Predictors of the Trajectories of Self-Reported Attentional Fatigue in Women With Breast Cancer Undergoing Radiation Therapy

Autor: William M. Wara, John D. Merriman, Patrick S. Swift, Bradley E. Aouizerat, Claudia West, Christine Miaskowski, Marylin J. Dodd, Theresa Koetters, Kathryn A. Lee, Bruce A. Cooper, Steven M. Paul, Catherine E. Jansen
Rok vydání: 2010
Předmět:
Zdroj: Oncology Nursing Forum. 37:423-432
ISSN: 1538-0688
0190-535X
Popis: Attentional fatigue is a decreased capacity to direct attention (Cimprich, 1992a). This capacity is defined by three concepts: selectivity, which is the ability to highlight one stimulus while ignoring others; sustained focus, which is the maintenance of selectivity over time; and limited capacity, which is a ceiling on the number of stimuli that can be processed successfully at any one time (Cimprich, 1992a; Kaplan & Kaplan, 1982; Posner & Boies, 1971). Attentional fatigue is not physical fatigue, so a person can experience the former with or without the latter (Cimprich, 1992b). In addition, the cognitive changes associated with chemotherapy that are popularly referred to as “chemo brain” include, but are not limited to, attentional fatigue (Hess & Insel, 2007). Anatomically, attention is thought to reside in the anterior and posterior attention systems of the frontal and parietal cortices (Cimprich, 1995; Posner & Dehaene, 1994; Posner & Petersen, 1990). This hypothesis is supported by findings from a recent imaging study that evaluated for changes in the prefrontal and anterior cingulate cortices of women with breast cancer prior to chemotherapy (Cimprich et al., 2009) and found significantly larger differences in the activation of the right inferior frontal gyrus compared to healthy controls. In addition, in these women with breast cancer, more areas of the brain were activated during the completion of tasks that required them to direct their attention. There are two types of attention, involuntary and voluntary (James, 1983; Kaplan & Kaplan, 1982). Some stimuli that originate in our thoughts or in the world around us (i.e., our internal and external environments) engage involuntary attention without effort (Cimprich, 1992a; James, 1983; Kaplan & Kaplan, 1982). These stimuli include nature, things that affect survival, and things that fascinate us (Cimprich, 1992a; James, 1983; Kaplan & Kaplan, 1982). Other stimuli must consciously be selected for processing by voluntary attention, which requires effort that reduces our capacity to direct attention further (Cimprich, 1992a; James, 1983; Kaplan & Kaplan, 1982). Voluntary attention is required to act purposefully (Lezak, 1982), to monitor one’s self, and to inhibit emotional reactions (Cimprich, 1992a). As involuntary attention is drawn to a greater diversity and intensity of sensory information, experienced as distraction, one must expend greater effort to direct voluntary attention (Cimprich, 1992a; Kaplan & Kaplan, 1982). After diagnosis with breast cancer, involuntary attention is drawn to the threatening information received and to the unfamiliar physical environment in which treatment occurs, both of which pertain to survival (Cimprich, 1992b). The concept of limited capacity suggests that the direction of voluntary attention during the time of diagnosis and treatment would require increased effort, which results in attentional fatigue and its sequelae (e.g., irritability when presented with further demands on one’s attention and a decreased ability to focus on selected stimuli) (Cimprich, 1992b; Kaplan & Kaplan, 1982). Three cross-sectional studies evaluated the correlates of self-reported attentional fatigue, as measured using the Attentional Function Index (AFI), before treatment in women diagnosed with breast cancer (Cimprich, 1999; Cimprich, So, Ronis, & Trask, 2005; Lehto & Cimprich, 1999). Across these studies with a total of 303 women, significant correlates of higher levels of attentional fatigue included younger age, pre-menopausal status, higher symptom distress scores and greater number of symptoms, greater mood disturbance, and high versus low-to-moderate anxiety. Two papers from the same study described self-reported attentional fatigue in women following breast cancer surgery. In these papers, higher levels of attentional fatigue were reported by women with greater mood disturbance (Cimprich, 1992b) and in those assessed closer to the time of surgery (Cimprich, 1993). In a more recent cross-sectional study of breast cancer survivors (Von Ah, Russell, Storniolo, & Carpenter, 2009), higher levels of attentional fatigue correlated with younger age, higher levels of depression and physical fatigue, and lower levels of psychological well-being and physical functioning. In a longitudinal study that evaluated self-reported attentional fatigue in women undergoing chemotherapy for breast cancer (Jansen, Dodd, Miaskowski, Dowling, & Kramer, 2008), higher levels of attentional fatigue were significantly correlated with the administration of chemotherapy and higher levels of depression. A number of studies have employed measures other than the AFI to assess self-reported attentional fatigue alone or in combination with other cognitive changes in patients with cancer. In a cross-sectional study of breast cancer survivors (Mehnert et al., 2007), higher levels of attentional fatigue, measured using a German questionnaire for self-perceived deficits in attention (Zimmermann, Merser, Poser, & Sedelmeier, 1991), were associated with higher levels of physical fatigue and lower health-related quality of life. Across two studies (Schagen et al., 1999; van Dam et al., 1998) that used a Dutch questionnaire that assessed for cognitive problems in daily life (Huyser, 1993), higher levels of attentional fatigue were associated with higher levels of anxiety and depression and a lower quality of life. Across three studies (Castellon et al., 2004; Jenkins et al., 2006; Jenkins, Shilling, Fallowfield, Howell, & Hutton, 2004) that used the Cognitive Failures Questionnaire (Broadbent, Cooper, FitzGerald, & Parkes, 1982), higher levels of attentional fatigue were associated with higher levels of depression, trait anxiety, psychological distress, and physical fatigue, as well as a lower quality of life. Finally, in an imaging study (Ferguson, McDonald, Saykin, & Ahles, 2007) that used the Multiple Ability Self-Report Questionnaire (Seidenberg, Haltiner, Taylor, Hermann, & Wyler, 1994), a higher level of attentional fatigue was associated with the administration of chemotherapy. Taken together, the findings from these studies suggest that attentional fatigue is associated with decreased physical functioning, higher levels of mood disturbance, and poorer quality of life. However, it is not known how well the AFI, which was used in the present study, correlates with these other subjective measures of attentional fatigue. No studies were found that examined the trajectories of self-reported attentional fatigue in women with breast cancer before, during, and after radiation therapy (RT). An increased understanding of the predictors and trajectories of attentional fatigue in women with breast cancer may help clinicians identify patients at risk for more severe attentional fatigue and may guide the development of interventions tailored to their individual experiences. Therefore, the purposes of this study, in a sample of women who underwent RT for breast cancer, were (1) to examine how self-ratings of attentional fatigue changed from the time of simulation to four months after the completion of RT and (2) to investigate whether specific participant, disease, and symptom characteristics predicted initial levels of attentional fatigue and/or characteristics of the trajectories of attentional fatigue.
Databáze: OpenAIRE