Symptom and state dependent predictors of everyday cognitive functioning in breast cancer survivors: A prospective ecological momentary assessment study
Ashley M. Henneghan, Robert A. Ackerman, Kate R. Oppegaard, Tara L. Kaufmann, Mansi Patel, Yuko Hamajima, Jaeil Ahn, Kathleen M. Van Dyk, Raeanne C. MooreObjective
Cancer-related cognitive impairment (CRCI) affects many breast cancer survivors and fluctuates from day to day. Between-person predictors of CRCI have been studied extensively, but far less is known about the within-person, state-dependent factors that shape everyday cognitive functioning. This study examined how symptom- and state-dependent predictors relate, within individuals, to self-reported cognitive symptoms and cognitive performance across several mobile cognitive tasks assessed via ecological momentary assessment (EMA).
Methods
This prospective, observational EMA study followed 121 breast cancer survivors, each within six years of finishing adjuvant treatment, through up to 28 sessions over eight weeks (one session every other day). Each session paired momentary ratings of distress, fatigue, sleep quality, relational quality, overall well-being, and cognitive symptoms with brief mobile tasks assessing executive functioning, working memory, processing speed, and verbal memory. Multilevel models estimated within- and between-person associations between these state-dependent predictors and cognitive outcomes, controlling for contextual and demographic covariates.
Results
Within-person increases in distress and fatigue raised the odds of reporting cognitive symptoms, while higher relational quality lowered them. Executive functioning performance was better on occasions of higher overall well-being, and both processing speed and executive functioning improved with higher sleep quality. Working memory performance declined on occasions of higher distress, and no significant within-person predictors emerged for verbal memory.
Conclusions
Cognitive symptoms and performance among breast cancer survivors are dynamically associated with modifiable, state-dependent psychosocial and behavioral factors, particularly distress, fatigue, sleep quality, relational quality, and overall well-being. These findings indicate that cognitive symptoms following breast cancer treatment occur as part of a broader, day-to-day symptom co-occurrence rather than in isolation, highlighting the importance of integrated screening for cognitive, psychosocial, and physical symptoms in survivorship care.