Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors.

The purpose of this study was to investigate developmental gender differences in academic achievement areas, with the primary focus on writing, using the child and adolescent portion (ages 6–21 years) of the Kaufman Test of Educational Achievement—Second Edition, Brief Form, norming sample (N = 1,574). Path analytic models with gender, parent education, age, age2, and gender‐by‐age moderation as predictors of reading, writing, and math were used to test for gender differences and for the influence of development on these differences. A small but consistent advantage was identified for females in reading. No gender differences were detected in math. The most important results of the present study pertain to a gender gap in writing in favor of females that increased as a function of age. Male students are at greater risk for writing failure than are females.

The gender similarities hypothesis by J. S. Hyde ( 2005 ), based on large-scale reviews of studies, concludes that boys and girls are more alike than different on most psychological variables, including academic skills such as reading and math (J. S. Hyde, 2005 ). Writing is an academic skill that may be an exception. The authors investigated gender differences in academic achievement using a large, nationally stratified sample of children and adolescents ranging from ages 7-19 years (N = 2,027). Achievement data were from the conormed sample for the Kaufman intelligence and achievement tests. Multiple-indicator, multiple-cause, and multigroup mean and covariance structure models were used to test for mean differences. Girls had higher latent reading ability and higher scores on a test of math computation, but the effect sizes were consistent with the gender similarities hypothesis. Conversely, girls scored higher on spelling and written expression, with effect sizes inconsistent with the gender similarities hypothesis. The findings remained the same after controlling for cognitive ability. Girls outperform boys on tasks of writing.

Cognitive functioning difficulties in breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy – Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r=−0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r=0.35, p=0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.