Pre-Surgery Demographic, Clinical, and Symptom Characteristics Associated with Different Self-Reported Cognitive Processes in Patients with Breast Cancer

Abstract

Simple SummaryOne in three patients with breast cancer report cancer-related cognitive impairment (CRCI) even before treatment. CRCI can persist and negatively impact patients’ quality of life. We used a self-report measure to assess CRCI. We assessed patients’ ability to plan and solve everyday life problems, concentrate, and have meaningful relationships with others. We evaluated subgroups of patients with different profiles regarding these abilities and whether they had different demographic and clinical characteristics. Our analyses showed that 64.2%, 43.3%, and 40.1% of the patients had clinically meaningful decrements in their abilities to plan and problem-solve, concentrate, and have meaningful relationships with others, respectively, from prior to through to 6 months after surgery. Pre-surgery symptoms (i.e., anxiety, depression, fatigue, sleep disturbance) and other characteristics (e.g., lower functional status, higher comorbidity) were associated with worse CRCI profiles and may be potential targets for personalized interventions.Cancer related cognitive impairment (CRCI) is a common and persistent symptom in breast cancer patients. The Attentional Function Index (AFI) is a self-report measure that assesses CRCI. AFI includes three subscales, namely effective action, attentional lapses, and interpersonal effectiveness, that are based on working memory, inhibitory control, and cognitive flexibility. Previously, we identified three classes of patients with distinct CRCI profiles using the AFI total scores. The purpose of this study was to expand our previous work using latent class growth analysis (LCGA), to identify distinct cognitive profiles for each of the AFI subscales in the same sample (i.e., 397 women who were assessed seven times from prior to through to 6 months following breast cancer surgery). For each subscale, parametric and non-parametric statistics were used to determine differences in demographic, clinical, and pre-surgical psychological and physical symptoms among the subgroups. Three-, four-, and two-classes were identified for the effective action, attentional lapses, and interpersonal effectiveness subscales, respectively. Across all three subscales, lower functional status, higher levels of anxiety, depression, fatigue, and sleep disturbance, and worse decrements in energy were associated with worse cognitive performance. These and other modifiable characteristics may be potential targets for personalized interventions for CRCI.