Article
Predictors of the Trajectories of Self-Reported Attentional Fatigue in Women With Breast Cancer Undergoing Radiation Therapy
Purpose/Objectives: To examine how attentional fatigue changed from the time of simulation to four months after the completion of radiation therapy and to investigate whether specific variables predicted initial levels and trajectories of attentional fatigue.
Design: Descriptive, longitudinal study.
Setting: Two radiation therapy departments.
Sample: 73 women with breast cancer who received primary or adjuvant radiation therapy.
Methods: Participants completed questionnaires prior to, during, and after radiation therapy. Descriptive statistics and hierarchical linear modeling were used for data analysis.
Main Research Variables: Attentional fatigue; demographic, clinical, and symptom characteristics.
Findings: Large amounts of interindividual variability were found in the trajectories of attentional fatigue. At baseline, higher levels of attentional fatigue were associated with younger age, not working, a higher number of comorbidities, and higher levels of trait anxiety. The trajectory of attentional fatigue improved over time for women with higher body mass index at baseline.
Conclusions: This study is the first to identify predictors of interindividual variability in attentional fatigue in women with breast cancer undergoing radiation therapy. The predictors should be considered in the design of future correlational and interventional studies.
Implications for Nursing: Nurses could use knowledge of the predictors to identify patients at risk for higher levels of attentional fatigue. In addition, nurses could use the information to educate patients about how attentional fatigue may change during and following radiation therapy for breast cancer.
Jump to a section
References
Banerji, A., Long, A. A., & Camargo, C. A., Jr. (2007). Diphenhydramine versus nonsedating antihistamines for acute allergic reactions: A literature review. Allergy and Asthma Proceedings, 28, 418-426. doi: 10.2500/aap.2007.28.3015
Bieling, P. J., Antony, M. M., & Swinson, R. P. (1998). The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined. Behaviour Research and Therapy, 36, 777-788. doi:10.1016/S0005-7967(98)00023-0
Broadbent, D. E., Cooper, P. F., Fitzgerald, P., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21(1), 1-16.
Carpenter, J. S., Andrykowski, M. A., Wilson, J., Hall, L. A., Rayens, M. K., Sachs, B., & Cunningham, L. L. (1998). Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression scale. Issues in Mental Health Nursing, 19, 481-494.
Castellon, S. A., Ganz, P. A., Bower, J. E., Petersen, L., Abraham, L., & Greendale, G. A. (2004). Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. Journal of Clinical and Experimental Neuropsychology, 26, 955-969. doi: 10.1080/13803390490510905
Cimprich, B. (1992a). Attentional fatigue following breast cancer surgery. Research in Nursing and Health, 15, 199-207.
Cimprich, B. (1992b). A theoretical perspective on attention and patient education. Advances in Nursing Science, 14(3), 39-51.
Cimprich, B. (1993). Development of an intervention to restore attention in cancer patients. Cancer Nursing, 16, 83-92.
Cimprich, B. (1995). Symptom management: Loss of concentration. Seminars in Oncology Nursing, 11, 279-288.
Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-194.
Cimprich, B., Reuter-Lorenz, P., Nelson, J., Clark, P. M., Therrien, B., Normolle, D., … Welsh, R. C. (2010). Prechemotherapy alterations in brain function in women with breast cancer. Journal of Clinical and Experimental Neuropsychology, 32, 324-331. doi: 10.1080/13803390903032537
Cimprich, B., & Ronis, D. L. (2003). An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nursing, 26, 284-292.
Cimprich, B., So, H., Ronis, D. L., & Trask, C. (2005). Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer. Psycho-Oncology, 14, 70-78. doi: 10.1002/pon.821
Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23, 129-138.
Daut, R. L., Cleeland, C. S., & Flanery, R. C. (1983). Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain, 17, 197-210. doi: 10.1016/0304-3959(83)90143-4
Dhruva, A., Dodd, M. J., Paul, S. M., Cooper, B. A., Lee, K., West, C., … Miaskowski, C. (2010). Trajectories of fatigue in patients with breast cancer before, during, and after radiation therapy. Cancer Nursing 33, 201-212.
