Associations of brain-derived neurotrophic factor rs6265 polymorphism and cognitive function in breast cancer survivors from a cross-sectional study.

BACKGROUND: Breast cancer survivors (BCS) often complain of cancer-related cognitive impairment (CRCI) during and even months after completing primary cancer treatments, particularly chemotherapy. The etiology of CRCI is unknown, but associations of CRCI with germline genetic polymorphisms have been reported, including Brain-Derived Neurotrophic Factor (BDNF) rs6265 polymorphism. The current study investigated the associations of specific BDNF rs6265 with CRCI. METHODS: Cancer-related cognitive impairment was assessed using subjective reports of cognitive symptoms (the version 1.0, 8-item short-forms of the Patient-Reported Outcomes Measurement Information System®) and computerized objective cognitive function scores (CANTAB®). BDNF rs6265 genotypes were determined from buccal swabs. The associations of specific BDNF rs6265 with CRCI were examined by either one-way analysis of variance or the Kruskal-Wallis test followed by post hoc tests and rank-based regression analysis. RESULTS: We examined 356 female BCS. The mean (SD) age was 55.6 (9.8) years old, the median (IQR) years since cancer diagnosis were 4.0 (6.0), and 331 (92.7%) were self-described as White. BCS carrying the Met/Met genotype showed poorer results on 'visual episodic memory and new learning' and 'spatial working memory and executive function.' This relationship was observed regardless of prior chemotherapy. CONCLUSION: Our findings suggest that carrying the BDNF rs6265 Met/Met genotype increases the risk for CRCI in BCS. These results are foundational in nature and provide important information to identify mechanisms underpinning CRCI.

Correlates of frailty in older female cancer survivors.

INTRODUCTION: Cancer survivors are at risk of frailty because of cancer and its treatment. Understanding the factors that increase the risk of frailty is an important aspect of cancer care for the development of interventions to prevent or manage frailty, thus improving cancer survival and overall quality of life of cancer survivors. This study aimed to identify demographic, clinical, and psychosocial correlates of frailty in older, female cancer survivors. MATERIALS AND METHODS: This is a sub-study focusing on the exploratory aim of a larger cross-sectional study (NURS-IIR-IUSCC-0748). A total of 213 female cancer survivors aged 59-87 years old were included from the parent study in the current analysis. Frailty, the primary outcome, was measured using the Tilburg Frailty Indicator scale. The independent variables were age, relationship status, clinical stage of cancer, treatment type, comorbidity, depression, affect, optimism, stress, and social support. Stepwise linear regression modeling identified the independent variables that were significantly associated with frailty. RESULTS: The final regression model revealed that high patient-reported stress and depression, comorbidity, not being married or living with a partner, and low positive affect were significantly associated with worsening frailty in this population. DISCUSSION: Understanding the context of frailty is important for the design of interventions that target factors known to be associated with frailty in older cancer survivors. Further validation with a larger and a more diverse sample from a broad spectrum of sociodemographic and clinical population would fully account for the multiple independent variables influencing frailty in cancer survivors.

Latent class symptom profiles of colorectal cancer survivors with cancer-related cognitive impairment.

PURPOSE: Colorectal cancer (CRC) survivors experience cancer-related cognitive impairment and co-occurring symptoms after cancer treatments. There has been little data to inform the risk factors of complex symptom phenotypes in CRC survivors. OBJECTIVES: To determine if subgroups of CRC survivors after cancer treatments could be identified based on the cognitive impairment and common co-occurring symptoms (depression, anxiety, sleep disturbance, fatigue, and pain); and to explore risk factors (sociodemographic and clinical characteristics, perceived stress, and social support) of these subgroups. METHODS: Latent class profile analysis (LCPA) was used to identify subgroups based on self-reported symptoms in 64 CRC survivors. Cognitive impairment was measured by assessing subjective cognitive function using the Patient-Reported Outcome Measurement Information System (PROMIS) measure. The Kruskal-Wallis test and regression analyses were performed. RESULTS: Three distinct latent classes were identified (Class 1: All Low '28.1%'; Class 2: High Psychological Symptoms (depression/anxiety) '25%'; Class 3: High Somatic Symptoms (fatigue, sleep disturbance, and pain) with High Cognitive Impairment'46.9%'). The pain was the most distinguishable symptom across the latent classes. The high symptom burden group was associated with less time since cancer diagnosis, higher perceived stress levels, and poor emotional social support. CONCLUSION: Our study adds to the information on interindividual variability in symptom experience of CRC survivors with cognitive impairment. Findings suggest a need for increased attention to screening for co-occurring symptoms (e.g., high pain) and future interventions focused on stress management and social support.

