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Psychological Symptoms and Stress Are Associated With Decrements in Attentional Function in Cancer Patients Undergoing Chemotherapy

Atallah, Marie, PhD; Cooper, Bruce, PhD; Muñoz, Ricardo F., PhD; Paul, Steven M., PhD; Anguera, Joaquin, PhD; Levine, Jon D., MD, PhD; Hammer, Marilyn, PhD, RN; Wright, Fay, PhD, RN; Chen, Lee-May, MD; Melisko, Michelle, MD; Conley, Yvette P., PhD; Miaskowski, Christine, PhD, RN; Dunn, Laura B., MD

doi: 10.1097/NCC.0000000000000713
Article: PDF Only

Background Decrements in attentional function—perceived effectiveness in everyday functioning related to cognitive dysfunction—are frequently reported by cancer patients during treatment. However, patients vary widely in their experiences of changes in attentional function.

Objective The aim of this study was to understand differences in attentional function among cancer patients during chemotherapy.

Methods Patients (n = 1329) undergoing chemotherapy were assessed at 6 time points during 2 rounds of chemotherapy. Latent profile analysis was used to identify subgroups of patients based on patterns in changes on the Attentional Function Index. Differences among the subgroups in demographic and clinical characteristics, psychological symptoms, and stress were evaluated.

Results Three latent classes (ie, high, moderate, and low attentional function) were identified. Patients in the low and moderate classes were younger, more likely to be female, and less likely to be employed compared with those in the high class. Patients in the low class had higher levels of depressive and anxiety symptoms, cancer-related distress, and perceived stress compared with those in the moderate class, who, in turn, reported higher levels of these symptoms compared with those in the high class.

Conclusions Different experiences of changes in self-perceived attentional function are associated with psychological symptoms in cancer patients.

Implications for Practice Relationships between changes in attentional function and psychological symptoms and stress suggest that clinicians should attend to the potential that patients’ cognitive and psychological experiences may be closely linked and may need to be addressed as related phenomena. Clinical trials are needed that evaluate treatments for both attentional and psychological symptoms.

Author affiliations: Palo Alto University, California (Drs Atallah and Muñoz); Schools of Nursing (Drs Cooper, Paul, and Miaskowski) and Medicine (Drs Anguera, Levine, Chen, and Melisko), University of California, San Francisco; Department of Nursing, Mount Sinai Hospital (Dr Hammer); and School of Nursing, New York University (Dr Wright), New York; School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); and Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, California (Dr Dunn).

This study was funded by a grant from the National Cancer Institute (NCI CA134900). C.M. is funded by grants from the NCI (CA168960) and the American Cancer Society.

The authors have no conflicts of interest to disclose.

Correspondence: Laura B. Dunn, MD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305 (

Accepted for publication February 12, 2019.

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