Exploring anxiety as an influencing factor of the impact of exercise and mind-body prehabilitation on cognitive functioning among women undergoing breast cancer surgery

Abstract

Objective

The purpose of this secondary analysis was to describe the prevalence of anxiety, depression, and perceived stress among women newly diagnosed with breast cancer and the impact of baseline and changes in anxiety on cognitive functioning following exercise and mind-body prehabilitation interventions.

Methods

The sample consisted of 49 women with newly diagnosed breast cancer (stages I–III) who planned to undergo breast cancer surgery at two academic cancer centers. Participants were randomized to receive an exercise or mind-body prehabilitation intervention between the time of diagnosis and breast cancer surgery. Participants completed self-report measures of anxiety, depression (HADS), perceived stress, and cognitive functioning (EORTC-QLQ-C30) at study enrollment and prior to surgery (post-intervention). The relationships between change in cognitive functioning and change in anxiety among all participants were estimated using linear regression modeling.

Results

A significant proportion of women with newly diagnosed breast cancer had clinically significant anxiety (34.0%). Greater anxiety was moderately associated with worse cognitive functioning (r = –0.33) at baseline. Linear modeling found that changes in cognitive functioning and anxiety were inversely related: Each one-unit decrease in anxiety was associated with a two-unit improvement in cognitive function (p = .06).

Conclusions

Anxiety was common in women with newly diagnosed breast cancer and was related to worse cognitive functioning. Assessment of anxiety at the time of diagnosis may allow for earlier anxiety management and subsequent improvement in cognitive functioning.

Keywords:

• anxiety
• breast cancer
• cognitive function
• prehabilitation
• symptom management

Trial Registration:

• ClinicalTrials.gov Identifier: NCT01516190. Registered January 24, 2012.

Acknowledgment

The authors would like to acknowledge Laura Shockro and Nancy Campbell for their assistance with data collection and implementation of the study interventions.

Disclosure statement

EW has received personal fees (consulting) from Athenex, Carrick Therapeutics, G1 Therapeutics, Genentech/Roche, Genomic Health, GSK, Jounce, Leap, Lilly, Novartis, Seattle Genetics, Syros, and Zymeworks; has received research funding from Astra Zeneca and Genentech/Roche; and serves on the scientific advisory board of Leap. RK has received personal fees (consulting) from Fors Marsh Group, Osmol Therapeutics, Inc., and the Comprehensive and Integrative Medicine Institute. No potential conflict of interest was reported by the authors.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

Funding was provided by the Susan G. Komen Foundation (in collaboration with the Society for Women’s Health Research) and the American Institute for Cancer Research. Susan G. Komen Foundation (Society for Women’s Health): SPSWHR1001 (principal investigator: J.A. Ligibel, co-principal investigator: M.L. Irwin; to J.A. Ligibel, M.L. Irwin, and A. Giobbie-Hurder); American Institute for Cancer Research (no grant number; principal investigator: J.A. Ligibel; to J.A. Ligibel, and A. Giobbie-Hurder).