---
title: "Cumulative symptom burden and cognitive impairment in breast cancer survivors: associations with s"
id: "pubmed-42747658"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42747658"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42747658/"
doi: "10.1007/s10549-026-08064-7"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Cumulative symptom burden and cognitive impairment in breast cancer survivors: associations with s
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42747658
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42747658/)
- **DOI:** [10.1007/s10549-026-08064-7](https://doi.org/10.1007%2Fs10549-026-08064-7)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This cross-sectional analysis used enrollment data from a randomized clinical trial of women with stage 0–III breast cancer who were disease-free and reported moderate or greater cancer-related cognitive impairment (CRCI) and insomnia. - The study evaluated both **subjective CRCI** (measured by the Functional Assessment of Cancer Therapy–Cognitive Function, **FACT-Cog**) and **objective CRCI** (measured by the Hopkins Verbal Learning Test–Revised, **HVLT**). - A **Cumulative Symptoms Score (CSS)** quantified co-occurring symptoms: insomnia, fatigue, pain, anxiety, and depression, each assessed with validated self-report instruments. - The cohort included 260 participants; mean age was 56.6 years; 21% were non-White and 10% were Hispanic. - Prevalences of comorbid symptoms were high: fatigue 90%, insomnia 70%, pain 45%, anxiety 35%, and depression 12%. - Multivariable linear regression adjusted for covariates including age and chemotherapy exposure found higher **CSS** was significantly associated with worse **subjective CRCI** (coefficient = −3.0; 95% CI −3.6 to −2.4; p < 0.001). - Each individual comorbid symptom was correlated with worse subjective CRCI (all p < 0.001). - The **CSS** was not associated with objective cognitive performance on the **HVLT** (p = 0.58), although **insomnia** alone correlated with HVLT scores (r = −0.20; p < 0.001). - The authors conclude that cumulative symptom burden relates to patients’ subjective appraisal of cognitive impairment but not to objective memory test performance; they suggest comprehensive symptom management may improve subjective CRCI and that sleep disturbance could be a target to improve objective outcomes. - Ethical approval was obtained from the institutional review board at Memorial Sloan Kettering Cancer Center (IRB number: 20–124). Conflicts of interest were declared for specific authors; details are reported in the source. - Keywords listed include breast cancer, cognitive impairment, fatigue, insomnia, survivorship, and symptom management.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 3 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 4 Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. maoj@mskcc.org. * PMID: **42747658** * DOI: [ 10.1007/s10549-026-08064-7 ](https://doi.org/10.1007/s10549-026-08064-7) Item in Clipboard # Association between cumulative symptom burden and cognitive impairment among breast cancer survivors: a cross-sectional study Xiaotong Li et al. Breast Cancer Res Treat. 2026. Show details Display options Display options Format Abstract PubMed PMID Breast Cancer Res Treat Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Breast+Cancer+Res+Treat%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Breast+Cancer+Res+Treat%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) . 2026 Sep 16;219(3):13. doi: 10.1007/s10549-026-08064-7. ### Authors [Xiaotong Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42747658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-1 "Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Kaitlin Lampson](https://pubmed.ncbi.nlm.nih.gov/?term=Lampson+K&cauthor_id=42747658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-1 "Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Kevin T Liou](https://pubmed.ncbi.nlm.nih.gov/?term=Liou+KT&cauthor_id=42747658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-1 "Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Yuelin Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Y&cauthor_id=42747658)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-2 "Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-3 "Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Susan Q Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+SQ&cauthor_id=42747658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-1 "Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Tim Ahles](https://pubmed.ncbi.nlm.nih.gov/?term=Ahles+T&cauthor_id=42747658)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-3 "Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [James Root](https://pubmed.ncbi.nlm.nih.gov/?term=Root+J&cauthor_id=42747658)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-3 "Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA."), [Jun J Mao](https://pubmed.ncbi.nlm.nih.gov/?term=Mao+JJ&cauthor_id=42747658)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42747658/#short-view-affiliation-4 "Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. maoj@mskcc.org.") ### Affiliations * 1 Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 3 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA. * 4 Integrative Medicine & Wellness Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. maoj@mskcc.org. * PMID: **42747658** * DOI: [ 10.1007/s10549-026-08064-7 ](https://doi.org/10.1007/s10549-026-08064-7) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Cancer-related cognitive impairment (CRCI) is a multifaceted symptom associated with various comorbid conditions, complicating management. This study aims to evaluate cumulative symptom burden and its impact on both subjective and objective CRCI in breast cancer survivors. **Method:** Enrollment data were analyzed from a randomized clinical trial involving women with stage 0-III breast cancer, free of oncology disease, reporting moderate or greater CRCI and insomnia. Subjective CRCI was measured using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), and objective CRCI with the Hopkins Verbal Learning Test-Revised (HVLT). Comorbid symptoms (insomnia, fatigue, pain, anxiety, depression) were assessed with validated self-report tools. A Cumulative Symptoms Score (CSS) was calculated to quantify symptom burden. Multivariable linear regression was used to examine associations with CRCI, adjusting for co-variables. **Results:** Among 260 participants (mean age 56.6 years), 21% were non-White and 10% Hispanic. Fatigue (90%) was the most common, followed by insomnia (70%), pain (45%), anxiety (35%), and depression (12%). Higher CSS was significantly associated with worse subjective CRCI after adjustment for age and chemotherapy (Coef. = -3.0, 95% CI: -3.6 to -2.4, p - [DOI](https://doi.org/10.1111/tbj.12862) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28845551/) 2. 1. Munir F, Kalawsky K, Lawrence C, Yarker J, Haslam C, Ahmed S (2011) Cognitive intervention for breast cancer patients undergoing adjuvant chemotherapy: a needs analysis. Cancer Nurs 34(5):385–392. . PubMed PMID: 21242770 - [DOI](https://doi.org/10.1097/ncc.0b013e31820254f3) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/21242770/) 3. 1. Von Ah D, Jansen CE, Allen DH (2014) Evidence-based interventions for cancer- and treatment-related cognitive impairment. Clin J Oncol Nurs 18:17–25 PubMed PMID: 25427606 - [DOI](https://doi.org/10.1188/14.cjon.s3.17-25) 4. 1. Collins B, Mackenzie J, Tasca GA, Scherling C, Smith A (2014) Persistent cognitive changes in breast cancer patients 1 year following completion of chemotherapy. J Int Neuropsychol Soc 20(4):370–379 Epub 20131115. . PubMed PMID: 24229809 - [DOI](https://doi.org/10.1017/s1355617713001215) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/24229809/) 5. 1. Wefel JS, Saleeba AK, Buzdar AU, Meyers CA (2010) Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer 116(14):3348–3356. . PubMed PMID: 20564075 - [DOI](https://doi.org/10.1002/cncr.25098) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/20564075/) Show all 69 references ## MeSH terms * Adult Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adult%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adult) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Anxiety / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anxiety%2Fepidemiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anxiety) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Breast Neoplasms* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Breast+Neoplasms%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Breast+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Breast Neoplasms* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Breast+Neoplasms%2Fepidemiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Breast+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Breast Neoplasms* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Breast+Neoplasms%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Breast+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Breast Neoplasms* / psychology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Breast+Neoplasms%2Fpsychology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Breast+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Cancer Survivors* / psychology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Survivors%2Fpsychology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cancer+Survivors) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747658/) * Cognitive Dysfunction* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cognitive+Dysfunction%2Fepidemiology%22%5
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