Cognitive profiles and predictors of cancer-related cognitive impairment in breast cancer survivors: integrating self-reported, neuropsychological, and process-based measures

Abstract

Abstract Objective Characterizing cancer-related cognitive impairment (CRCI) remains challenging due to limitations in the sensitivity of neuropsychological tests and diagnostic criteria. This study aimed to (a) classify breast cancer survivors in CRCI groups using self-reported and neuropsychological categories; (b) explore whether CRCI is related to specific cognitive domains; (c) analyze if comorbid symptoms predict CRCI group membership; (d) study the correspondence between Montreal Cognitive Assessment (MoCA) and neuropsychological CRCI; and (e) explore cognitive profiles of CRCI groups considering Boston Process Approach (BPA) indices. Method This cross-sectional study included 82 breast cancer survivors undergoing treatment and presenting mild depressive symptoms. Self-reported CRCI was assessed using the PROMIS-CF 8a, neuropsychological CRCI was defined following recommended criteria. Participants were classified into four independent CRCI groups: (a) non-CRCI; (b) subjective CRCI; (c) objective CRCI; (d) combined CRCI. Logistic regression models examined predictors, χ2 tests assessed MoCA correspondence, and group differences in BPA indices were studied through ANOVA. Results Participants’ mean age was 47.76 years, 71.95% exhibited self-reported CRCI and 48.78% neuropsychological CRCI. Anxiety predicted subjective and combined CRCI, while lower self-efficacy predicted combined CRCI. MoCA showed limited sensitivity and specificity for neuropsychological CRCI. The combined CRCI group exhibited poorer quality of life and lower performance on processing speed and verbal fluency tasks. Conclusions CRCI assessment should include self-reported and neuropsychological measures. MoCA should not replace comprehensive neuropsychological assessment, while BPA may provide complementary meaningful information to characterize CRCI profiles. CRCI interventions should target executive functioning, anxiety, and self-efficacy. Longitudinal studies with control groups are required.