Acceptability of computerized cognitive training and global cognitive stimulating-based games delivered remotely: Results from a randomized controlled trial to address cancer and cancer-related cognitive impairment in breast cancer survivors.

BACKGROUND: Although the cancer-related cognitive impairment (CRCI) is a common symptom incurred by the breast cancer survivors (BCS), more emphasis is needed in identifying acceptable interventions for survivors. PURPOSE: The purpose of this qualitative descriptive study was to examine the acceptability of cognitive programs by identifying the facilitators and barriers for implementing computerized cognitive training (BrainHQ) and computerized global cognitive stimulating-based games (e.g., computerized word-find, puzzles, etc.) comparator delivered remotely to improve CRCI from the perspective of BCS. METHODS: BCS (n = 35) who enrolled and completed a randomized controlled trial of computerized cognitive training: 19 cognitive training (BrainHQ) and 16 global cognitive stimulating-based games (crosswords, puzzles, etc.) were interviewed post-training. Semi-structured questions were used, recorded, and transcribed verbatim. Qualitative data were analyzed using standard content analytic procedures for each intervention. RESULTS: Facilitators of training varied by intervention with cognitive training seen as challenging, engaging, and gave a sense of accomplishment whereas global stimulating games were seen as a way of taking mind off issues, enjoyable, and easy to navigate. Barriers of cognitive training included an awareness of failing whereas global stimulating games were deemed to be too repetitive. Both groups endorsed the convenience/flexibility of online training and common concerns of time constraints and fatigue to complete the training. Each group also provided recommendations for improvement. CONCLUSIONS: Cognitive training and global stimulating games were generally well received by BCS. Designing more support elements to promote engagement may be key to successful long-term implementation.

The Relationship Between Self-reported Cognitive Abilities and Psychological Symptoms in Breast Cancer Survivors.

BACKGROUND: Many breast cancer survivors (BCSs) report numerous symptoms following cancer treatment, including cognitive concerns and psychological symptoms (anxiety and depression). However, the association among these symptoms is not well understood. OBJECTIVES: The objectives were to, primarily, examine the relationship between self-reported cognitive ability and psychological symptoms (anxiety and depressive symptoms) controlling for potential confounders of age, education, and time posttreatment and, secondarily, examine the relationship between self-reported cognitive domains (attention, language, visuoperception, visual memory, and verbal memory) and psychological symptoms. METHODS: This secondary data analysis pooled data from 2 theoretically and conceptually congruent, institutional review board-approved studies of BCSs. Breast cancer survivors completed the Multiple Ability Self-report Questionnaire (cognitive ability), Spielberger State Trait Anxiety Inventory-State (anxiety), and Center for Epidemiological Studies-Depression Scale (depressive symptoms). Data were analyzed using descriptive statistics, Pearson correlations, and separate linear regression. RESULTS: One hundred fifty-five BCSs who were on average 54.8 (SD, 8.9) years of age, approximately 5 years (mean, 5.2 [SD, 3.8] years) posttreatment, and well-educated (mean, 15.2 [SD, 2.2] years) completed questionnaires. In bivariate correlations, higher anxiety and depressive symptoms were significantly related to cognitive abilities in all domains ( P = <.01). In the regression model, increased anxiety was associated with poorer cognitive abilities in all domains ( P < .01). CONCLUSIONS: Anxiety and depressive symptoms were associated with decrements in self-reported cognitive abilities among BCSs. IMPLICATIONS FOR PRACTICE: With increasing numbers of BCSs, more research is needed to address psychological symptoms, which correlate with cognitive function. Findings from this analysis can inform clinical BCS survivorship care planning and future interventional research, focused on comprehensive symptom management.

Association Between Cardiovascular Disease and Cognitive Dysfunction in Breast Cancer Survivors.

