Benefits of adaptive cognitive training on cognitive abilities in women treated for primary breast cancer: Findings from a 1-year randomised control trial intervention.

OBJECTIVE: While adaptive cognitive training is beneficial for women with a breast cancer diagnosis, transfer effects of training benefits on perceived and objective measures of cognition are not substantiated. We investigated the transfer effects of online adaptive cognitive training (dual n-back training) on subjective and objective cognitive markers in a longitudinal design. METHODS: Women with a primary diagnosis of breast cancer completed 12 sessions of adaptive cognitive training or active control training over 2 weeks. Objective assessments of working memory capacity (WMC), as well as performance on a response inhibition task, were taken while electrophysiological measures were recorded. Self-reported measures of cognitive and emotional health were collected pre-training, post-training, 6-month, and at 1-year follow-up times. RESULTS: Adaptive cognitive training resulted in greater WMC on the Change Detection Task and improved cognitive efficiency on the Flanker task together with improvements in perceived cognitive ability and depression at 1-year post-training. CONCLUSIONS: Adaptive cognitive training can improve cognitive abilities with implications for long-term cognitive health in survivorship.

Quality of working life can protect against cognitive and emotional vulnerability in women living with metastatic breast cancer: a cross-sectional study.

PURPOSE: Research focusing on the cognitive and emotional health of women with metastatic breast cancer (MBC) is limited. The focal aim of the current study was to explore how quality of working life was related to global health, perceived cognitive function, anxiety and depression. To this end, women's experience of employers after MBC diagnosis and its relationship to quality of working life was also explored. METHODS: Women living with MBC (N = 88) completed online questionnaires assessing their global health status, perceived cognitive and emotional vulnerability and their experience of employers following diagnosis. Women working at the time of the study also reported on their quality of working life. RESULTS: Women's experience of employers after MBC diagnosis was positively related to their quality of working life. Importantly, greater quality of working life met with better perceived cognitive function and global health, as well as lower levels of depression in working women. CONCLUSIONS: Our study is the first to establish the role of quality of working life in protecting against levels of cognitive vulnerability and emotional vulnerability to depression in women with MBC. We also highlight the importance of having a positive experience with employers. Our findings suggest that educational programmes can be provided to employers to enhance their understanding and awareness of the needs of women with MBC. IMPLICATIONS FOR CANCER SURVIVORS: Women with MBC may benefit from employers accessing educational (or support) programmes that can increase their awareness of the treatment-related sequelae and needs of women with MBC in the workplace.

Experiences of cognitive training on primary breast cancer survivor's cognitive impairments at work: A longitudinal qualitative study.

OBJECTIVES: Cancer-related cognitive impairment (CRCI) is associated with adverse work-related outcomes in women living with a history of primary breast cancer. We explored the perceived impact of receiving adaptive cognitive training (dual n-back training) or active control training (dual 1-back training) on CRCI. Furthermore, we explored the perceived transfer effects of cognitive training on work-related self-management methods for cognitive impairment and work-related outcomes such as career development. DESIGN: Longitudinal qualitative study. METHODS: A 'framework' analysis approach was used to analyse semi-structured telephone interviews completed by women with a history of primary breast cancer before training (N = 40), one month (N = 30) and six months (N = 29) post-training. RESULTS: Four main themes were identified: (1) impact of cognitive impairment at work, (2) perceived impact of cognitive training on impaired cognitive function, (3) perceived effects of training on work-related self-management methods for cognitive impairment and (4) perceived impact on women's career development and progression. Compared to baseline, women who received adaptive dual n-back training reported sustained improvement in multiple cognitive domains including memory and attention up to six months post-training when the follow-up interviews were conducted. Perceived improvements in cognitive function were associated with greater self-confidence and better emotional well-being in work. These improvements were found to lower dependency on self-management methods for cognitive impairment and enhance effectiveness as well as prompt career development or progression for many women. Although some findings of a similar nature were reported in the active control dual 1-back training group the perceived effects were more pronounced and consistent in the dual n-back group. CONCLUSIONS: Adaptive cognitive training (dual n-back training) improves perceived CRCI experienced by women in the workplace, enhancing their self-confidence and general emotional well-being. These perceived improvements, in turn, can decrease reliance on self-management methods for cognitive impairment and improve work efficiency and contribute to career development and progression.

Exploring primary breast cancer survivors' self-management of sustained cancer-related cognitive impairment in the workplace.

OBJECTIVE: Work plays a central role in return to a more 'normal' life among women diagnosed with primary breast cancer. However, ongoing cancer-related cognitive impairment (CRCI) and cancer-related sequelae continue to detrimentally impact workability. Only a few studies have explored the long-term consequences of CRCI and self-management coping strategies applied in the workplace. This study explored women's experiences of sustained post-treatment CRCI and its impact on workability beyond the initial return-to-work (RTW), as well as experiences of self-management coping strategies. METHOD: Forty employed women with a diagnosis of primary breast cancer who were between 6 and 60 months post-active treatment completed a semi-structured telephone interview. A 'framework' analysis approach was used. RESULTS: Two superordinate themes were identified: 'Sustained consequences of CRCI' and 'Self-management coping strategies to support work-related performance'. We found that the impact of CRCI extends beyond the initial RTW. The adopted self-management coping strategies could provoke mixed emotions, including emotional distress. Reduced workability was experienced up to 5-years post-active-treatment. CONCLUSION: Sustained CRCI induces negative emotions, fatigue and diminishes confidence reducing workability long into survivorship beyond RTW. The self-management coping strategies implemented to manage these sequelae generate mixed feelings, with some describing the strategies as problematic and of little benefit.

