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Cancer-Related Symptoms and Cognitive Intervention Adherence Among Breast Cancer Survivors

A Mixed-Methods Study

Bail, Jennifer R., PhD, RN; Ivankova, Nataliya, PhD, MPH; Heaton, Karen, PhD, COHN-S, FNP-BC, FAAN, FAAOHN; Vance, David E., PhD, MGS; Triebel, Kristen, PsyD; Meneses, Karen, PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000700
Article: PDF Only

Background Breast cancer survivors (BCSs) experience long-term symptoms of cancer and treatment, which may exacerbate cognitive function and ability to adhere to interventions aimed at improving cognition.

Objective The intent of this study was to explore the relationship between selected cancer-related symptoms and adherence to the Speed of Processing in Middle Aged and Older BreAst Cancer SuRvivors (SOAR) cognitive training (CT) intervention among BCSs residing in Alabama.

Methods A sequential quantitative to qualitative (Quan→Qual) mixed-methods design was used. First, the relationship between selected cancer-related symptoms and adherence to SOAR among BCSs (n = 30) was examined using self-reported questionnaire data. Follow-up semistructured interviews with 15 purposefully selected participants (adherent and nonadherent) were conducted to explore how symptoms contributed to/explained differences in adherence to SOAR. Data were analyzed using RStudio and NVivo software.

Results Spearman’s ρ correlation suggested relationships between adherence and perceived cognitive impairment, depressive symptoms, and sleep quality. Inductive thematic analysis yielded 4 themes: (1) experiences of cancer-related symptoms, (2) influences of CT, (3) adherence to CT, and (4) environment for CT. Integration of quantitative and qualitative results revealed that experiences of and responses to CT and cancer-related symptoms differently shape adherence to CT among BCSs.

Conclusions To aid in cognitive intervention adherence among BCSs, future studies may consider applying a comprehensive approach aimed at addressing concurrent cancer-related symptoms.

Implications for Practice Clinicians can routinely assess cognition and provide education and resources for management of cancer-related symptoms.

Authors Affiliations: Department of Nutrition Sciences (Dr Bail), School of Health Professions (Dr Ivankova), School of Nursing (Drs Ivankova, Heaton, Vance, and Meneses), and Department of Neurology (Dr Triebel), University of Alabama at Birmingham.

This study was supported by the American Cancer Society Doctoral Degree Scholarship in Cancer Nursing (DSCN-16-066-01; principal investigator: J.R.B.), Susan G. Komen Graduate Traineeship in Disparities Research Award (GTDR 15329376; principal investigator: K.M./Demark-Wahnefried), and Center for Translational Research on Aging and Mobility, Edward R. Roybal Center Project (P30 AG022838; principal investigator: J.R.B.; pilot principal investigator: K.M.). D.E.V. has served as a paid consultant for Posit Science, Inc (the software used for the cognitive training in this study).

The authors have no conflicts of interest to disclose.

Correspondence: Jennifer R. Bail, PhD, RN, Department of Nutrition Sciences, University of Alabama at Birmingham, WTI 102C, 1824 6th Ave S, Birmingham, AL 35294 (

Accepted for publication December 27, 2018.

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