Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer

Abstract

Background Women with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment. Methods Participants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross‐lagged panel model assessed relationships among symptoms over time. Results The sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (β = −0.78, z = 17.48, p < .01) and symptoms of insomnia (β = −0.58, z = 5.24, p < .01). Short‐term fluctuations in perceived CI (p < .05), but not fatigue or insomnia, predicted future perceived CI. Fatigue (p < .001) was a significant predictor of future reported symptoms of fatigue and insomnia. Conclusion Subjective CI is more prevalent than objective impairments. Fatigue, insomnia, and perceived CI remain stable and are associated during the first year of treatment. Changes in insomnia and fatigue may have little effect on future perceived cognition. Women with breast cancer likely require targeted intervention for these side effects.

Prevalence and factors associated with insomnia symptoms in adolescents and young adults with cancer during the COVID-19 pandemic

“… 35 Specifically in cancer survivors, insomnia is further associated with impaired quality of life, 36 problems with cognitive function, 37 and cancer-related fatigue. 38 Our results add to the growing recognition that the impact of cancer on AYAs does not end with the completion of treatment. 39 In order to improve overall well-being and recovery from cancer, greater access for AYAs with cancer to evidence-based interventions to manage insomnia and support their mental health is desperately needed, and even more so during the COVID-19 pandemic.…”

Cancer-related cognitive impairment in survivors of adolescent and young adult cancer: A scoping review

“…assessments giving insight into the patient's experience. Although objectively measured impairment is less prevalent than subjectively measured impairment 14 , the possible correlation between objective and subjective cognitive assessments reported by Trachtenberg et al 47 implies that clinicians may at least be able to use selfreport measures for screening rather than referring the bulk of survivors for expensive and time-consuming objective cognitive assessments.…”

“…Cognitive function can be assessed using either objective neuropsychological batteries, which measure performance in specific domains, or subjective patient self-reports, which give insights into the patient's experience of their cognitive capacity. The outcomes differ, with objective impairment being less prevalent than subjective impairment in cancer survivors 14 . Evidence suggests that subjective cognitive deficits are strongly correlated to depression, anxiety, or fatigue and only weakly correlated to objectively measured cognitive impairment 15 .…”

Prospective Rates, Longitudinal Associations, and Factors Associated With Comorbid Insomnia Symptoms and Perceived Cognitive Impairment

“…In a more recent cross sectional online survey of 1,393 breast cancer survivors, 47% showed current cognitive complaints and those who reported sleep difficulties were twice as likely to report cognitive impairments ( Boscher et al, 2020 ). When assessed prospectively in a different sample of 98 women with breast cancer from the time of diagnosis to 12 months, rates of perceived cognitive impairments were stable at roughly 36% ( Rodriguez et al, 2021 ). While fatigue and insomnia were associated with greater perceived cognitive impairment, insomnia did not significantly predict future cognitive impairment ( Rodriguez et al, 2021 ).…”

“…When assessed prospectively in a different sample of 98 women with breast cancer from the time of diagnosis to 12 months, rates of perceived cognitive impairments were stable at roughly 36% ( Rodriguez et al, 2021 ). While fatigue and insomnia were associated with greater perceived cognitive impairment, insomnia did not significantly predict future cognitive impairment ( Rodriguez et al, 2021 ). In men with prostate cancer, insomnia symptoms significantly mediated the relationship between receiving androgen deprivation therapy and perceived cognitive function and satisfaction with cognition ( Garland et al, 2021b ).…”