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Optimism, sleep quality, physical activity, and cancer-related cognitive impairment in middle-to-older aged patients undergoing breast cancer treatment

Jenna L. Hansen,Rachel Plotke,Millan R. Kanaya,Sarah N. Webster,Paula Popok,Emily A. Walsh,Molly Ream,Mason Krueger,Estefany Saez-Clarke,D. Perdomo,Daniela Frasca,S. B. Kesmodel,Bonnie Blomberg,Michael H Antoni

Published 2025 in International Journal of Clinical and Health Psychology

ABSTRACT

Background Patients with breast cancer (BC) are at risk for cancer-related cognitive impairment (CRCI) due to BC-related stress and cancer treatment. Optimism and positive health behaviors may mitigate CRCI. This study examined relationships between optimism, health behaviors (sleep quality and physical activity) and CRCI in BC patients during the post-surgical period and whether optimism and health behaviors interacted in this relationship. Methods Women with recently diagnosed BC enrolled in a stress management trial following BC surgery. At baseline, participants completed questionnaires that measured CRCI, optimism, sleep quality, and physical activity. Results 79 patients were enrolled (M = 61 years; range=50–85). Multiple regression models controlling for patient age, stage, surgery type, body mass index, and comorbidities revealed that optimism was associated with fewer perceived cognitive impairments (β=0.32, p=.01) and greater perceived cognitive abilities (β=0.38, p=.001). Poorer sleep quality was associated with poorer perceived cognitive abilities (β =-0.37, p=.01) and greater impact of cognitive impairments on quality of life (β=-0.39, p=.01). Moderation models revealed an interaction between optimism and sleep quality on perceived cognitive impairments (β=2.06, p=.02), such that among those low in optimism, poorer sleep quality was associated with greater perceived cognitive impairments (b=-2.42, p=.01) but not among those with high optimism (p=.46). No other models were statistically significant. Conclusions Results suggest that optimism and sleep quality may be associated with better cognitive function in BC patients in the post-surgical period. Interventions that improve optimistic expectancies and sleep quality may help to mitigate CRCI in mid-to-older BC patients initiating treatment.

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