The Association between Caregiver Characteristics and Cognitive Complaints of Women with Breast Cancer

Abstract

Cognitive complaints are among the most common symptoms reported by women with breast cancer undergoing chemotherapy. These complaints include difficulties with memory, verbal fluency, attention, and thought processing, which are assessed by patient self-report. Individuals with cognitive complaints have been reported to have a low rate of medication adherence, impaired daily functioning at work and home, impaired social relationships with family and friends, and poor overall life satisfaction at some point in their disease trajectory. Researchers have demonstrated that cognitive complaints in cancer patients have been associated with the disease itself, adverse effects from cancer treatments, and other clinical factors, including the patients’ age or menopause status. However, these factors do not fully explain the clinical variability in this symptom among cancer patients. One literature review suggested that the caregiver of a woman undergoing cancer treatments influences how a woman negotiates the experience. Caregivers’ physical and mental health are strongly associated with patient comorbid conditions, which are in turn contributing factors to patient cognitive complaints. Caregiver characteristics represent factors that may help to explain the clinical variability in patient cognitive complaints. Several neurocognitive studies have indicated associations between the degree of patients’ cognitive complaints and caregiver burden, the caregivers’ personality, type of coping strategy used by the caregiver, or closeness of relationship with the patient. However, no consensus exists regarding whether (and how) caregiver characteristics are associated with cognitive complaints in individuals with cancer. Therefore, this dissertation explored the association between caregiver characteristics and cognitive complaints of women with breast cancer undergoing chemotherapy. Chapter 2 presents an integrative review of the influence of psychological variables on cancer-related cognitive impairment in women with breast cancer. Chapter 3 describes the literature on the association between caregiver characteristics and cognitive function of adults with cancer. Chapter 4 presents a secondary analysis that explores the role of caregiver burden on the association between emotional distress and concentration among individuals with cancer. The findings presented in Chapter 2- 4 provided the foundation for the larger study presented in Chapter 5 which explores the association between caregiver characteristics and cognitive complaints of women with breast cancer. Caregiver characteristics (e.g., burden, general health, and avoidance coping) served as predictors of cognitive complaints in women with breast cancer. Also, if the patient was depressed, their mental state mediated the association between the caregiver’s general health condition and their patient’s cognitive complaints. These findings reinforce the need for health professionals to assess and consider caregiver characteristics when developing interventions for the patient with cognitive complaints. Such dyadic interventions will contribute to the improvement in not only the patients’ cognitive complaints but their caregivers’ overall well-being.