The Relationship Between Biopsychosocial Functioning and Work-Related Cognitive Limitation Among Employed Breast Cancer Survivors: Case Control Study.

PURPOSE AND JUSTIFICATION

Cancer related psychological sequelae have significant impact on breast cancer survivors' cognitive functioning. Depression and negative affect have been shown to be highly correlated with reduced verbal knowledge, verbal memory, spatial ability, and figural memory. In addition, self-reported psychological stress was correlated with perceived cognitive deficits and poor performance on tests of memory, verbal fluency, and attention in breast cancer patients post-treatment. Similarly, depression and anxiety among breast cancer survivors have shown to be significantly correlated with subjective cognitive dysfunction including reduced attention, concentration, and memory. Moreover, persisting somatic sequelae including pain, fatigue, and sleep disturbances have indirect critical influence on breast cancer survivors' cognitive functioning. The study by Caplette-Gingras, Savard, Savard, and Ivers indicated that breast cancer survivors with sleep disturbance exhibited reduced cognitive functioning in episodic memory and executive functioning and reported subjective cognitive deficit in comparison to breast cancer survivors without sleep disturbances. Further, fatigue and cognitive dysfunction have shown significant association among breast cancer survivors. Somatic challenges that persist after the survivors' completion of treatment clearly exhibit adverse cognitive impairment.

Cognitive deficit is one of the cognitive sequelae of breast cancer that adversely impacts survivors' general well-being. Persisting psychological and somatic symptoms and various treatments received for breast cancer are some reasons for cognitive deficits post-cancer. Chemotherapy and hormonal blockade therapy have been directly associated with adverse impacts on cognitive functioning including memory, executive functioning, and attention. Radiotherapy and surgery have also shown to impact breast cancer survivors' cognitive functioning. These cognitive impairments impact survivors' quality of life and general functioning. Therefore, enduring cognitive deficits resulting from breast cancer and its treatments have significant effect on survivors' health and re-establishment of normalcy. While breast cancer survivorship bolsters hope for a cancer-free life, enduring cancer-related symptoms impacts the survivors' occupational and social functioning, which in return may impinge on their recovery. Returning to the previously held roles allows a better recovery from breast cancer treatments, longer survivorship and lower reoccurrence rate. However, breast cancer survivors are among the majority of about 13% of cancer survivors that stop working 4 years post-cancer due to "cancer-related reasons". Employed women with breast cancer history report learning, long-term memory, attention, concentration, and executive functioning problems. Hence, these reported cognitive difficulties impact job performance, ability to work, and job maintenance. These cognitive deficits not only impact the breast cancer survivors' work performance and ability to retain their position but they also impact the survivors' psychological and social well-being and vice-versa.

Most individuals who experience psychological (i.e., depression, anxiety) and somatic distress (pain, fatigue and sleep) have reported cognitive difficulties and shortcomings. Similarly, breast cancer survivors report experiencing cognitive difficulties in relation to their psychological and somatic distresses. Although, cognitive difficulties experienced by individuals' with and without cancer history has an impact on individuals quality of life and level of functioning; the cognitive deficit breast cancers survivors endure through cancer treatment (i.e., chemotherapy) impacts their cognitive functioning on a greater extend. This shortcoming post cancer treatment impacts cancer survivors' everyday functioning and quality of life on a different level, which impacts their survivorship experience and overall functioning.

Cognitive limitation among breast cancer survivors in the context of work assesses cognitive deficits that survivors experience at work. Given that cognitive functioning among breast cancer survivors is affected by various factors, such as cancer diagnosis and treatment, work-related cognitive limitation might also be impacted by numerous variables. Nevertheless, there are more studies yet to be done exploring work-related cognitive limitation among employed breast cancer survivors in association with various cancer-related symptoms. Most studies have assessed implication of survivorship and work performance outcome among breast cancer survivors but few have focused on work-related cognitive limitation. For example, work-output and performance have been shown to be impacted negatively as a result of persisting symptoms experienced by breast cancer survivors, such as fatigue and reduced physical and mental ability. The few studies that have investigated work-related cognitive limitation have looked at the relationship between work-related cognitive limitation and work output. Other than Ottati and Feuerstein, no other study has looked at the relationship between cancer-related symptoms and work-related cognitive limitations among breast cancer survivors. Although, the study by Ottati and Feuerstein has looked at the relationship between cancer-related symptoms and work-related cognitive limitation, they only assessed depression, anxiety, fatigue and pain as cancer-related symptoms. They did not assess the association of cognitive functioning and sleep disturbance as cancer-related symptoms in relation to work-related cognitive limitation. In addition, their study did not involve a healthy control group to assess for any differences amongst the two groups.