The impact of cognitive impairment on self‐regulatory styles in breast cancer survivors

Abstract

Objective Cognitive impairment (CI) is highly prevalent in breast cancer survivors (BCS), and can be a barrier to health‐promoting behaviours. However, the ways in which CI may affect self‐regulation or motivation to perform such behaviours have not been explored. We assessed if BCS with CI report greater extrinsic self‐regulation compared to those without CI and if this relationship persists after controlling for depression. Methods We recruited BCS with diabetes and assessed cognition and motivation to perform healthy diabetes management behaviours (e.g., diet and exercise). Participants completed a cognitive battery evaluating attention, working memory, executive functioning (EF), processing speed (PS), language and memory. The Treatment Self‐Regulation Questionnaire (TSRQ) assessed intrinsic versus extrinsic motivation. Depression was determined by a score ≥16 on the Center for Epidemiological Studies Depression Scale. Wilcoxon rank‐sum test compared associations between CI and TSRQ scores. Results Participants were 118 older adults (mean age 65 years). Participants with CI in the following domains had higher extrinsic self‐regulation scores compared to those without CI: attention (p < 0.01), PS (p = 0.01), EF (p < 0.01), language (p = 0.02; p = 0.04) and memory (p = 0.04; p = 0.03). After adjusting for depression, the relationship between CI and higher extrinsic self‐regulation scores remained significant. Conclusions BCS with CI appear to rely more on external sources of motivation to perform health behaviours, regardless of depression. Future studies and interventions to improve health behaviours should consider screening for CI and involving caregivers for those with CI to improve outcomes.

Dietary Drivers and Challenges of Australian Breast Cancer Survivors: A Qualitative Study

“…This is especially important in light of recent research identifying that cancer survivors with cognitive impairment are more likely to rely on external cues and sources of motivation for self-managed health-related lifestyle behaviors, than survivors without cognitive impairment. 16 Participants in the current study varied regarding when they would have wanted to receive nutritional information ( e.g. , during vs. after treatment), representing survivors' heterogenous needs and experiences of cancer, congruent with previous research.…”

“… 15 Survivors with cognitive impairment have different self-regulatory styles for managing health conditions through diet and exercise, compared with survivors without cognitive impairment. 16 Cancer-related cognitive impairment can be identified through subjective (self-report) or objective (neuropsychological assessment) methods, however, they are often poorly correlated: survivors frequently report cognitive difficulties despite an absence of poor performance on cognitive assessments. 17 , 18 …”