Ferguson, R. J., McDonald, B. C., Saykin, A. J., & Ahles, T. A. (2007). Brain structure and function differences in monozygotic twins: Possible effects of breast cancer chemotherapy. Journal of Clinical Oncology, 25, 3866-3870. doi: 10.1200/JCO.2007.10.8639
Hess, L. M., & Insel, K. C. (2007). Chemotherapy-related change in cognitive function: A conceptual model. Oncology Nursing Forum, 34, 981-994. doi: 10.1188/07.ONF.981-994
Huyser, Y. (1993). De symptomatologie van depressieve stoornissen en angststoornissen [The symptomatology of depressive disorders and anxiety disorders]. Amsterdam, the Netherlands: Benecke Consultants.
James, W. (1983). The principles of psychology. Cambridge, MA: Harvard University Press.
Jansen, C. E., Dodd, M. J., Miaskowski, C. A., Dowling, G. A., & Kramer, J. (2008). Preliminary results of a longitudinal study of changes in cognitive function in breast cancer patients undergoing chemotherapy with doxorubicin and cyclophosphamide. Psycho-Oncology, 17, 1189-1195. doi: 10.1002/pon.1342
Jenkins, V., Shilling, V., Deutsch, G., Bloomfield, D., Morris, R., Allan, S., … Winstanley, J. (2006). A three-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. British Journal of Cancer, 94, 828-834. doi: 10.1038/sj.bjc.6603029
Jenkins, V., Shilling, V., Fallowfield, L., Howell, A., & Hutton, S. (2004). Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition? A pilot study. Psycho-Oncology, 13, 61-66. doi: 10.1002/pon.709
Jensen, M. P. (2003). The validity and reliability of pain measures in adults with cancer. Journal of Pain, 4, 2-21. doi: 10.1054/jpai.2003.1
Kaplan, S., & Kaplan, R. (1982). Cognition and environment: Functioning in an uncertain world. New York, NY: Praeger.
Karnofsky, D. (1977). Performance Scale. In G. T. Kennealey & M. S. Mitchell (Eds.), Factors that influence the therapeutic response in cancer (pp. 97-101). New York, NY: Plenum Press.
Kennedy, B. L., Schwab, J. J., Morris, R. L., & Beldia, G. (2001). Assessment of state and trait anxiety in subjects with anxiety and depressive disorders. Psychiatric Quarterly, 72, 263-276. doi: 10.1023/A:1010305200087
Lee, K. A. (1992). Self-reported sleep disturbances in employed women. Sleep, 15, 493-498.
Lee, K. A., & DeJoseph, J. F. (1992). Sleep disturbances, vitality, and fatigue among a select group of employed childbearing women. Birth, 19, 208-213.
Lee, K. A., Hicks, G., & Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Psychiatry Research, 36, 291-298.
Lee, K. A., Lentz, M. J., Taylor, D. L., Mitchell, E. S., & Woods, N. F. (1994). Fatigue as a response to environmental demands in women's lives. Image—The Journal of Nursing Scholarship, 26, 149-154.
Lee, K. A., Portillo, C. J., & Miramontes, H. (1999). The fatigue experience for women with human immunodeficiency virus. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28, 193-200. doi: 10.1111/j.1552-6909.1999.tb01984.x
Lee, K. A., Portillo, C. J., & Miramontes, H. (2001). The influence of sleep and activity patterns on fatigue in women with HIV/AIDS. Journal of the Association of Nurses in AIDS Care, 12(Suppl.), 19-27.
Lehto, R. H., & Cimprich, B. (1999). Anxiety and directed attention in women awaiting breast cancer surgery. Oncology Nursing Forum, 26, 767-772.
Lezak, M. D. (1982). The problem of assessing executive functions. International Journal of Psychology, 17, 281-297.
