Investigating the efficacy of adaptive cognitive training and understanding the role of work-related factors on the cognitive and emotional health of women with a history of breast cancer

Chapman, Bethany Louise (2022) Investigating the efficacy of adaptive cognitive training and understanding the role of work-related factors on the cognitive and emotional health of women with a history of breast cancer. PhD thesis, Birkbeck, University of London.

Abstract

Worldwide breast cancer is the most common form of cancer diagnosed in women, with more than 150 new cases each day in the UK alone. The overall aim of this PhD thesis was to provide a more comprehensive understanding of how cognitive function and emotional vulnerability (anxiety and depression) relate to workability and work-related factors in women diagnosed with breast cancer, as well as ascertain the longer-term efficacy of adaptive cognitive training (see box 1) to empower women’s workability which is known to be crucial in promoting better cognitive and emotional health. This PhD thesis was two-fold. A mixed-methods approach was utilised. First, this thesis will present and discuss the ‘BRiCatWork’ study which aimed to examine the efficacy of adaptive dual n-back training as an intervention for helping women affected by primary breast cancer sustain workability over time by targeting impaired cognitive function. To this end, the study also investigated women’s experiences with sustained cancer-related cognitive impairment (CRCI) and its impact at work before receiving the intervention. This thesis will then go on to present a study that aimed to investigate the role of quality of working life in predicting perceived cognitive impairment and anxiety and depression in women with metastatic breast cancer (MBC), a population who are understudied and minimised in society. As a result of the Coronavirus disease (COVID-19) outbreak during this PhD, the final study focused on exploring the impact of COVID-19on cognitive and emotional health. Findings from the ‘BRiCatWork’ study are outlined in Chapters 3, 4, and 5. Chapter 3 found women can experience CRCI up to five years after active treatment, adversely affecting their workability. Women had mixed experiences and feelings with self-management coping strategies. Chapter 4 found women who received dual n-back training perceived experiencing sustained improvements in their cognitive functioning. These perceived improvements were associated with self-confidence and emotional wellbeing, as well as dependency on work-related self-management methods for cognitive impairment and career progression or development, increasing workability. In addition, findings revealed that women found dual n-back training to be highly engaging, with experiences indicating that dual n-back training can be flexibly offered six-to 12 months after active treatment. Chapter 5 evidenced that dual n-back training elicited improvements in perceived cognitive ability and workability, as well as in transfer-related gains in depression, with effects sustained up to one year. Significant increases in working memory capacity and P3 amplitude, as well as a reduction in poster-error slowing, were also found. The ‘BRiCatWork’ study corroborates that dual n-back training can be offered to women treated for primary breast cancer to promote cognitive functioning and workability, as well as reduce vulnerability to depression, a known risk factor for recurrence and premature mortality. Chapter 6 found women’s experiences with their employers following their MBC diagnosis was associated with their perceived quality of working life, such that a better experience met with a greater quality of working life. Importantly, a greater self-reported quality of working life predicted a better perceived cognitive function and quality of life, as well as reduced vulnerability to depression. Chapter 7 found women affected by primary breast cancer may be at an increased risk for developing more severe emotional distress and poorer perceived cognitive functioning as a result of the COVID-19 outbreak. Taken together, the studies presented in Chapters 6 and 7 indicate that work-related factors including job security and quality of working life play an important role in protecting against escalating cognitive and emotional vulnerability in women diagnosed with breast cancer. Overall, this thesis has made important contributions to theory as well as method while providing strong implications for informing oncologists and oncology services including occupational health, as well as employers, on supporting women diagnosed with breast cancer in sustaining their workability over time.

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