BACKGROUND: Breast cancer survivors (BCSs) may have a greater risk for cardiovascular disease (congestive heart failure and hypertension), which in turn, can affect cognitive dysfunction, a frequent, bothersome, and potentially debilitating symptom. OBJECTIVE: The purpose of this study was to examine the relationship of cardiovascular disease on cognitive function in BCSs. METHODS: Baseline data from a double-blind randomized controlled trial for cognitive training of BCSs were examined. Early-stage BCS (stages I-IIIA) who were 21 years or older, completed adjuvant therapy (≥6 months), and reported cognitive concerns completed questionnaires and a brief neuropsychological assessment, including tests of memory, attention and working memory, speed of processing, and verbal fluency. Descriptive statistics, Pearson correlation coefficient, and separate linear regression models for each cognitive domain were conducted. RESULTS: Forty-seven BCSs, who were on average 57.3 (SD, 8.1) years old, were 58% White, and had some college education (75%), completed the study. Furthermore, 44.7% of the BCS had cardiovascular disease (congestive heart failure or hypertension). In linear regression models, cardiovascular disease was significantly related to immediate and delayed memory and attention and working memory ( P < .01-.05). CONCLUSION: Breast cancer survivors who have cardiovascular disease may also be at a greater risk for cognitive dysfunction post treatment. Results from this study inform both clinical practice and future research, specifically by examining the intersection between cancer, cardiovascular disease (cardiotoxicity), and cognition. IMPLICATIONS FOR PRACTICE: Nurses should be aware that BCSs with co-occurring cardiovascular disease are at a higher risk for cognitive dysfunction and work within the multidisciplinary team to optimize BCS health and function.

Randomized double-masked controlled trial of cognitive training in breast cancer survivors: a preliminary study.

PURPOSE: To evaluate the acceptability, satisfaction, and preliminary efficacy of cognitive training for improving cognitive function and health outcomes in breast cancer survivors (BCS). PATIENTS AND METHODS: BCS enrolled in this 2-group randomized, double-masked controlled trial of cognitive training. Primary outcomes included the acceptability and satisfaction of the interventions. Secondary outcomes included examining the effect size and reliable improvement of perceived cognitive function and health outcomes, including work ability, health perception (status and change), and quality of life. Exploratory outcomes were performance on neuropsychological tests and plasma levels of brain-derived neurotropic factor (BDNF). Data were collected at baseline and immediately post-intervention. Using ANCOVA models, the intervention was compared to attention control while adjusting for covariates and baseline values. The effect sizes for differences in means and the reliable improvement percentage were reported. RESULTS: Thirty-six BCS completed the study and were on average 57.6 (SD = 8.0) years old, 59.4% Caucasian, and had some college education (74.5%). Both programs were reported to be satisfactory and acceptable. Non-significant small effect sizes were noted for the intervention on cognitive abilities (d = 0.26) and cognitive concerns (d = - 0.32), with reliable improvement noted in 32% and 28% of BCS, respectively. Small to medium effect sizes were noted in improvement in work ability (d = 0.37) and health perception status (d = 0.30) and change (d = 0.60, p < 0.05). CONCLUSIONS: Cognitive training was acceptable to BCS and resulted in improvement in perceived cognitive function and perceptions of "real-world" health benefits. A larger randomized controlled trial is warranted to determine its effectiveness for objective cognitive performance.

Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors.

PURPOSE: Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). METHODS: Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. RESULTS: BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue. CONCLUSIONS: Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL. IMPLICATIONS TO CANCER SURVIVORS: Assessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS.

Comorbidity, cognitive dysfunction, physical functioning, and quality of life in older breast cancer survivors.

PURPOSE: Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS. METHODS: A secondary data analysis was conducted on data from 335 BCS (stages I-IIIA) who were ≥ 60 years of age, received chemotherapy, and were 3-8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory, and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted. RESULTS: BCS were on average 69.79 (SD = 3.34) years old and 5.95 (SD = 1.48) years post-diagnosis. Most were stage II (67.7%) at diagnosis, White (93.4%), had at least some college education (51.6%), and reported on average 3 (SD = 1.81) comorbidities. All 6 physical functioning models were significant (p < .001), with more comorbidities and worse subjective attention identified as significantly related to decreased physical functioning. One model found worse subjective attention was related to poorer QoL (p < .001). Objective cognitive function measures were not significantly related to physical functioning or QoL. CONCLUSIONS: A greater number of comorbidities and poorer subjective attention were related to poorer outcomes and should be integrated into research seeking to determine predictors of physical functioning and QoL in breast cancer survivors.

Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review.

