helpful ways, and to encourage you to take steps that help you live your best life.
Why are you losing things more than usual?
During and after cancer treatment, some patients note a change in their ability to think clearly and quickly. One of the possible reasons is cancer-related cognitive impairment (CRCI). [For more information, go to https://tinyurl.com/acsCRCI.] This handout outlines healthy ways to deal with CRCI-related changes in attention and short-term memory that often lead to losing things.
What makes losing things so distressing?
"Losing things" seems like no big deal compared to "cancer." After all, everyone loses things now and then. But this is different than normal "losing things" of healthy, busy people.
Besides disrupting your day, losing things all the time can cause embarrassment and loss of confidence, which can strain relationships and reshape roles in unwanted ways. The sense of wasting time looking for lost items can be upsetting, especially if you believe every minute is precious. If you're dealing with major losses due to your illness, the loss of an item-no matter how unimportant and easily replaceable-can feel like salt on a wound. If repeated losses lead you to feel that things are disappearing into thin air, a sense that the physical world has become uncertain may exacerbate anxiety related to uncertainty about the future.
After cancer, can losing things be a symptom of Alzheimer's disease?
Please tell us if you have any worries about having Alzheimer's or something else wrong with your brain. A proper medical evaluation will enable you to let go of unnecessary worry-and receive a timely evaluation and proper care if anything else that can affect brain function (not just Alzheimer's) might be going on.
What general measures may help?
Anything that promotes brain health may help with attention and memory, which should decrease the risk of misplacing things. Given that these measures also help your overall health after cancer, let's work together to ensure you are ...
* Getting adequate, high-quality sleep.
* Taking in high-quality nutrition.
* Getting safe, appropriate exercise.
* Minimizing negative stress (emotional, financial, social, spiritual); using support resources optimally.
What practical steps can you take to decrease the chance of losing things?
To compensate for CRCI-related changes in attention and memory:
* Slow down. Do one thing at a time.
* Get rid of ALL piles and clutter.
* Create habits. For items you use regularly, always put them in the same (logical) place-and don't make exceptions unless absolutely necessary.
* Talk aloud to yourself when doing something unusual, e.g., "I'm putting this wrapped gift on the mantle."
* Find "memory buddies" whom you can tell where you store important items, such as a passport, and where you hide things, such as a surprise gift.
When leaving home:
* Simplify. Don't take more than you need.
* Use a checklist to ensure you take everything you need.
* Use labels to put contact information on all outerwear, gadgets (cell phone; electronics), glasses (e.g., on hidden part of frame), and anything else you could accidentally leave somewhere.
* Latch things together when possible. For example, use clips or plastic coils to attach your keys and wallet to your pocketbook or belt loop.
* Count how many things you are carrying, e.g., "I have four things: keys, wallet, suitcase, coat." Before leaving any location, such as a bus or building, STOP and do a quick count.
* Leave extra time to get from one place to another. This way, you can minimize multitasking and also have time to find any misplaced items noticed during your quick count.
What can you do to decrease the emotional distress associated with losing things?
Whether you consider "losing things" a minor annoyance or a major disaster, talk with us and your loved ones about what you're experiencing. Everyone needs to understand that this type of "losing things" is real, and it's different than normal "losing things" of healthy, busy people who've never had cancer.
Remind yourself that this is not your fault; CRCI is a cost of your survival.
Try to see using memory aids as empowering. Using checklists keeps you from forgetting important items. Labeling your possessions increases the chance you'll get them back if you leave them somewhere. Attaching your keys to your purse or belt loop decreases your stress, because you can stop worrying about losing them. It also gives you the gift of time: minutes or hours you might otherwise spend looking for them.
Consider scheduling a session with a social worker or counselor who specializes in cognitive issues after cancer. Just as athletes use trainers to optimize their performance, a session or two with a counselor can help you personalize your approach to CRCI and overcome many of the challenges, including losing things.
What now?
While researchers keep exploring how to prevent and treat CRCI, keep talking with us and with loved ones about your experiences after cancer. Working together, we can help you live your best life today, tomorrow, and every day.