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Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer

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Abstract

Research on neuropsychological difficulties among cancer patients has focused on chemotherapy as a primary cause, yet several studies have now shown that some patients evidence cognitive weaknesses prior to chemotherapy. As an alternative to the ‘chemo–brain’ theory, this study examined the hypothesis that stress and coping style may be associated with observed neuropsychological difficulties among female cancer patients. Thirty-six women completed neuropsychological testing and psychological questionnaires following surgery for breast cancer and prior to any subsequent treatments. Twenty-seven percent of participants evidenced deficits on at least one measure of verbal fluency, and 14% of participants were impaired on at least one memory measure. Self-reported stress was correlated with deficits in memory, verbal fluency, and attention. Subsequent mediational analyses indicated that use of passive coping styles may underlie this relationship between stress and neuropsychological deficits. These findings highlight the potential relevance of psychological mechanisms, such as coping style, in cancer patients’ experience of neuropsychological deficits.

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Notes

  1. Analyses looking at the effect of type of surgery on self-reported stress, coping style, and neuropsychological measures revealed a significant effect of surgery on substance use coping, F(2, 31) = 3.69, p = .04, with women receiving a biopsy (M = 2.50, SD = 2.12) reporting more substance use coping than women receiving a mastectomy (M = 1.17, SD = .60). There was no significant difference between biopsy and lumpectomy and lumpectomy and mastectomy conditions. Because all of the remaining analyses were non-significant, Fs(2, 31) ≤ 1.04, ps ≥ .37, surgery type was not included as a variable in subsequent analyses.

  2. Analyses looking at the effect of cancer stage on self-reported stress, coping style, and neuropsychological measures revealed a significant effect of cancer stage on MAC fighting spirit, F(3, 31) = 3.64, p = .02, with Stage 2 patients reporting more fighting spirit (M = 3.47, SD = .30) than Stage 1 patients (M = 3.08, SD = .36). There were no other significant pairwise comparisons. Because all of the remaining analyses were non-significant, Fs(3, 31) ≤ 1.01, ps ≥ .40, cancer stage was not included as a variable in subsequent analyses.

  3. All analyses controlled for depression (POMS-SF Depression; Baker et al., 2002), to reflect the hypothesis that stress levels, rather than clinical depression, would contribute to cognitive difficulties.

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Acknowledgments

We wish to thank Paul Dale, M. D. and the health care team in the Margaret Proctor Mulligan Breast Health and Research Program at the University of Missouri for their assistance in identifying participants for this research. We also thank the women whose participation made this study possible. This research was supported by a grant from the University of Missouri System (UM Research Board, PI: S. A. Reid-Arndt).

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  1. Department of Health Psychology, School of Health Professions, University of Missouri, One Hospital Drive, DC116.88, Columbia, MO, 65212, USA

    Stephanie A. Reid-Arndt

  2. Department of Psychology, Texas Christian University, Fort Worth, TX, USA

    Cathy R. Cox

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Correspondence to Stephanie A. Reid-Arndt.

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Reid-Arndt, S.A., Cox, C.R. Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer. J Clin Psychol Med Settings 19, 127–137 (2012). https://doi.org/10.1007/s10880-011-9274-z

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