Physical Activity, Cognitive Function, Psychological Well-Being, and Quality of Life in Adolescents and Young Adults Treated for Cancer
Creators: name: Sharma, Sitara
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2022
Subjects: Cognitive function
Physical activity
Adolescents and young adults
Cancer
Mixed methods

description: Background: Many adolescents and young adults (AYAs) aged 15-39 years describe struggling with cancer-related cognitive impairment (CRCI) after treatment. CRCI (e.g., memory, concentration, and learning difficulties) often causes distress, diminishes quality of life (QoL), and impedes young adults' participation in academic, recreational, and social experiences. Yet, CRCI is poorly understood in AYAs and options to prevent or treat this burdensome side effect are lacking. Based on growing evidence suggesting that physical activity (PA) may enhance cognitive function in older adults, individuals with diseases of cognition, and breast cancer survivors, research exploring links between PA and CRCI in AYAs is warranted. Thus, the purpose of this observational, mixed methods thesis was to explore how AYA cancer survivors experience and cope with CRCI, taking into consideration potential predisposing factors (i.e., medical, psychological), interventional strategies (i.e., PA), and outcomes (i.e., QoL). Methods: Over a nine-month period, 90 AYAs who had completed primary cancer treatment self-referred; 49 were eligible and enrolled into the study. Of these, 46 participants (M_age=31.4±5.4; 91.3% female; 39.1% blood cancer) completed an online survey and three web-based neuropsychological tests; semi-structured interviews were conducted on a rolling basis with a sub-set (n=16) who reported clinically meaningful CRCI. Quantitative data were analyzed descriptively and qualitative data were analyzed thematically. Results: Overall, participants were active based on their self-reported moderate-to-vigorous intensity PA (MVPA; M=27.3±20.6) and relative to scale ranges, they reported moderate levels of depressive symptoms, stress, fatigue, and quality of life (M=12.1±5.5; M=21.1±7.2; M=25.2±11.5; M=68.8±18.3, respectively). On average, participants reported clinically meaningful CRCI (M=44.7±17.4), and as compared to normative values, their neuropsychological test scores indicated poor executive functioning and processing speed, but not working memory. Bivariate correlations between cognitive function (self-reported and objective) and medical characteristics (i.e., time since diagnosis, cancer stage, chemotherapy exposure) had small-to-moderate effect sizes. Small-to-large correlations were observed between cognitive function and psychological factors (i.e., depressive symptoms, stress, fatigue, QoL). Finally, correlations between cognitive function and MVPA were favourable, though effect sizes were small. Moreover, qualitative data provided insight into how AYAs experience and cope with their cognitive impairment, which was summarized within four themes: (1) descriptions and interpretations of the CRCI phenomenon, (2) effects of CRCI on day-to-day life and QoL, (3) cognitive-behavioural self-management strategies, and (4) recommendations for improving care. Conclusion: Results confirm that cancer can impact AYAs' cognitive function and have detrimental effects for their daily life and overall QoL. AYAs reported using various cognitive-behavioural self-management strategies, including PA; taken together with quantitative data, findings suggest that PA may be a promising strategy to cope with CRCI. However, high-quality experimental research is needed to confirm this association, test the processes by which this may occur, as well as to determine optimal PA dosages/contexts for managing CRCI.