Exploring Cognitive Function and Potential Behavioral Interventions in Breast Cancer Survivors

Abstract

Background: Cancer-related cognitive impairment (CRCI) is one of the common concerns among breast cancer (BC) survivors, negatively impacting their daily functioning and quality of life. To understand the contributing factors and potential intervention strategies, three studies were conducted, examining the psychosocial moderators of sleep-related cognitive impairment, the landscape of behavioral interventions, and the effectiveness of a technology-based sleep intervention on perceived cognitive function. Methods: The first manuscript was a secondary analysis of 199 BC patients assessed at baseline and 3-month follow-up, examining associations between sleep disturbance and cognitive outcomes using Spearman correlations, linear regression, and linear mixed models, with depressive symptoms, social support, and perceived stress tested as moderators. The second manuscript was a systematic review, which narratively synthesized findings from 34 studies on behavioral interventions targeting cognitive function in BC survivors. The third manuscript was a secondary analysis of a pilot waitlist randomized controlled trial in which 60 BC survivors were randomized to either the Cecebot intervention, an SMS-based and sleep-based conversational agent, or a waitlist control group. Perceived cognitive function was assessed using the Perceived Cognitive Impairment Subscale of Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog PCI), and linear mixed models were applied to examine intervention effects. Results: The first manuscript reported that sleep disturbance was concurrently associated with poorer subjective cognitive function, though it did not predict 3-month cognitive outcomes longitudinally. Depressive symptoms significantly moderated the sleep–perceived cognitive ability relationship, and social support moderated the sleep–verbal fluency relationship. The second manuscript included 34 studies and identified five categories of behavioral interventions: (1) exercise/physical activity, (2) mindfulness/mind–body, (3) cognitive training, (4) psychoeducational/psychosocial, and (5) multicomponent interventions. Among them, mindfulness-based and psychoeducational interventions reported the most consistent improvements in subjective cognitive function. In the third manuscript, the Cecebot intervention significantly improved perceived cognitive function at Week 6 compared to the control group (p < 0.01; Cohen's d = 0.97), although mediation analyses indicated that improvements in insomnia symptoms and physical activity did not significantly mediate this effect. Conclusions: Overall, these findings reported the interplay of sleep quality, psychosocial factors, and behavioral interventions in shaping cognitive outcomes. Moreover, the studies offer preliminary evidence that sleep-related interventions may improve perceived cognitive function, while multicomponent behavioral interventions also demonstrate potential strategies. More rigorous and standardized research is still needed to inform the development of the interventions and clinical approaches for this population.