Relationship between self-reported cognitive function and work-related outcomes in breast cancer survivors
This study examined the relationship between perceived cognitive function including perceived cognitive impairment (PCI) and perceived cognitive ability (PCA) and work ability, work performance, work productivity, and intention to leave employment in breast cancer survivors (BCS).
A cross-sectional study design was used in the study. Employed BCS completed questionnaires assessing PCI and PCA (Functional Assessment of Cancer Therapy–Cognitive-3); emotional work demands (Self-Focused Emotional Labor Scale); and work ability index (WAI), work performance, work productivity (Work Limitations Questionnaire (WLQ), and intention to turnover. Separate regression models examined the relationship between PCI and PCA and work-related outcomes.
Participants were 68 employed female BCS who were on average 52 (SD = 8.6) years old and 5 (SD = 3.8) years post-treatment with majority working full time. PCI was associated with poorer work ability (B = − 0.658), work performance (time-B = 0.647, physical-B = − 0.414, and mental-B = 0.689), and work productivity (B = 0.731), but not intent to leave work. PCA was related to higher levels of work ability (B = 0.472), work performance (time-B = − 0.462 and mental-B = − 0.453), and work productivity (β = − 0.494), but not physical demands or intent to turnover.
Employed BCS with negative perceptions of cognitive function reported poorer work outcomes with the exception of the intent to leave employment. In contrast, positive views of one’s cognitive abilities were related to improved ratings of work outcomes again with the exception of intent to leave employment.
Implications for Cancer Survivors
Healthcare providers need to assess and address perceived cognitive functioning to promote work-related outcomes in BCS.
KeywordsBreast cancer survivor Cognitive impairment Work ability Work productivity Work performance
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Howlader N, Noone A, Krapcho M, Miller D, Bishop K, Altekruse S. SEER cancer statistics review. Bethesda: National Cancer Institute; 1975–2013.Google Scholar
- 2.Cancer Research UK. Cancer Incidence by Age. 2016. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero.
- 4.Spelten E, Verbeek J, Uitterhoeve J, Ansink A, van der Leliee J, Reijke TM, et al. Cancer, fatigue and the return of patients to work—a prospective cohort study. Eur J Cancer. 2003;39:1562–67.Google Scholar
- 5.Islam T, Dahlui M, Majid HA, Nahar AM, Taib N, Su TT. Factors associated with return to work of BCS: a systematic review. BMC Public Health. 2014;14(Suppl 3):S8.Google Scholar
- 6.Kennedy F, Haslam C, Munir F, Pryce J. Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer. Eur J Cancer Care (Engl). 2007;16:17–25.Google Scholar
- 7.Feuerstein M, Todd BL, Moskowitz MC, Bruns GL, Stoler MR, Nassifet T, et al. Work in cancer survivors: a model for practice and research. J Cancer Surviv. 2010;4:415–37. https://doi.org/10.1007/s11764-010-0154-6.
- 8.Von Ah D, Russell KM, Storniolo AM, Carpenter JS. Cognitive dysfunction and its relationship to quality of life in BCS. Oncol Nurs Forum. 2009;36:326–36.Google Scholar
- 9.Taskila T, Lindbohm ML. Factors affecting cancer survivors' employment and work ability. Acta Oncol. 2007;4:446–51. https://doi.org/10.1080/02841860701355048.
- 10.Steiner JF, Cavender TA, Main DS, Bradley CJ. Assessing the impact of cancer on work outcomes: what are the research needs? Cancer. 2004;101:1703–11. https://doi.org/10.1002/cncr.20564.
- 11.Ferlay J, Soerjomataram I, Ervik M. GLOBOCAN 2012 v1. 1, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research.Google Scholar
- 12.Koppelmans V, Breteler M, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol. 2012;30:1080–6. https://doi.org/10.1200/JCO.2011.37.0189.
- 13.Hess LM, Insel KC. Chemotherapy-related change in cognitive function: a conceptual model. Oncol Nurs Forum. 2007;34:981–94. https://doi.org/10.1188/07.ONF.981-994.
- 14.Mitchell T, Turton P. 'Chemobrain': concentration and memory effects in people receiving chemotherapy - a descriptive phenomenological study. Eur J Cancer Care (Engl). 2011;20:539–48.Google Scholar
- 15.Von Ah D, Haberman B, Carpenter JS, Schneider BL. Impact of perceived cognitive impairment in BCS. Eur J Oncol Nurs. 2013;17:236–41. https://doi.org/10.1016/j.ejon.2012.06.002.
