photo of a smiling man wearing a suit and tie with the words THINKING WELLNESS below

For more than 30 years, Rich Serino spent his days caring for and protecting the residents of Boston. As one of the city’s first medics and later as the Chief of Boston EMS, he saw every type of medical emergency. Toward the end of his career in Boston, as fate would have it, he became a patient. After two serious bouts of unrelated cancer, his surgeries and treatments left him weakened. After returning to work, he recalls the fogginess of thought that cancer survivors often describe after their treatment. With time, effort, and the support of his family Rich’s energy and concentration improved. So much so, that when President Obama called for him to serve as the Deputy Administrator and Chief Operating Officer of the Federal Emergency Management Agency, Rich did what comes naturally; he answered the call and said yes.

Survivor Story

Learn more about Rich’s wellness journey.


What It Is

Thinking, or cognitive wellness, is about expanding your knowledge and stimulating your brain by taking part in activities that feed your curiosity and express your creative talents. It can involve learning a new skill, taking a class, reading about a new subject, or writing that novel that you have always wanted to write. This dimension of wellness is about challenging yourself, keeping your mind active, and taking action on your desire to learn and be creative.

Why It Is Important

Many cancer survivors report changes in the way they think, learn and remember things before, during and after treatment for the illness. Small tasks done with ease before a cancer diagnosis can become difficult afterwards.

There are many factors that can contribute to a loss of sharp thinking for cancer survivors, including age, the location of the cancer, stress or depression, sleep problems, and hormonal changes. Many studies have explored the link between certain cancer treatments and problems with memory and thinking.

The term “chemo brain” is used to describe foggy thinking and the difficulty with memory and concentration that survivors often describe after treatment for cancer, especially if the treatment involved chemotherapy drugs. While a definite cause is not known, the signs and symptoms of chemo brain are real and can seriously impact the quality of life for some cancer survivors.

The important thing to remember is that for many survivors, these problems get better with time. Nurturing your wellness in this area can:

  • Teach you strategies to manage day-to-day tasks of life, work and school
  • Help you expand your knowledge and skills
  • Keep your mind active and stimulated
  • Create new learning pathways in the brain

What You Can Do

If you are interested in strengthening your thinking or “cognitive” skills, here are some things to consider:

  • Use tools & technology to keep yourself organized. Creating lists or using a daily planner can help you keep track of your daily activities. There are many free, or low-cost smartphone apps available to help you create lists, task and appointment reminders. Or, just writing it down may help.
  • Take notes during a conversation or a meeting.
  • Exercise your brain. Your brain is like a muscle and regular activities that are challenging, new and different can help create new learning pathways. Consider reading new and difficult material, or learning a new language or musical instrument. Choose activities that are interesting but do not add to your stress level.
  • Crossword puzzles, Sudoku, or learning how to play chess are a few examples of games that challenge your thinking.
  • Get enough sleep. Memory and thinking problems are made worse by a lack of sleep.
  • Write more, or keep a journal of your thoughts and experiences. This can also be a way for you to keep track of any memory problems that you are experiencing.
  • Keep your body active. Staying physically active helps all parts of your body, including your brain. Moving more will improve your mood, make you feel more alert and less tired.
  • Try not to multi-task. This is easier said than done in our busy lives, but focusing on one thing at a time can help.
  • Practice “active listening” by repeating back information you just heard someone say. (For example, “OK, so what you are saying is…”)
  • Talk to your doctor or care team about your concerns. Talking to your care team will help them evaluate possible treatment or support options. Some cancer treatment centers have specific programs to help survivors deal with thinking and memory problems.

Questions to Ask Yourself

  • Am I getting enough sleep, and if not what can I do to improve my sleep habits?
  • What new and interesting activity would I most enjoy doing?
  • Is there a class I am interested in taking?
  • Are there techniques I can use to help me concentrate better?
  • What tools would work for me to keep track of events and tasks? Should I use a paper-based system or technology tool?

Questions to Ask Your Doctor or Care Team

  • Are my problems with thinking and memory something that can be treated medically?
  • Can you refer me to a program to help with my thinking and memory problems?
  • Are there other survivors I can talk to about their experiences and how they coped with similar problems?

Survivor Story

After being diagnosed with breast cancer, public health professional and Norwell resident, Christina Nordstrom experienced a range of physical, emotional and cognitive effects both from the cancer and treatments. A gifted singer-songwriter, Chris turned to her creativity and passion for music to help her cope and to “exercise” her brain. Watch her perform the “Chemo Brain Blues,” a song she wrote for cancer survivors and their friends and families to “lighten up this journey that we share together.”


Expert Voices

Ed O’Malley, PhD, an expert in neurofeedback and integrative sleep medicine, from Great Barrington, explains what “chemo brain” is, and talks about strategies cancer survivors can try to address the symptoms.


According to the National Cancer Institute, upwards of 50% of cancer survivors report some trouble sleeping. Ed O’Malley, PhD, talks about the importance of sleep for improved brain wellness.


Additional Resources


This information is provided by the Comprehensive Cancer Prevention and Control Network.