Author

Heather Reens

Date of Award

4-20-2021

Document Type

Dissertation

Copyright Status for Dissertations

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

Abstract

Introduction

Cognitive impairments associated with cancer and cancer treatment are side effects that have and continue to elude the oncology world. Cognitive impairments related to chemotherapy are also known as “chemo-brain” or “chemo-fog” and encompasses deficits in cognitive domains that include memory, verbal fluency, attention, and concentration, and one’s ability to recall information. Patients who experience cognitive impairments during and after cancer treatments, chemotherapy in particular, are often afflicted with impaired executive functioning, problems with memory and recall, loss of control and decreased sense of self, increased stress and depression, role conflicts when returning to work, and impaired quality of life. While the treatment may impact patients’ cognitive function, other factors, including personal characteristics and other stressors, may also influence their memory.

Objectives

The purpose of this descriptive correlational study is to determine relationships between women with breast cancer who are currently receiving or who have received at least one type of treatment and the negative impact that these treatments and other factors have or have had on their memory as reported by these participants.

Methods

A descriptive correlational approach was used for this study. A one-time questionnaire was sent via email to participants, including two instruments to assess memory; one measure of stress and questions obtaining demographics; information related to treatments received; stress and the negative impact of these factors on memory. Tools used to assess memory included the Everyday Memory Questionnaire (EMQ) and the Functional Assessment of Cancer Therapy-Cog(FACT-Cog). The tool used to assess stress was the Perceived Stress Scale (PSS). Of the 171 participants of this study, they were predominately White/Caucasian (89.5%), college educated (49.7%), and married or partnered (76%). Ages of participants in this study ranged from 24 to 80 years old (mean age was 53.8 years). For eligibility requirements, all participants in this sample were female.

Results

The results of this study indicate that age had an impact on memory/cognition on this sample, with EMQ, p = .01; Perceived Cognitive Impairments Subscale, p = .01; and Chi-square (yes/no self-reported stress), p = .02. A statistically significant difference was shown in Perceived Cognitive Abilities in those who had surgery versus those who did not, p = .05. Those who received chemotherapy demonstrated a statistical difference than those who did not receive chemotherapy using Chi-square (yes/no self-reports of stress), p = .01. There was a statistical difference in those who received radiation and those who did not receive radiation on the EMQ, p = .03; and Perceived Cognitive Impairments, p = .05. There was a statistical significance between those who received hormonal therapy versus those who did not using Chi-square (yes/no self-reports of stress), p = .02. Adriamycin was shown to be statistically significant using Chi-square (yes/no self-reports of stress), p = .02. Those receiving Cytoxan were statistically significant than those not receiving this medication on the EMQ, p = .01. Tamoxifen shown statistically significant results in Perceived Cognitive Impairments, p = .05; and in Chi-square self-reports of stress (yes/no), p = .05. PSS meanings, indicating low, moderate, and high levels of stress demonstrated significance on EMQ scores with p < .01. PSS raw scores (total non-categorical scores) were statistically significant using both parametric correlations (Pearson product-moment correlationcoefficient), p = < .01 and non-parametric correlations (Spearman’s rho), p < .01. Statistically significant results were also found in the PSS meaning (low, moderate, high stress level) and FACT-Cog scores, p = < .01.

Conclusions

In this study, age was shown to have an effect on both memory and cognition among the sample utilizing the EMQ and the Perceived Cognitive Impairments Subscale of the FACT-Cog. Participants who received chemotherapy and hormonal therapy had more self-reported memory impairments than those who did not receive these treatment modalities. Those receiving radiation had lower scores on the PCI subscale and thus more perceived cognitive impairments. On the contrary, those who did not receive radiation were shown to have higher EMQ scores indicating more memory problems than participants who did receive radiation. Participants in this study experiencing moderate and high levels of stress had higher EMQ scores, indicating more memory problems than those with low stress. The results from this study indicate that many factors, including age, certain treatment modalities, particular medications, and stress can have a negative impact on an individual’s memory or cognition. This signifies an importance for future research to be conducted in relation to cognitive impairments to distinguish and identify probable causes, increase awareness and education among healthcare providers to directly benefit patients through knowledge, and the development of potentially beneficial therapeutic treatments.

Related Pillar(s)

Study

Included in

Nursing Commons

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