The Cognitive Struggle Is Real in Breast Cancer Survivors: Xiaotong Li, PhD, MS

The results of an investigation into cognitive difficulties exhibited by stage 0 to III breast cancer survivors were presented today at the San Antonio Breast Cancer Symposium by Xiaotong Li, PhD, MS, clinical research acupuncturist and member of Memorial Sloan Kettering Cancer Center’s Integrative Medicine Service. Her team’s research, presented in the poster, “Association Between Cumulative Symptom Burden and Cognitive Difficulties Among Breast Cancer Survivors: A Cross-Sectional Study,” evaluated the impact of this symptom burden on cancer-related cognitive difficulties and insomnia. Here she explains why this is such an important area of investigation, and why there cannot be just 1 method of addressing objective and subjective cognitive difficulties in survivors.

“Our research suggests that cognitive difficulties require a really multicomponent management approach,” Li explains. “Because all these symptoms are very common among this population, a single treatment may not be that effective.”

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

Can you discuss the importance of studying cognitive difficulties among breast cancer survivors?

The reason why we focus on this is because cancer-related cognitive difficulty is really a very common, long-lasting, distressing symptom among this population, especially when the symptom affects their daily activities. Currently, there is no effective treatment in the guidelines [that] we can offer patients. This population with this symptom suffers a lot. Also, it's a multifaceted symptom; it coexists with many comorbid symptoms. We hope that [by] effectively addressing this symptom, we can recognize its complexity and multiphase nature. It's important, especially focusing on these comorbid symptoms, those associated with cognitive function.

Currently, most researchers' studies mainly focus on a general breast cancer population. [There is a] lack of focus among the population that really seeks help. That's why we conducted this study, using baseline data from a clinical trial to really understand the prevalence of those comorbid symptoms, their association with subjective and objective cognitive function, to just get a better sense of this symptom.

What is the clinical significance of differentiating between subjective and objective cognitive difficulties?

First, we know that subjective and objective cognitive metrics reflect different aspects of cognition. That's why we identified different associations with the symptom burden. Subjective metrics, such as service, we use typically reflect patients' everyday cognitive challenges. When these people have a very high level of symptom burden, like fatigue, pain, or anxiety, this just makes them feel like they have a higher level of cognitive difficulties; it makes finishing their daily tasks harder than before. But objective cognition, through a very structured, time-limited neuropsychological test conducted in very optimal conditions, in that condition it actually reduced the influence of real-life stressors, including the impact of comorbid symptoms. When we try to diagnose patients with cognitive difficulties, this is something that we need to keep in mind. Not everybody has both objective and subjective cognitive difficulties, and also based on our research data, only 1 out of 3 really have objective cognitive difficulties. That’s something we need to keep in mind.

Also, second, because the symptom burden is significantly associated with subjective cognition, our research suggests that cognitive difficulties require a really multicomponent management approach. Because all these symptoms are very common among this population, a single treatment may not be that effective. We suggest some holistic treatments, maybe mind-body therapy, such as acupuncture, mindfulness, or exercise. This type of treatment can help address the symptom cluster and maybe have the potential to help them to improve the perceived cognition.