Indiana University-Purdue University Indianapolis (IUPUI) / Up to 75% of the more than 3.5 million breast cancer survivors (BCS) living in the United States report cognitive dysfunction. However, little is known about cognitive dysfunction among older BCS, who may be at greater risk. Therefore, the purpose of this dissertation was to characterize cognitive dysfunction in older BCS. Specific aims included: (1) synthesize the literature regarding cognitive dysfunction in older BCS; and (2) examine the relationships between a) objective cognitive function (immediate memory, delayed memory, attention, executive function-working memory, verbal fluency) and subjective cognitive function (attention); b) demographic factors, medical factors, treatment factors, and cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive function; and c) comorbidity and cognitive function and physical functioning, and quality of life (QoL) in older BCS. In an integrative review, to address aim 1, 12 studies were identified. Up to 41% of older BCS showed objective cognitive dysfunction on neuropsychological assessment, up to 64% reported subjective cognitive dysfunction concerns pre-treatment, and 50% incurred cognitive decline from pre- to post-treatment. Cognitive dysfunction was associated with older age, multiple comorbidities, chemotherapy, sleep disturbance, neuropsychological symptom cluster, frailty, and poorer QoL. To address aim 2, data were leveraged from a large, nationwide, QoL in younger versus older BCS study (PI: Champion), which included 335 older BCS who were ≥60 years of age, had breast cancer (stage I-IIIa), received chemotherapy, and were 3-8 years post-diagnosis without recurrence. Findings included up to 19% of older BCS had mild-moderate objective cognitive dysfunction on at least one neuropsychological assessment, with 26% reporting poor-moderate subjective attention function. BCS, who were older, had less education and more depressive symptoms had greater cognitive dysfunction. Objective attention and executive function-working memory significantly and positively correlated with subjective attention. In turn, subjective cognitive dysfunction and increased number of comorbidities were related to poorer physical functioning. Subjective cognitive dysfunction was also related to poorer QoL. The findings from this study highlights the prevalence and complexity of cognitive dysfunction in older BCS. Further research is needed to better understand the intersection of aging, cancer, comorbidities and cognitive dysfunction and the negative implications in older BCS.

Background: Breast cancer is the most common cancer in the world with approximately 1.7 million new cases diagnosed in 2012. While women with breast cancer are treated with a multitude of different therapies, these treatments can lead to long-term effects that impact quality of life (i.e. fatigue, pain, lymphedema, anxiety, depression, osteoporosis). With more people looking into complementary and alternative medicine (CAM), research on yoga’s effect on quality of life in breast cancer survivors is vital. Methods: This literature synthesis used PsychINFO, MEDLINE, and CINAHL explore current research on yoga’s effects on quality of life in breast cancer survivors. Search terms included: breast cancer, survivor, quality of life, lifestyle, wellbeing, clinical trial, and controlled trial. Literature was excluded if it included men, women under cancer treatment and if yoga was included in a mindfulness intervention. Results: Eleven articles met the inclusion criteria. Yoga was shown to have a positive impact on fatigue, pain, anxiety, depression, and breast cancer survivors’ quality of life. A majority of the studies measured quality of life using the FACT-B and FACT-G scale. Others used similar measurement tools and qualitative journal entries. Specific studies indicated improvements in aromatase-inhibitor associated arthralgia, diurnal salivary cortisol levels, and menopausal symptoms. Conclusions: Yoga appears to be beneficial in improving breast cancer survivor’s quality of life. More research is needed. However, nurses can use this information to educate clients about the benefit of yoga in survivorship. This research may promote further utilization of CAM in improving quality of life.

Recent advances in early detection and treatment of breast cancer have led to increasing numbers of long term survivors of breast cancer. There is a growing concern about the potential adverse effects of chemotherapy on cognitive functioning. The current study examines the neuroanatomical correlates of late neurocognitive effects of chemotherapy in elderly breast cancer survivors who have survived more than ten years and were exposed to chemotherapy at the time of their cancer treatment. The participants in this study are 30 women breast cancer survivors in the age range of 65-81 years. In this cross sectional design, regional brain volumes measured using magnetic resonance imaging were correlated with cognitive test scores using multiple regression analyses. The test scores from Wisconsin Card Sorting Test and Trail Making Test B are used as measures of executive function. The test scores from the Letter Number Sequencing subset of the Wechsler Adult Intelligence Scale (WAIS) are used for measures of working memory. We found support for the hypothesized association between reduction in performance on specific neuropsychological tests and reduced volumes predominantly in the frontal, temporal and subcortical white matter regions. These results suggest that the frontal, temporal and subcortical white matter region are a neuroanatomical correlate of cognitive impairment seen in our study population. Future research will be needed to discern whether the structural correlates of cognitive impairment seen in long term cancer survivors is likely to be developed as an imaging marker for cognitive evaluation and rehabilitation.

