# Effect of Intolerance of Uncertainty on Perceived Cognitive Function Among Breast Cancer Patients Before Chemotherapy

## TL;DR

Breast cancer patients with higher intolerance to uncertainty experience worse cognitive function before chemotherapy, likely due to increased anxiety.

## Contribution

This study identifies intolerance of uncertainty as a novel predictor of cognitive impairment in chemotherapy-naïve breast cancer patients.

## Key findings

- Higher intolerance of uncertainty is linked to increased anxiety in breast cancer patients.
- Anxiety mediates the relationship between intolerance of uncertainty and lower cognitive function.
- Assessing intolerance of uncertainty could help identify patients at risk for cognitive impairment before chemotherapy.

## Abstract

Cancer-related cognitive impairment (CRCI) is one of the symptoms that breast cancer patients frequently experience, even before chemotherapy. Despite its high prevalence, it is unclear what factors contribute to CRCI among chemotherapy-naïve breast cancer patients. Several studies have suggested that individuals with difficulty tolerating uncertainty (i.e., intolerance of uncertainty [IU]) are more likely to experience cognitive problems. Consistent with these findings, our study also indicates that higher IU is related to higher anxiety and such higher anxiety is linked to more cognitive problems. This result suggests that health care providers need to screen breast cancer patients with high IU and triage those at risk for CRCI.

Background: Cancer-related cognitive impairment (CRCI) is one of the most frequently reported symptoms by breast cancer patients. However, it remains unclear precisely what contributing factors are present among chemotherapy-naïve breast cancer patients that contribute to CRCI. Thus, it is essential to identify potential factors related to CRCI that may occur before chemotherapy so that interventions can be employed to help prevent the worsening of CRCI. Objective: This study examined the association between intolerance of uncertainty (IU) and cognitive function among breast cancer patients before chemotherapy and explored whether anxiety mediates this association. Methods: A total of 58 females diagnosed with stage I-III breast cancer and scheduled for chemotherapy were included in this study. Data on cognitive function, IU, anxiety, and other relevant information were analyzed. Results: We found that higher IU was associated with higher anxiety and such higher anxiety was subsequently associated with lower cognitive function being reported by breast cancer patients who were scheduled for chemotherapy. The association between IU and cognitive function was largely mediated through anxiety with standardized β = −0.19 (SE = 0.07) for the indirect association via anxiety and β = −0.2 (SE = 0.12) for the total association. Conclusions: IU shows an impact on cognitive function. Therefore, it is necessary to assess IU before chemotherapy, which may help detect patient risk for cognitive impairment early.