- 16.Pullens MJ, De Vries J, Roukema JA. Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psychooncology. 2010;19:1127–38. https://doi.org/10.1002/pon.1673.
- 17.Von Ah D, Storey S, Tallman E, Nielsen A, Johns SA, Pressler SJ. Cancer, cognitive impairment and work-related outcomes: an integrative review. Oncol Nurs Forum. 2016;43:602–16.Google Scholar
- 18.Ahn E, Cho J, Shin D, Park B, Ahn S, No DY. Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them. Breast Cancer Res Treat. 2009;116:609–16. https://doi.org/10.1007/s10549-008-0209-9.
- 19.Peugniez C, Fantoni S, Leroyer A, Skrzypczak J, Duprey M, Bonneterre J. Return to work after treatment for breast cancer: single center experience in a cohort of 273 patients. Bull Cancer. 2011;98:E69–79. https://doi.org/10.1684/bdc.2011.1401.
- 20.Bradley CJ, Oberst K, Schenk, M. Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis. Psychooncology. 2006;15:739–47.Google Scholar
- 21.Lai JS, Butt Z, Wagner L, Sweet JJ, Beaumont JL, Vardy J, et al. Evaluating the dimensionality of perceived cognitive function. J Pain Symptom Manag. 2009;37:982–95. https://doi.org/10.1002/pon.
- 22.Lai JS, Wagner, LI, Jacobsen JB, Cella D. Self-reported cognitive concerns and abilities: two sides of one coin? Psychooncology. 2014;23:1133–41. https://doi.org/10.1002/pon.3522.
- 23.Von Ah D, Tallman EF. Perceived cognitive function in BCS: evaluating relationships with objective cognitive performance and other symptoms using the functional assessment of cancer therapy-cognitive function instrument. J Pain Symptom Manag. 2015;49:697–706.Google Scholar
- 24.Ono M, Ogilive JM, Wilson JS, Green HJ, Chambers SK, Ownsworth T, et al. A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol. 2015;5:1–19.Google Scholar
- 25.Von Ah D. Cognitive changes associated with cancer and cancer treatment: state of the science. Clin J Oncol Nurs. 2015;:47–56. https://doi.org/10.1188/15.CJON.19-01AP.
- 26.Bender CM, Thelen BD. Cancer and cognitive changes: the complexity of the problem. Semin Oncol Nurs. 2013;29:232–7. https://doi.org/10.1016/j.soncn.2013.08.003.
- 27.Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109–30. https://doi.org/10.1016/j.critrevonc.2010.01.004.
- 28.van Muijen P, Weevers NLEC, Snels IAK, Duijts SFA, Bruinvels DJ, Schellart AJM, van der Beek AJ. Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care. 2013;22:144–60. https://doi.org/10.1111/ecc.12033.
- 29.Lindbohm ML, Taskila T, Kuosma E, Hietanen P, Carlsen K, Gudbergsson S, et al. Work ability of survivors of breast, prostate, and testicular cancer in Nordic countries: a NOCWO study. J Cancer Surviv. 2012;6:72–81. https://doi.org/10.1007/s11764-011-0200-z.
- 30.Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for BCS. J Clin Oncol. 2006;24:345–53. https://doi.org/10.1200/JCO.2004.00.4929.
- 31.de Boer AG, Verbeek JH, Spelten ER, Uitterhoeve AL, Ansink AC, de Reijke TM. Work ability and return-to-work in cancer patients. Br J Cancer. 2008;98:1342–7. https://doi.org/10.1038/sj.bjc.6604302.
- 32.Diefendorff JM, Croyle MH, Gosserand RH. The dimensionality and antecedents of emotional labor strategies. J Vocat Behav. 2005;66:339–57. https://doi.org/10.1016/j.jvb.2004.02.001.
- 33.Wagner L, Sweet J, Butt Z, Lai L, Cella D. Measuring patient self-reported cognitive function: development of the functional assessment of cancer therapy - cognitive function instrument. J Supp Oncol. 2009;7(6):W32–9.Google Scholar
- 34.Jacobs SR, Jacobsen PB, Booth-Jones M, Wagner LI, Anasetti C. Evaluation of the functional assessment of cancer therapy cognitive scale with hematopoietic stem cell transplant patients. J Pain Symptom Manag. 2007;33:13–23.Google Scholar
- 35.Kruml SM, Geddes D. Exploring the dimensions of emotional labor the heart of Hochschild’s work. Manag Commun Q. 2000;14:8–49.Google Scholar
- 36.Ilmarinen J. The WAI (WAI). Occup Med-Oxford. 2007;57:160.Google Scholar
- 37.Nieuwenhuijsen K, de Boer A, Spelten E, Sprangers MA, Verbeek JH. The role of neuropsychological functioning in cancer survivors’ return to work one year after diagnosis. Psychooncology. 2009;18:589–97. https://doi.org/10.1002/pon.1439.