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Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor och patientgruppen bröstcanceröverlevare blir allt större till följd av moderna forskningsframsteg. Då fler kvinnor får chansen att leva ett långt liv efter sin diagnos har livskvalitet blivit ett centralt begrepp och en bibehållen livskvalitet har blivit ett viktigt mål. Forskning har visat att livskvaliteten kan påverkas av att ha överlevt bröstcancer och sjuksköterskor uttrycker svårigheter att tillgodose patientgruppens behov efter avslutad behandling. Syfte: Syftet med litteraturöversikten var att beskriva kvinnors upplevelser av livskvalitet efter att ha överlevt bröstcancer. Metod: En litteraturöversikt med deskriptiv kvalitativ design som baserats på tio kvalitativa vetenskapliga originalartiklar hämtade från PubMed och CINAHL. Resultat: Fyra kategorier med tillhörande subkategorier identifierades: fysisk påverkan, psykisk påverkan, social påverkan och personlig utveckling. Fysisk påverkan beskrev hur den sexuella hälsan, fysiska symtom samt sömn och fatigue inverkade på livskvaliteten. Psykisk påverkan beskrev hur bröstcanceröverlevares livskvalitet påverkades i förhållande till kroppsbild, känsloliv och kognitiv förmåga. Social påverkan beskrev hur livskvaliteten påverkades genom relationer, arbetsliv och ekonomi. Personlig utveckling beskrev hur bröstcanceröverlevarna till följd av upplevelsen fått nytt perspektiv och hur detta påverkade livskvaliteten.  Slutsats: Kvinnor hade olika upplevelser av livskvalitet efter att ha överlevt bröstcancer. Försämrad livskvalitet visade sig orsakas av biverkningar efter behandling och av den existentiella oron som en livshotande sjukdom kan innebära. Vissa bröstcanceröverlevare fick ett nytt perspektiv där tacksamhet, tillfredsställelse och meningsfullhet präglade upplevelsen vilket påverkade livskvaliteten positivt. Sjuksköterskans roll och hälsofrämjande insatser i förhållande till patientgruppens behov visade sig spela en central roll under rehabilitering. / Background: Breast cancer is the most common form of cancer in women and the group breast cancer survivors is growing as modern research advances. Quality of life has become a central concept and an important goal due to the fact that more women get the chance to live a long life after their diagnosis. Research has shown that quality of life can be affected by having survived breast cancer and nurses express difficulties in meeting the needs of these patients after completed treatment. Aim: The aim of the literature review was to describe women's experience of quality of life after surviving breast cancer.   Method: A literature review with descriptive qualitative design based on ten qualitative scientific original articles from PubMed and CINAHL.  Result: Four categories with associated subcategories were identified: physical impact, psychological impact, social impact and personal development. Physical impact described how sexual health, physical symptoms and fatigue affected the quality of life of breast cancer survivors. Psychological impact described how quality of life was affected by body image, emotional life and cognitive ability. Social impact described how the quality of life was affected by relationships, work life and financial position. Personal development described how breast cancer survivors gained a new perspective as a result of the experience and how this had a positive effect on their quality of life. Conclusion: Women had different experiences of quality of life after surviving breast cancer. Reduced quality of life was found to be caused by side effects after treatment and by the existential anxiety that a life-threatening disease can entail. Some breast cancer survivors obtained a new perspective of life, where gratitude, satisfaction and meaningfulness defined the experience and therefore improved their quality of life. The nurse’s role and health-promoting interventions proved to play a key role during breast cancer rehabilitation.

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Eudaimonic psychological well-being (PWB) refers to a lifelong process of purposeful engagement in goal-driven tasks or activities resulting in positive psychological functioning. These activities reflect autonomy, purpose in life, self-acceptance, personal growth, positive relations with others, and environmental mastery. While more women are surviving breast cancer, they face a multitude of late and long term physiopsychosocial challenges that result from being diagnosed and treated. Protective health effects associated with the experience of PWB can potentially mitigate ill-being and benefit overall health of breast cancer survivors (BCS). Adequate preparation by healthcare teams to transition them from primary treatment to early survivorship is critical for the immediate and long term PWB of BCS. The purpose of this dissertation was to: 1) summarize current literature addressing PWB among BCS; 2) describe the helpfulness of information BCS satisfied and dissatisfied receive from their healthcare team to prepare to transition into life immediately after treatment; and 3) examine relationships between PWB and factors that negatively influence BCS’ ability to successfully transition to early survivorship Three manuscripts describe results of data analysis. From a literature review, factors that correlate with PWB among BCS were identified: coping, social support, self-esteem, post-traumatic growth, religious struggles and the impact of physical symptoms. Based on qualitative responses, BCS who are satisfied and dissatisfied with information received to prepare for transition into early survivorship emphasized the importance of receiving comprehensive information on: (1) what to expect physically and emotionally post-treatment, and (2) how their lives moving forward will be unlike their lives prior to being diagnosed. Among a convenience sample of 56 BCS, significant negative relationships between PWB and a) cancer problems frequently experienced by early survivors of breast cancer, b) psychological distress, and c) satisfaction with information received to transition from primary treatment into early survivorship was noted from a prospective, cross-sectional research design study. PWB is becoming increasingly important given that BCS live longer. Information learned from this dissertation can be used by healthcare teams to promote or maintain positive psychological functioning among these survivors, focusing initially on preparing them for life immediately after treatment.