Association between cumulative symptom burden and cognitive impairment among breast cancer survivors: a cross-sectional study

Cancer-related cognitive impairment (CRCI) is a multifaceted symptom associated with various comorbid conditions, complicating management. This study aims to evaluate cumulative symptom burden and its impact on both subjective and objective CRCI in breast cancer survivors. Enrollment data were analyzed from a randomized clinical trial involving women with stage 0–III breast cancer, free of oncology disease, reporting moderate or greater CRCI and insomnia. Subjective CRCI was measured using the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog), and objective CRCI with the Hopkins Verbal Learning Test–Revised (HVLT). Comorbid symptoms (insomnia, fatigue, pain, anxiety, depression) were assessed with validated self-report tools. A Cumulative Symptoms Score (CSS) was calculated to quantify symptom burden. Multivariable linear regression was used to examine associations with CRCI, adjusting for co-variables. Among 260 participants (mean age 56.6 years), 21% were non-White and 10% Hispanic. Fatigue (90%) was the most common, followed by insomnia (70%), pain (45%), anxiety (35%), and depression (12%). Higher CSS was significantly associated with worse subjective CRCI after adjustment for age and chemotherapy (Coef. = -3.0, 95% CI: -3.6 to -2.4, p < 0.001). Each comorbid symptom was correlated with subjective CRCI (all p < 0.001). CSS was not associated with objective cognitive performance ( p = 0.58), although insomnia correlated with HVLT scores ( r = -0.20; p < 0.001). Cumulative symptom burden was associated with subjective but not objective CRCI. Comprehensive symptom management has the potential to improve subjective appraisal of CRCI. Sleep disturbance may be a therapeutic target for improving objective outcomes.