Page 143 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology CRCI factors in breast cancer

2. Materials and methods perceived cognitive impairment (20 items), comments
from others (4 items), perceived cognitive abilities
2.1. Study design and participants (9 items), and impact on quality of life (4 items). Each
Between October 2018 and May 2019, a cohort of patients item is rated on a 5-point Likert scale ranging from 0 to
diagnosed with breast cancer was selected through 4, with higher scores indicating better cognitive function.
convenience sampling. All participants were exclusively The estimated minimum clinically important difference
undergoing chemotherapy, which included neoadjuvant (MCID) for this scale is between 6.9 and 10.6 points.
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chemotherapy before surgery and adjuvant chemotherapy A difference exceeding this range in pre- and post-
following surgery, with a minimum of three chemotherapy study scores for the same subject is considered clinically
cycles. The inclusion criteria are as follows: (i) patients significant, indicating potential cognitive dysfunction. In
diagnosed with primary breast cancer confirmed by biopsy this study, the maximum MCID score utilized was 10.6.
or post-operative pathology; (ii) patients who received no The Cronbach’s alpha coefficient for the scale was 0.96,
more than three cycles of chemotherapy; and (iii) patients indicating high internal consistency.
possessing effective communication skills, which enable
them to make informed consent. The exclusion criteria 2.2.3. Anxiety and depression assessment
include: (i) patients with brain metastases; (ii) patients The Hamilton Anxiety (HAMA) Scale and the Hamilton
with other significant diseases; (iii) patients with malignant Depression (HAMD) Scale were employed to assess anxiety
tumors in other anatomical locations; and (iv) patients who and depression levels following chemotherapy. The HAMA
received alternative treatments, such as targeted therapy, Scale consists of 14 items related to anxiety, each rated on
radiotherapy, or immunotherapy. This study received a 4-point scale ranging from “no symptoms” to “extremely
ethical approval from the Ethics Committee of the Shaanxi severe.” A standardized score of ≥7 signifies the presence of
Provincial People’s Hospital, Xi’an (approval number: anxiety, with severity levels delineated as possible anxiety
2021071609). Based on the sample size estimation formula (7 – 14), anxiety (14 – 21), obvious anxiety (21 – 29), and
commonly employed in medical research, the incidence severe anxiety (≥29). Similarly, the HAMD Scale comprises
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rate of cognitive impairment among patients undergoing 17 items pertaining to depressive symptoms, scored in a
chemotherapy for breast cancer ranges from 16% to 75%. manner analogous to the HAMA Scale. A standardized
Consequently, the minimum required sample size for this score of ≥7 indicates the presence of depression, with
study was determined to be 196 participants. Ultimately, severity classified as mild (7 – 17), moderate (17 – 24), or
the study encompassed a total of 380 breast cancer patients. severe (≥24).
2.2. Data collection instruments 2.2.4. Level of social support
2.2.1. General information questionnaire The social support rating scale (SSRS), developed by
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A custom-designed questionnaire was employed to collect Shuiyuan Xiao, is a widely utilized instrument for
demographic and sociological data, including variables assessing varying levels of social support experienced by
such as age, gender, body mass index (BMI), educational individuals. The scale comprises 10 items distributed across
attainment, marital status, and occupation. Furthermore, three dimensions: objective social support, subjective
clinical disease data encompass various parameters, social support, and the utilization of social support. The
including the stage of the disease, family medical history, total SSRS score ranges from 12 to 66, with higher scores
the presence of complications, and the existence of indicating greater levels of social support. Specifically,
comorbid conditions such as diabetes, among other factors. a total SSRS score below 22 signifies a low level of social
support, scores between 23 and 44 denote a medium level,
2.2.2. Cognitive function assessment and scores above 44 reflect a high level of social support.

The cognitive function of the patients was assessed The Cronbach’s alpha coefficients for the overall scale and
utilizing the Chinese version of the Functional Assessment its three dimensions were 0.896, 0.849, 0.825, and 0.833,
of Cancer Therapy–Cognitive Function (FACT-Cog) Scale. respectively, demonstrating good reliability.
This scale was originally developed by Wagner et al.
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and subsequently translated into Chinese by Cheung’s 2.2.5. Method of intervention
team in Singapore, in accordance with the guidelines Patients who exhibited cognitive dysfunction in the prior
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established by the Functional Assessment of Chronic assessment were allocated to the intervention group.
Illness Therapy (FACIT) and the International Society for The intervention group was provided with cognitive
Pharmacoeconomics and Outcomes Research. The scale behavioral intervention training in addition to the
comprises 37 items distributed across four dimensions: conventional treatment and health rehabilitation guidance

Volume 9 Issue 3 (2025) 135 doi: 10.36922/EJMO025130073