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. 2020 Jun;59(6):1172-1185.
doi: 10.1016/j.jpainsymman.2020.01.001. Epub 2020 Jan 15.

Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery

Carmen Kohler  1 , Ming Chang  2 , Yu-Yin Allemann-Su  2 , Marcus Vetter  1 , Miyeon Jung  3 , Misook Jung  4 , Yvette Conley  5 , Steven Paul  6 , Kord M Kober  6 , Bruce A Cooper  6 , Betty Smoot  7 , Jon D Levine  7 , Christine Miaskowski  8 , Maria C Katapodi  9
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Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery

Carmen Kohler et al. J Pain Symptom Manage. 2020 Jun.

Abstract

Context: Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time.

Objectives: This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery.

Methods: Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function.

Results: Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease.

Conclusion: Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.

Keywords: Cancer-related cognitive impairment; anxiety; attentional function; breast cancer; coping; fatigue; sleep disturbance.

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Conflict of interest statement

Conflicts of interest – The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Trajectory of cognitive function evaluated using the Attentional Functional Index over the 12 months (A). Influence of comorbidity (B) and receipt of adjuvant chemotherapy (CTX) (C) on interindividual differences in the severity of attentional function over 12 months.
Figure 2.
Figure 2.
Influence of levels of trait anxiety (A), fatigue (B), energy (C), sleep disturbance (D), and sense of control (E) on interindividual differences in the severity of attentional function over 12 months.
Figure 3.
Figure 3.
Influence of race/ethnicity (A), receipt of a sentinel lymph node biopsy (B), receipt of hormonal therapy (C), preoperative level of attentional fuction (D), and level of difficulty coping with the disease (E) on interindividual differences in severity of attentional fatigue over 12 months.
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