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer.

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women's COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.

COVID-19 Outbreak Effects on Job Security and Emotional Functioning Amongst Women Living With Breast Cancer.

The outbreak of Coronavirus disease 2019 (COVID-19) has negatively impacted global economies and employment. In the UK, it is predicted that approximately eight million jobs were furloughed as a result of the outbreak and the associated restriction of movement or shielding measures. This study aimed to investigate the impact of changes in employment status on cognitive and emotional health as well as perceptions of work. Furthermore, it examined the relationships between women's job security and anxiety, depression and cognitive function. Women living with breast cancer (N = 234) completed online questionnaires to measure their cognitive function, general emotional well-being, COVID-19 related emotional vulnerability (COVID-EMV), work ability and COVID-19 related perceptions of work. Our results revealed that threat to job security was predictive of depression and cognitive function in the entire sample Such that those with higher levels of perceived job security had lower depression and better cognitive function. Further, women who were furloughed or unable to continue work reported higher job insecurity compared to those who had worked throughout the pandemic. Greater rumination was also associated with worse anxiety and depression as well as poorer cognitive function. Finally, moderation analysis highlighted that women who had better cognitive functioning were less likely to experience anxiety when their job security was high. Given our findings, we suggest that employers provide women with accessible interventions to enhance cognitive and emotional resilience and thus help protect against the detrimental effects of job insecurity created by the COVID-19 outbreak.

COVID-19 Lockdown and Its Adverse Impact on Psychological Health in Breast Cancer.

The Coronavirus disease 2019 (COVID-19) outbreak generated an unprecedented set of emotional challenges for women diagnosed with breast cancer. In the United Kingdom (UK), the pandemic significantly disrupted oncology services as resources were reassigned to care for COVID-19 patients. In addition to service disruptions, many women received a UK Government letter advising them to shield for 12-weeks. We aimed to explore the effect of disruption to scheduled oncology services and the UK Government shielding letter on emotional and cognitive vulnerability. A further aim was to investigate the relationship between COVID-19 related emotional vulnerability (COVID-EMV) and anxiety, depression and perceived cognitive function. Women diagnosed with primary breast cancer (N = 234) completed a series of online questionnaires to assess their cognitive and emotional wellbeing as well as their COVID-EMV. Results indicated that disrupted oncology services had a significant impact on COVID-EMV, anxiety and depression, with those experiencing disruptions expressing higher general emotional vulnerability as well as COVID-EMV. Further, the UK Government letter had a significant effect on perceived cognitive function; those who received the letter reported poorer cognitive function. Regression analyses revealed that after allowing for the effects of sociodemographic and clinical variables, women's COVID-EMV significantly predicted worse outcomes of anxiety, depression and perceived cognitive function. Our findings indicate that concerns about COVID-19 amongst women affected by breast cancer leads to increased risk of developing affective disorder, such as anxiety and depression symptomatology, among this sample. We advocate the rapid implementation of accessible interventions designed to promote emotional resilience in the breast cancer population.

Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals.

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

Trauma Data Quality Improvement: One Center's Experience With Telecommuting and Paperless Data Management.

The American College of Surgeons requires that trauma centers collect and enter data into the National Trauma Data Registry in compliance with the National Trauma Data Standard. ProMedica supports employment of 4 trauma data analysts who are responsible for entering information in a timely manner, validating the data, and analyzing data to evaluate established benchmarks and support the performance improvement and patient safety process. Historically, these analysts were located on-site at ProMedica Toledo Hospital. In 2017, a proposal was developed including modifications to data collection to streamline processes, move toward paperless documentation, and allow for the analysts to telecommute. To measure the effect of these changes, the timeliness of data entry, rate of data validation, productivity, and staff satisfaction were measured. After the transition to electronic data management and home-based workstations, registry data were being entered within 30 days and 100% of cases were being validated, without sacrificing effective and efficient communication between in-hospital and home-based staff. The institution also benefitted from reduced expense for physical space, employee turnover, and decreased employee absenteeism. The analysts appreciated benefits related to time, travel, environment, and job satisfaction.It is feasible to transition trauma data analysts to a work-from-home situation. An all-electronic system of data management and communication makes such an arrangement possible and sustainable. This quality improvement project solved a workspace issue and was beneficial to the trauma program overall, with the timeliness and validation of data entry vastly improved.

Perceived cognitive functioning and its influence on emotional vulnerability in breast cancer.

We investigated the relationship between perceived cognitive function and emotional vulnerability of breast cancer survivors while examining the moderating effect of various risk factors. Results confirmed that perceived cognitive function predicted emotional vulnerability with grade of breast cancer moderating this relationship. Age at diagnosis exhibited a trend towards significance for emotional vulnerability, and time since diagnosis as well as grade significantly predicted quality of life. Our findings imply that (younger) women with a higher breast cancer grade are at a greater risk for emotional and cognitive vulnerability and can benefit from interventions designed to reduce emotional vulnerability through training cognitive efficiency.