Supportive Care in Cancer

, Volume 27, Issue 3, pp 1121–1128 | Cite as

Pupillary response: cognitive effort for breast cancer survivors

  • Jamie S. MyersEmail author
  • Melike Kahya
  • Melissa Mitchell
  • Junqiang Dai
  • Jianghua He
  • Sanghee Moon
  • Kevin Hamilton
  • Mary Valla
  • Anne O’Dea
  • Jennifer Klemp
  • Monica Kurylo
  • Abiodun Akinwuntan
  • Hannes Devos
Original Article



The purpose of this cross-sectional comparative pilot study was to evaluate cognitive effort, indexed by pupillary response (PR), for breast cancer survivors (BCS) with complaints of cognitive dysfunction following chemotherapy.

Study Aims

Compare the cognitive effort employed by BCS to healthy controls (HC) during neuropsychological tests (NPT) for memory, sustained attention, verbal fluency, visuospatial ability, processing speed and executive function; and Investigate the relationship between PR-indexed cognitive effort and participants’ self-report of cognitive function.


Self-report of cognitive function was collected from 23 BCS and 23 HC. PR was measured during NPT. Independent two-sample t tests or Wilcoxon rank sum tests were used to compare group scores. Between-group effect size (Cohen’s d) was calculated for each outcome. Correlation between mean self-report scores and PR values, as well as 95% confidence intervals, was calculated.


No group differences were demonstrated for NPT performance. BCS reported more issues with cognitive function than HC (p < .0001). A group effect for BCS was seen with PR-indexed cognitive effort for components of most NPT (p < .05). PR was correlated with most self-report measures of cognitive function (r = 0.33–0.45).


PR sensitivity to cognitive effort across a variety of NPT and correlation with self-report of cognitive function was demonstrated. The portability, affordability, and “real-time” aspects of PR are attractive for potential use in the clinic setting to assess cognitive function. A larger study is needed to confirm these results. Prospective investigation of PR in BCS is needed to demonstrate sensitivity to cognitive function changes over time.


Breast cancer Cognitive dysfunction Cognitive neuroscience Pupillary response 


Funding information

The study was funded by the University of Kansas Medical Center Frontiers Pilot & Collaborative Studies Award.

Compliance with ethical standards

Approval from the University of Kansas Human Subjects Committee was obtained, and all procedures were performed in accordance with institutional ethical standards and the 1964 Helsinki declaration and its later amendments.

Informed consent

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

Conflict of interest

The authors have no financial relationships to disclose. The first author and Primary Investigator for the study have full control of all primary data. However, data sharing agreement execution would be necessary if the journal requests data review.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jamie S. Myers
    • 1
    Email author
  • Melike Kahya
    • 2
  • Melissa Mitchell
    • 3
  • Junqiang Dai
    • 4
  • Jianghua He
    • 4
  • Sanghee Moon
    • 2
  • Kevin Hamilton
    • 2
  • Mary Valla
    • 5
  • Anne O’Dea
    • 6
  • Jennifer Klemp
    • 7
  • Monica Kurylo
    • 8
  • Abiodun Akinwuntan
    • 2
  • Hannes Devos
    • 2
  1. 1.Office of Grants and ResearchUniversity of Kansas School of NursingKansas CityUSA
  2. 2.Department of Physical Therapy and Rehabilitation ScienceUniversity of Kansas School of Health ProfessionsKansas CityUSA
  3. 3.Department of Radiation OncologyUniversity of Kansas Medical CenterKansas CityUSA
  4. 4.Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityUSA
  5. 5.North Kansas City HospitalNorth Kansas CityUSA
  6. 6.Department of Medical OncologyUniversity of Kansas Medical CenterKansas CityUSA
  7. 7.University of Kansas Cancer CenterWestwoodUSA
  8. 8.Department of Psychiatry & Behavioral SciencesUniversity of Kansas Medical CenterKansas CityUSA

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