Abstract
An estimated 75% of women diagnosed with breast cancer who receive treatment experience cancer-related cognitive impairment (CRCI), with up to 35% continuing to report symptoms months or years after treatment. Psychological distress and inflammation have been associated with CRCI; however, underlying mechanisms remain unclear. Given that most women diagnosed with breast cancer are over age 50 and transition into survivorship, further research is needed to understand how breast cancer exacerbates cognitive decline, particularly in the context of normal aging. Previous research has examined interventions such as cognitive behavioral therapy (CBT) and relaxation training for improving cognitive functioning, but none have tested the efficacy of an intervention that encompasses both elements, such as a remotely-delivered cognitive-behavioral stress management (R-CBSM) intervention. This study examined the effects of a 10-week R-CBSM intervention (compared to a wait-list control [WLC]) on subjective cognitive functioning in women (>50 years) with breast cancer and whether changes in breast cancer-specific distress and inflammation mediate intervention effects from baseline to 6-month follow-up. Women (N=101) with non-metastatic breast cancer were randomized to R-CBSM (N=51) or WLC (N=50). Participants completed psychosocial batteries and blood draws at baseline and 6-month follow-up. Results revealed no significant differences in cognitive functioning, distress, or inflammation between study conditions. Across the sample, cognitive functioning worsened, distress improved, and inflammation remained unchanged over time. Exploratory moderation analysis revealed that R-CBSM participants with moderate-to-high post-intervention distress had a significant cognitive decline; those with low distress had no change. Among WLC participants, distress was not associated with cognitive change. Findings underscore the importance of tailoring psychosocial interventions to address age-related stressors and cognitive health in breast cancer survivors.