Journal of Cancer Survivorship

, Volume 12, Issue 6, pp 753–761 | Cite as

Cognitive challenges while at work and work output in breast cancer survivors employed in a rapidly evolving economy

  • Andy S. K. Cheng
  • Yingchun Zeng
  • Xiangyu Liu
  • Shaxin Liu
  • Stella W. C. Cheng
  • Cindy T. T. Kwok
  • Raymond C. K. Chung
  • Jianfei Xie
  • Michael Feuerstein



To determine whether work output was related to cognitive limitations while at work in occupationally active breast cancer survivors (BCS) employed in a rapidly developing economy.


Measures of demographics, job type, job stress, general distress (anxiety, depression), fatigue, work-related cognitive limitations, and work output were obtained using self-report measures in a cross-sectional study in both BCS and controls (n = 267/group).


Groups had similar educational backgrounds, job types, and levels of job stress. The BCS group was a median of 3.2 years post-primary treatment, slightly older, more likely to be divorced, have children, and was more likely working part-time. The BCS group reported higher levels of fatigue, general distress, and lower levels of work output (p < .05). A multivariate regression adjusting for group differences indicated that cognitive symptoms at work were related to lower levels of quantity, quality, and timeliness of completed work in the BCS group (adj. R2 = .57, unstandardized coefficient = 1.062, 95% CI = .436 to 1.689).


When reported in the context of work, cognitive limitations were associated with lower levels of reported work output exclusively in the BCS group.

Implications for Cancer Survivors

This study provides further evidence that cognitive limitations reported in the context of work in a developing country is similar to that of BCS working in more developed economies and is specific to BCS and not healthy workers with similar job types and job stress. Solutions to this problem may be applicable across countries.


Breast cancer survivors Fatigue and depression Cognitive function at work Work output Multicenter study 


Compliance with ethical standards

The study protocol was approved by the Ethics Committees for Human Subjects at the four hospitals and the Hong Kong Polytechnic University.

Conflict of interest

All authors report no conflicts of interest. Dr. Feuerstein is Editor-in-Chief of JCSU; however, this paper went through peer review and revision.

Ethical approval

The study protocol and all procedures performed in this study were approved by the Ethics Committees for Human Subjects at the four hospitals and the Hong Kong Polytechnic University.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Andy S. K. Cheng
    • 1
  • Yingchun Zeng
    • 2
  • Xiangyu Liu
    • 3
  • Shaxin Liu
    • 4
  • Stella W. C. Cheng
    • 5
  • Cindy T. T. Kwok
    • 1
  • Raymond C. K. Chung
    • 1
  • Jianfei Xie
    • 6
  • Michael Feuerstein
    • 7
  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityKowloonHong Kong
  2. 2.The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
  3. 3.Department of NursingHunan Cancer HospitalChangshaChina
  4. 4.Rehabilitation Medicine CenterWest China Hospital of Sichuan UniversityChengduChina
  5. 5.Department of Occupational TherapyPrincess Margaret HospitalKwai ChungHong Kong
  6. 6.The Third Xiangya Hospital of Central South UniversityChangshaChina
  7. 7.GaithersburgUSA

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