- 38.Torp S, Nielsen RD, Gudbergsson SM, Dahl AA. Worksite adjustments and work ability among employed cancer survivors. Support Care Cancer. 2012;20:2149–56.Google Scholar
- 39.Lerner D, Reed JI, Massarotti E, Wester LM, Burke TA. The WLQ’s validity and reliability among patients with osteoarthritis. J Clin Epidemio. 2002;55:197–208.Google Scholar
- 40.Munir F. The work limitation questionnaire. Occup Med. 2008;58:310–1.Google Scholar
- 41.Calvio L, Peugeot M, Bruns GL, Todd BL, Feuerstein M. Measures of cognitive function and work in occupationally active BCS. J Occup Environ Med. 2010;52:219–27.Google Scholar
- 42.Prasad M, et al. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. PharmacoEconomics. 2004;22:225–44. https://doi.org/10.1097/JOM.0b013e3181d0bef7.
- 43.Lacity MC, Iyer VV, Rudramuniyaiah PS. Turnover intentions of India IS professionals. Inform Syst Front. 2008;10:225–41.Google Scholar
- 44.Cook JD, Hepworth SJ, Wall TD, Warr PB. The experience of work. New York: Academic Press Inc.; 1981.Google Scholar
- 45.50 IBM Corp. Released. IBM SPSS statistics for windows, version 23.0. Armonk: IBM Corp; 2014.Google Scholar
- 46.Feuerstein M, Hansen JA, Calvio L, Johnson L, Ronquillo JG. Work productivity in brain tumor survivors. J Occup Environ Med. 2007;49:803–11. https://doi.org/10.1097/JOM.0b013e318095a458.
- 47.Hansen JA, Feuerstein M, Calvio LC, Olsen CH. BCS at work. J Occup Environ Med. 2008;50:777–84. https://doi.org/10.1097/JOM.0b013e318165159e
- 48.Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of financial burden of cancer on survivors' quality of life. J Oncol Pract. 2014;10:332–8. https://doi.org/10.1200/JOP.2013.001322.
- 49.Taskila T, Martikainen R, Hietanen P, Lindbohm M. Comparative study of work ability between cancer survivors and their referents. Eur J Cancer. 2007;43:914–20. https://doi.org/10.1016/j.ejca.2007.01.012.
- 50.Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. WAI. 2nd revised edn HelsinkiFinnish Institute of Occupational Health: Helsinki, Finland; 1998.Google Scholar
- 51.Tuomi K, Ilmarinen J, Martikainen R, Aalto L, Klockars M. Aging, work, life-style and work ability among Finnish municipal worksers in 1981-1992. Scand J Work Environ Health. 1997;23(Suppl.1):58–65.Google Scholar
- 52.Tuomi K, Toikkanen J, Eskelinen L, Backman AL, Ilmarinen J, Järvinen E, et al. Mortality, disability and change in occupation among aging municipal employees. Scand J Work Environ Health. 1991;17(Supp.1):58–65.Google Scholar
- 53.Liira JE, Marikaninen E, Leino-Arjas P, Malmivaara A, Mutanen P, Rytkonen H, et al. Work ability of middle-aged Finnish construction workers--a follow-up study in 1991-1995. Int J Ind Ergon. 2000;25:477–81.Google Scholar
- 54.Alavinia SM, de Boer A, van Duivenbooden JC, Firngs-Dresen M, Burdorf A. Determinants of work ability and its predictive value for disability. Occup Med (Lond). 2009;59:32–7.c. https://doi.org/10.1093/occmed/kqn148.
- 55.Salonen P, Aroloa H, Nygård CH, Huhtala H, Koivisto AM. Factors associated with premature departure from working life among ageing food industry. Occup Med (Lond). 2003;53:65–8. https://doi.org/10.1093/occmed/kqg012.
- 56.Sell L. Predicting long-term sickness absence and early retirement pension from self-reported work ability. Int Arch Occup Environ Health. 2009;82:1133–38. https://doi.org/10.1007/s00420-009-0417-6.
