Chemofog, also known as chemobrain or cancer-related cognitive impairment, refers to difficulties in memory, attention, processing speed, and executive functioning experienced by patients undergoing or after chemotherapy [1]. Epidemiologically, it affects up to 50–75% of patients during treatment and around 20–35% may have persistent symptoms months to years afterward [1,2]. The risk is higher in older adults, those receiving highdose or combination chemotherapy, and individuals with fatigue, depression, or sleep disturbance [3]. The implications of chemofog can be substantial, disrupting patients’ ability to perform Activities of Daily Living (ADL), work and social roles [3]. Given that there are limited pharmacological interventions, the role of nonpharmacological therapies, particularly Occupational Therapy (OT) has become increasingly prominent. OT offers a functional and person-centered approach to managing cognitive impairments, addressing not only the symptoms but also their real-world consequences [4,5].

OT interventions for chemofog are diverse and adaptable, often tailored to the unique goals, environments, and roles of the individual survivor [6]. One widely used intervention is cognitive strategy training [7]. This involves teaching compensatory techniques such as using memory aids (planners, alarms, visual checklists), simplifying complex tasks, breaking activities into simpler steps, and establishing consistent daily routines [8]. Additionally, remedial cognitive exercise has been used as one of the OT intervention tools for patient experiencing chemofog [9]. The strategies aim to strengthen patient’s cognition function, such as memory, attention and reasoning, through verbal rehearsal, memory and problem-solving exercises. ^9-10 These strategies are designed not only to enhance cognitive function but also to reduce frustration and increase confidence in performing everyday tasks [7,9].

Environmental modification is another core element of OT in this context [11]. Occupational therapists assess home and work settings to identify and mitigate barriers to cognitive functioning [11]. Recommendations might include reducing sensory distractions, improving lighting, labelling storage areas, or rearranging workspaces to support task sequencing. These environmental adaptations can significantly reduce cognitive overload and improve task performance [12,13]. Fatigue is both a common consequence of cancer treatment and a contributing factor to cognitive impairment [1-4]. Occupational therapists frequently incorporate energy conservation strategies, rest-activity balance training, and pacing techniques into therapy plans [14]. Additionally, interventions may address sleep hygiene, stress reduction, and emotional regulation, recognizing that fatigue and mood symptoms often exacerbate cognitive complaints.¹⁴ Mindfulness-based approaches and relaxation training are sometimes integrated to enhance self-regulation and cognitive clarity [15-17].

Psychoeducation and self-awareness training are essential aspects of occupational therapy for chemofog [16,17]. Educating clients about the nature, variability, and course of chemotherapyrelated cognitive changes helps demystify their experiences and reduce associated anxiety [18,19]. Occupational therapists also support the development of metacognitive skills enabling clients to monitor their cognitive performance, recognize patterns of difficulty, and self-generate strategies for improvement [18,19]. Finally, many cancer survivors seek to return to work following treatment, yet cognitive limitations can be a significant barrier [1]. Occupational therapists play a key role in vocational rehabilitation by conducting job task analyses, facilitating workplace accommodations, developing graded return-to-work plans, and advocating for client needs with employers [20]. Evidence supports the effectiveness of OT-led return-to-work programs in improving employment outcomes and quality of life in cancer survivors [21].

While a growing body of literature supports the role of occupational therapy in managing cognitive dysfunction among cancer survivors, several limitations persist. The field lacks standardized screening tools specific to chemofog, and interventions often vary widely in content and delivery [1,12]. Most studies focus on breast cancer populations, with limited research on other cancer types and on diverse demographic groups [16,18,19]. Furthermore, randomized controlled trials isolating OT-specific outcomes are scarce. There is an urgent need for longitudinal studies, validated assessment protocols, and the integration of digital health solutions such as cognitive training apps or telehealth platforms into OT practice.

Chemofog remains a significant yet often under-recognized challenge in cancer survivorship, impairing cognitive function and reducing engagement in meaningful life roles [1,2,12]. Occupational therapy offers a comprehensive, individualized, and functionfocused approach to managing this condition [4,5]. Through strategies that address cognitive symptoms, environmental barriers, fatigue, and vocational challenges, occupational therapists help survivors regain control, improve participation, and enhance quality of life [6, 11,14,16,17,20]. Future research should emphasise on the development of standardized intervention frameworks in maximizing the impact of occupational therapy for individuals living with chemofog.

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