A prospective observational study investigating cognitive impairment and comorbid symptoms in newly diagnosed women with nonmetastatic breast cancer

Rodriguez, Nicole (2021) A prospective observational study investigating cognitive impairment and comorbid symptoms in newly diagnosed women with nonmetastatic breast cancer. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

This thesis is an investigation into the prevalence of subjective executive functioning deficits and subjective and objective cognitive impairment in women with breast cancer throughout the first year of treatment. This thesis examined the relationship between cognitive impairment and comorbid symptoms in women with breast cancer. Participants were assessed at four time points (baseline, 4, 8, and 12 months) using objective and subjective measures of cognition and sleep, and subjective measures of fatigue, mood, insomnia, and sleep quality. The final sample size was 98. The first study used baseline data to investigate the prevalence of perceived executive functioning deficits as well as associations between perceived cognitive impairment and insomnia, fatigue, sleep quality, and mood before participants began systemic treatment and radiation. Twelve percent of the sample reported perceived executive functioning deficits and these individuals were significantly older and reported greater levels of fatigue and depressive symptoms than individuals without perceived executive functioning deficits. After partitioning out variability from other independent variables, only fatigue remained significantly associated with perceived cognitive impairment. Using the same sample, the second study aimed to establish the prevalence of cognitive impairment throughout the first year of treatment and to examine the relationships between cognitive impairment, fatigue, insomnia, and mood using structural equation modelling. Prevalence of objective cognitive impairment ranged from 3.1 to 8.2 percent throughout the year, whereas 36.7 percent demonstrated a clinically meaningful decline in perceived cognitive impairment from baseline to 4 months, which remained relatively stable up to one year. Greater perceived cognitive impairment was associated with greater fatigue and insomnia symptomology. Short-term fluctuations in perceived cognitive impairment, but not fatigue or insomnia, predicted future perceived cognitive impairment. Fatigue was a significant predictor of future reported symptoms of fatigue and insomnia.

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