- 57.Kuoppala J, Lamminpää A, Väänänen-Tomppo I, Hinkka K. Employee well-being and sick leave, occupational accident, and disability pension: a cohort study of civil servants. J Occcup Environ Med. 2011;53:633–40. https://doi.org/10.1097/JOM.0b013e31821aa48c.
- 58.Stajkovic A, Luthans F. Self-efficacy and work-related performance: a meta-analysis. Psychol Bull. 1998;124:240–61. https://doi.org/10.1037/0033-2909.1242.240.
- 59.Bains M, Munir I, Yarker J, Bowley D, Thomas A, Armitage N, et al. The impact of colorectal cancer and self-efficacy beliefs on work ability and employment status: a longitudinal study. Eur J Cancer Care (Engl). 2012;21:634–41.Google Scholar
- 60.Byrne ZS. Fairness reduces the negative effects of organizational politics on turnover intentions, citizenship behavior and job performance. J Bus Psychol. 2005;20:175–200.Google Scholar
- 61.Hakanen JJ, Lindbohm MH. Work engagement among BCS and the referents: the importance of optimism and social resources at work. J Cancer Surviv. 2008;2:283–95.Google Scholar
- 62.Tiedtke C, de Rijk A, Dierckx de Casterle B, Christiaens M, Donceel P. Experiences and concerns about returning to work for women BCS: a literature review. Psychooncology. 2010;19:677–83. https://doi.org/10.1002/pon.1633.
- 63.Klasuwa Mbengi R, Otter R, Mortelman K, Arbyn M, Van Oyen H, Bouland C, et al. Barriers and opportunities for return-to-work of cancer survivors: time for action—rapid review and expert consultation. Sci Rev. 2016;5:35. https://doi.org/10.1186/s13643-016-0210-z.
- 64.Ekwueme DU, Trogdon JG, Khavjou OA, Guy GP. Productivity costs associated with breast cancer among survivors aged 18-44 years. Am J Prev Med. 2016;50:286–94. https://doi.org/10.1016/jamepre.2015.10.006.
- 65.Feuerstein M, Gerhrke AK, McMahon BT, McMahon C. Challenges persist under Americans with disabilities act amendments act: how can oncology providers help? J Oncol Pract. 2017;13:e543–51. https://doi.org/10.1200/JOP.2016.016758.
- 66.Short PF, Vargo MM. Responding to employment concerns of cancer survivors. J Clin Oncol. 2006;24(32):5138–41. https://doi.org/10.1200/JCO.2006.06.6316.
- 67.Silver JK, Baima J, Newman R, Galantino ML, Shockney LD. Cancer rehabilitation may improve function in survivors and decrease the economic burden of cancer to individuals and society. Work: J Prevent Assess Rehab. 2013;46(4):455–72.Google Scholar
- 68.Rick O, Kalusche EM, Dauelsberg T, Koinig V, Korsukewitz C, Seifart U. Reintegrating cancer patients into the workplace. Deutsch Arztebl Int. 2012;109(42):702–8.Google Scholar
- 69.Stergiou-Kita M, Grigorovich A, Tseung V, Milosevic E, Hebert D, Phan S, et al. Qualitative meta-synthesis of survivors' work experiences and the development of strategies to facilitate return to work. J Cancer Surviv. 2014;8(4):657–70.Google Scholar
- 70.Wells M, Amir Z, Cox T, Eva G, Greenfield D, Hubbard G, et al. Time to act: the challenges of working during and after cancer, initiatives in research and practice. Eur J Oncol Nurs. 2014;18(1):1–2.Google Scholar
- 71.Munir F, Kalawsky K, Wallis DJ, Donaldson-Feilder E. Using intervention mapping to develop a work-related guidance tool for those affected by cancer. BMC Public Health. 2013;13(1):6.Google Scholar
- 72.MCS. We are Macmillan Cancer Support. 2017. Available from: https://www.macmillan.org.uk/about-us/what-we-do/how-we-work/work-and-cancer/macmillan-at-work.
- 73.Office of Disability Employment Policy USDoL, JAN, Job Accommodation Nework. 2017. Available from: https://askjan.org/media/canc.htm.
- 74.Duijts SF, van der Beek A, Boelhouwer I, Schagen SB. Cancer-related cognitive impairment and patients' ability to work: a current perspective. Curr Opin Support Palliat Care. 2017;11:19–23. https://doi.org/10.1097/SPC.0000000000000248.