We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field.

In this issue, we are privileged to feature an innovative longitudinal study led by Dr. Yu Bi and Professor Aihua Zhang from China. Their research, "Trajectories of Subjective Cognitive Function in Breast Cancer Patients: A Latent Class Growth Model Study", uncovers heterogeneous patterns of chemotherapy-induced cognitive impairment through pioneering analytical methods.

Why We Chose this Research Topic?

Chemotherapy-related cognitive impairment was recognized as a common and distressing side effect of breast cancer treatment, with a substantial impact on patients’ quality of life. However, existing studies on cognitive function trajectories in this population were found to yield inconsistent findings and rarely examined heterogeneous patterns of change over time or their associated influencing factors.

To address this gap, the study was designed to:

- Identify distinct trajectories of subjective cognitive function in breast cancer patients undergoing postoperative chemotherapy using a latent class growth model.

- Explore the demographic, clinical, and psycho-behavioral factors associated with these trajectory classes, so that evidence could be provided to inform more personalized clinical interventions.

What We Discovered?

This longitudinal study was conducted with 282 breast cancer patients, who were followed up at five time points: before the first chemotherapy cycle, 1 month, 3 months, 6 months, and 9 months after the first chemotherapy.

Using latent class growth modeling, four heterogeneous trajectories of subjective cognitive function were identified: the “No impairment class”, “Impair-recover class”, “Delayed recovery class”, and “Persistent impaired class”. Distinct patterns of cognitive change over the follow-up period were demonstrated by these four classes, and different recovery processes after chemotherapy were reflected. Several factors closely associated with poorer subjective cognitive function were also identified, including demographic and clinical factors (older age, postmenopausal status, and specific chemotherapy regimens) as well as psycho-behavioral factors (higher levels of anxiety, depression, cancer-related fatigue, and lower physical activity levels).

The psycho-behavioral profiles were found to differ markedly across trajectory classes. For example, the Delayed Recovery Class was observed to have the highest scores for negative emotional states, including anxiety and depression, whereas the Persistent Impairment Class was characterized by continuously high levels of cancer-related fatigue and persistently low physical activity throughout the follow-up period. These results indicated that patients did not follow a uniform cognitive trajectory after chemotherapy and that emotional and behavioral factors played an important role in shaping these patterns.

Implications for Cancer Care

The importance of tailored cognitive care for breast cancer patients undergoing postoperative chemotherapy was emphasized by the findings.

Early screening was recommended for high-risk groups, including older and postmenopausal patients and those with pre-existing or emerging emotional distress (anxiety, depression). Dynamic monitoring of cognitive function was advised across the entire treatment and follow-up period. Interventions were suggested to target modifiable psycho-behavioral factors: emotional support and psychological counseling were proposed to alleviate negative emotions, fatigue management strategies were encouraged, and individualized physical activity programs were advocated. On the basis of different cognitive trajectories, personalized follow-up plans were proposed, with increased monitoring for the Delayed Recovery Class and more intensive, multidisciplinary support for the Persistent Impairment Class.

Source:

Bi Y, Lu Y, Gao X, Shi X, Zhang A. Trajectories and related factors of subjective cognitive function in patients living with breast cancer receiving postoperative chemotherapy: a latent class growth model study. Supportive Care in Cancer. 2025;33:998. doi: 10.1007/s00520-025-10027-5 

                                                                                                                 

                                                     Yu Bi (First author)                                                                                           Aihua Zhang (Corresponding author)