BACKGROUND: Approximately 60% of the more than 3.8 million breast cancer survivors (BCSs) living in the United States are 60 years or older. Breast cancer survivors experience many symptoms including cognitive dysfunction; however, little is known regarding how age affects these symptoms. OBJECTIVE: This integrative review was conducted to synthesize the literature on cognitive dysfunction in older BCSs. The purpose was to (1) describe the prevalence of objective and subjective cognitive dysfunctions and (2) examine factors associated with cognitive dysfunction in older BCSs. METHODS: Whittemore and Knafl's integrative review methodology was used to examine cognitive dysfunction in BCSs 60 years or older. RESULTS: Twelve quantitative studies were included. Up to 41% of older BCSs experienced cognitive dysfunction on neuropsychological examination, and up to 64% reported cognitive dysfunction on subjective measures pretreatment. Approximately half of older BCSs experienced cognitive decline from pretreatment to posttreatment regardless of cognitive measure. The domains most impacted were memory, executive functioning, and processing speed. Objective and subjective cognitive dysfunctions were associated with age, comorbidities, chemotherapy receipt, sleep, neuropsychological symptom cluster, frailty, and quality of life. CONCLUSIONS: Cognitive dysfunction among older BCSs was common both prior to and following treatment. Cognitive dysfunction was associated with multiple factors that are compounded in the aging population and could be detrimental to quality of life and independent living. IMPLICATIONS TO PRACTICE: Early assessment and intervention by healthcare providers, including nurses, for cognitive dysfunction in older BCSs are essential. Future research should focus on evidence-based interventions for cognitive dysfunction incorporating the unique needs of older BCSs.

Cognitive dysfunction prevalence and associated factors in older breast cancer survivors.

OBJECTIVES: The purpose of this study was to examine the prevalence and factors associated with objective and subjective cognitive dysfunction in older breast cancer survivors (BCS). MATERIALS AND METHODS: This cross-sectional descriptive study leveraged previously collected data from older BCS (n = 335). Separate linear regression models were used to determine relationships between demographic factors (age, education), medical factors (comorbidities), disease factors (time since diagnosis, cancer stage), cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive dysfunction measures, including objective learning, delayed recall, attention, executive function-working memory, verbal fluency and subjective attentional function. RESULTS: Cognitive dysfunction was prevalent with up to 18.6% of older BCS experiencing mild-moderate dysfunction (1.5 standard deviations below mean of non-cancer controls) in at least one cognitive domain. Poor to moderate subjective attentional function was reported by 26% of older BCS. More depressive symptoms were significantly related to poorer cognitive function including learning (p < .01), delayed recall (p < .05), verbal fluency (p < .001), and subjective attentional function (p < .001) but not attention and executive function-working memory. Age, education, anxiety, and fatigue were also negatively associated with cognitive function in some models (p < .05-0.001). CONCLUSION: Cognitive dysfunction is common among older BCS and depressive symptoms, anxiety, and fatigue are related factors. Importantly, depressive symptoms were not only related to self-report, but also to cognitive performance. Healthcare providers should be aware of and assess for related factors and cognitive dysfunction itself in older BCS even years after diagnosis and treatment thorough geriatric assessment. Future longitudinal research is needed to discern these relationships.

Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors.

INTRODUCTION: Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment. OBJECTIVES: The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS. METHODS: A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data. RESULTS: BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education. CONCLUSIONS: Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work. IMPLICATIONS TO PRACTICE: Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.

Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice.

OBJECTIVE: To provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment. DATA SOURCES: Review and synthesis of empirical articles. CONCLUSION: Cognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.

Incidence and Factors Associated With Attentional Fatigue in Working Long-term Breast Cancer Survivors.

PURPOSE: The purpose of this study was to examine the incidence of attentional fatigue and the relationship between sleep disturbance and attentional fatigue in working long-term breast cancer survivors (BCS). METHODS: A descriptive, correlation design was used. The data for this study were drawn from a larger descriptive study designed to understand the impact of cognitive dysfunction on work-related outcomes. Breast cancer survivors completed questionnaires regarding sleep disturbance, attentional fatigue, and demographic and medical characteristics. Sleep disturbance, a subscale of the Pittsburgh Sleep Quality Index, is measured by asking 9 questions about sleep disturbances. Attentional fatigue was measured by the Attentional Function Index. Descriptive statistics and multiple regression were performed to assess the impact of sleep disturbance on attentional fatigue, controlling for covariates. RESULTS: Sixty-eight female BCS, ranging from 29 to 68 years old (mean [SD], 52.1 [8.6] years old) and, on average, 4.97 (SD, 3.36) years posttreatment, participated. Thirty-four percent of BCS had poor to moderate attention function. Sleep disturbance significantly predicted attentional fatigue (P < .05), explaining 16% of the variance, F4,57 = 2.68, P < .04, R = 0.16. CONCLUSIONS: Clinicians can assess and intervene to decrease sleep disturbance, which may also improve attentional fatigue in BCS. However, sleep disturbance is only 1 contributing factor. Further investigation into factors contributing to attentional fatigue in BCS is warranted.

