Cancer-Related Symptoms and Cognitive Intervention Adherence Among Breast Cancer Survivors: A Mixed-Methods Study

Background Breast cancer survivors (BCSs) experience long-term symptoms of cancer and treatment, which may exacerbate cognitive function and ability to adhere to interventions aimed at improving cognition. Objective The intent of this study was to explore the relationship between selected cancer-related symptoms and adherence to theSpeed of Processing in Middle Aged andOlder BreAst Cancer SuRvivors (SOAR) cognitive training (CT) intervention among BCSs residing in Alabama. Methods A sequential quantitative to qualitative (Quan -> Qual) mixed-methods design was used. First, the relationship between selected cancer-related symptoms and adherence to SOAR among BCSs (n = 30) was examined using self-reported questionnaire data. Follow-up semistructured interviews with 15 purposefully selected participants (adherent and nonadherent) were conducted to explore how symptoms contributed to/explained differences in adherence to SOAR. Data were analyzed using RStudio and NVivo software. Results Spearman's rho correlation suggested relationships between adherence and perceived cognitive impairment, depressive symptoms, and sleep quality. Inductive thematic analysis yielded 4 themes: (1) experiences of cancer-related symptoms, (2) influences of CT, (3) adherence to CT, and (4) environment for CT. Integration of quantitative and qualitative results revealed that experiences of and responses to CT and cancer-related symptoms differently shape adherence to CT among BCSs. Conclusions To aid in cognitive intervention adherence among BCSs, future studies may consider applying a comprehensive approach aimed at addressing concurrent cancer-related symptoms. Implications for Practice Clinicians can routinely assess cognition and provide education and resources for management of cancer-related symptoms.