Li, L. W. (2005a). From caregiving to bereavement: Trajectories of depressive symptoms among wife and daughter caregivers. Journal of Gerontology: Psychological Sciences, 60, P190-P198. doi: 10.1093/geronb/60.4.P190
Li, L. W. (2005b). Longitudinal changes in the amount of informal care among publicly paid home care recipients. Gerontologist, 45, 465-473. doi: 10.1093/geront/45.4.465
Mehnert, A., Scherwath, A., Schirmer, L., Schleimer, B., Petersen, C., Schulz-Kindermann, F., … Koch, U. (2007). The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health-related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Education and Counseling, 66, 108-118. doi: 10.1016/j.pec.2006.11.005
Miaskowski, C., & Lee, K. A. (1999). Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study. Journal of Pain and Symptom Management, 17, 320-332.
National Heart, Lung and Blood Institute. (2009). Body mass index table. Retrieved from http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf
Palos, G. R. (2008). Opioids and cancer survivors: Issues in side-effect management. Oncology Nursing Forum, 35(Suppl.), 13-19. doi: 10.1188/08.ONF. S1.13-19
Posner, M. I., & Boies, S. J. (1971). Components of attention. Psychological Review, 78, 391-408.
Posner, M. I., & Dehaene, S. (1994). Attentional networks. Trends in Neuroscience, 17(2), 75-79.
Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25-42. doi: 10.1146/annurev.ne.13.030190.000325
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
Raudenbush, S. W. (2001). Comparing personal trajectories and drawing causal inferences from longitudinal data. Annual Review of Psychology, 52, 501-525. doi: 10.1146/annurev.psych.52.1.501
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage Publications.
Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., & Congdon, R. T. (2004). HLM 6: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International.
Schagen, S. B., van Dam, F. S., Muller, M. J., Boogerd, W., Lindeboom, J., & Bruning, P. F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640-650. doi: 10.1002/(SICI)1097-0142(19990201)85:3<640::AID-CNCR14>3.0.CO;2-G
Seidenberg, M., Haltiner, A., Taylor, M. A., Hermann, B. B., & Wyler, A. (1994). Development and validation of a Multiple Ability Self-Report Questionnaire. Journal of Clinical and Experimental Neuropsychology, 16, 93-104.
Sheehan, T. J., Fifield, J., Reisine, S., & Tennen, H. (1995). The measurement structure of the Center for Epidemiologic Studies Depression Scale. Journal of Personality Assessment, 64, 507-521. doi: 10.1207/s15327752jpa6403_9
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y): (Self-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press.
van Dam, F. S., Schagen, S. B., Muller, M. J., Boogerd, W., v.d. Wall, E., Droogleever Fortuyn, M. E., & Rodenhuis, S. (1998). Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High-dose versus standard-dose chemotherapy. Journal of the National Cancer Institute, 90, 210-218. Retrieved from http://jnci.oxfordjournals.org/cgi/reprint/90/3/210?view=long&pmid=9462… http://jnci.oxfordjournals.org/cgi/reprint/90/3/210?view=long&pmid=9462678
Von Ah, D., Russell, K. M., Storniolo, A. M., & Carpenter, J. S. (2009). Cognitive dysfunction and its relationship to quality of life in breast cancer survivors. Oncology Nursing Forum, 36, 326-336. doi: 10.1188/09.ONF.326-334
Williams, R. A., Hagerty, B. M., Cimprich, B., Therrien, B., Bay, E., & Oe, H. (2000). Changes in directed attention and short-term memory in depression. Journal of Psychiatric Research, 34, 227-238. doi:10.1016/S0022-3956(00)00012-1
Zimmermann, P., Merser, C., Poser, U., & Sedelmeier, P. (1991). Ein fragebogen erlebter defizite der aufmerksamkeit (FEDA) [A questionnaire of experienced deficits in attention]. Freiburg, Germany: University Institute of Psychology.