Relationship between self-reported cognitive function and work-related outcomes in breast cancer survivors.

PURPOSE: This study examined the relationship between perceived cognitive function including perceived cognitive impairment (PCI) and perceived cognitive ability (PCA) and work ability, work performance, work productivity, and intention to leave employment in breast cancer survivors (BCS). METHODS: A cross-sectional study design was used in the study. Employed BCS completed questionnaires assessing PCI and PCA (Functional Assessment of Cancer Therapy-Cognitive-3); emotional work demands (Self-Focused Emotional Labor Scale); and work ability index (WAI), work performance, work productivity (Work Limitations Questionnaire (WLQ), and intention to turnover. Separate regression models examined the relationship between PCI and PCA and work-related outcomes. RESULTS: Participants were 68 employed female BCS who were on average 52 (SD = 8.6) years old and 5 (SD = 3.8) years post-treatment with majority working full time. PCI was associated with poorer work ability (B = - 0.658), work performance (time-B = 0.647, physical-B = - 0.414, and mental-B = 0.689), and work productivity (B = 0.731), but not intent to leave work. PCA was related to higher levels of work ability (B = 0.472), work performance (time-B = - 0.462 and mental-B = - 0.453), and work productivity (ß = - 0.494), but not physical demands or intent to turnover. CONCLUSIONS: Employed BCS with negative perceptions of cognitive function reported poorer work outcomes with the exception of the intent to leave employment. In contrast, positive views of one's cognitive abilities were related to improved ratings of work outcomes again with the exception of intent to leave employment. IMPLICATIONS FOR CANCER SURVIVORS: Healthcare providers need to assess and address perceived cognitive functioning to promote work-related outcomes in BCS.

Addressing Cognitive Impairment After Breast Cancer: What Do Women Want?

PURPOSE: Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on daily life. Breast cancer survivors frequently engage in self-management strategies to lessen the impact of these cognitive symptoms. There is little information from the perspective of BCS as to their preference of interventions. The purpose of this study was to explore how BCSs cope and self-manage the symptoms associated with cognitive changes, their preferences for the type of intervention(s), and perceived facilitators and barriers to interventions. METHODS: A qualitative descriptive study using content analysis was conducted. Semistructured telephone interviews were conducted with 13 BCSs. RESULTS: Breast cancer survivors articulated that validation and self-management strategies were used to relieve cognitive symptoms. Nonpharmacologic, evidence-based interventions that use a combined onlinein-person approach and include follow-up with healthcare providers are preferred by BCSs. Ease of use, accessibility, and convenience were identified by BCSs as most important to facilitate participation. Cost, time intensiveness, and distance to travel hampered participation. CONCLUSIONS: Patient-centered interventions tailored to meet the needs of BCSs should be considered when implementing programs or interventions to maximize their utilization and benefit. The process of implementation should be dynamic and include an ongoing collaboration between BCSs and clinical nurse specialists.

Relationship of Self-reported Attentional Fatigue to Perceived Work Ability in Breast Cancer Survivors.

BACKGROUND: Breast cancer survivors (BCSs) have identified attentional fatigue, a decrease in the ability to focus, as a persistent daily challenge; however, little is known regarding its impact on work ability. OBJECTIVE: The purpose of this study was to examine the relationship between attentional fatigue and perceived work ability in BCSs controlling for the known covariates of age, education, household income, and time posttreatment. METHODS: A cross-sectional, descriptive design was used. Breast cancer survivors who were currently employed and at least 1 year post-adjuvant treatment participated. Breast cancer survivors completed the Attentional Function Index and Work Ability Index questionnaires. Descriptive statistics, linear regression, and Fisher exact test were used for analysis. RESULTS: Sixty-eight female BCSs, ranging from 29 to 68 years of age (mean, 52.1 [SD, 8.6]) and on average 4.97 (SD, 3.36) years posttreatment, participated. More than one-fourth of BCSs (26.5%) reported poor to moderate perceived work ability, indicating substantial concerns regarding work performance. Attentional fatigue was found to significantly predict perceived work ability (P < .001), explaining 40% of the variance of perceived work ability. CONCLUSIONS: Attentional fatigue is a prevalent symptom posttreatment that is negatively related to perceived work ability in BCSs. IMPLICATIONS FOR PRACTICE: Nurses are in a prime position to assess and intervene to alleviate attentional fatigue to improve work ability. Findings suggest a need for individual, comprehensive survivorship care plans to effectively address symptoms that impact work ability and, ultimately, the quality of life of cancer survivors.