Journal of Cancer Survivorship

, Volume 12, Issue 2, pp 224–233 | Cite as

Modifiable correlates of perceived cognitive function in breast cancer survivors up to 10 years after chemotherapy completion

  • Ashley Henneghan
  • Alexa Stuifbergen
  • Heather Becker
  • Shelli Kesler
  • Elisabeth King



Cognitive changes following breast cancer treatment are likely multifactorial and have been linked to emotional factors, biophysiological factors, and fatigue, among others. Little is known about the contributions of modifiable factors such as stress, loneliness, and sleep quality. The purpose of this study was to explore the direct and indirect effects of perceived stress, loneliness, and sleep quality on perceived cognitive function (PCF) in breast cancer survivors (BCS) after chemotherapy completion.


In this observational study, BCS 6 months to 10 years post chemotherapy were recruited from the community. We measured perceived stress, loneliness, sleep quality, anxiety, depression, fatigue, and PCF. Data analyses included descriptive statistics, correlations, and mediation analyses utilizing ordinary least square regression.


Ninety women who were on average 3 years post chemotherapy completion participated in the study. Moderate to largely negative correlations were found between PCF and the psychosocial and sleep variables (r values ranged from − 0.31 to − 0.70, p values < .0009). Mediation analyses revealed that stress and daytime sleepiness both directly and indirectly impact PCF and that loneliness and sleep quality only have indirect effects (through anxiety and fatigue).


Our findings suggest that perceived cognitive changes following breast cancer treatment are multifactorial and that higher stress levels, loneliness, daytime sleepiness, and poorer sleep quality are linked to worse perceived cognitive functioning. Also, stress, loneliness, and sleep quality may affect cognitive functioning through a shared psychobiological pathway.

Implications for cancer survivors

Interventions targeting stress, loneliness, and sleep quality may improve perceived cognitive functioning in breast cancer survivors.


Breast cancer survivors Fatigue Perceived cognitive function Loneliness Sleep Stress 


Funding information

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number F31NR015707. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Ashley M. Henneghan was supported by the Doctoral Degree Scholarship in Cancer Nursing, DSCN-15-072-01 from the American Cancer Society.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Ashley Henneghan
    • 1
  • Alexa Stuifbergen
    • 1
  • Heather Becker
    • 1
  • Shelli Kesler
    • 2
  • Elisabeth King
    • 3
  1. 1.School of NursingUniversity of Texas at AustinAustinUSA
  2. 2.Department of Neuro-OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Texas OncologyAustinUSA

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