Symptom Severity and Importance in Metastatic Breast Cancer Patients: An Examination of Cognitive Complaints and Related Symptoms

Abstract

Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.