Trajectories of cognitive symptoms and associated factors in cancer survivors after return to work: an 18-month longitudinal cohort study

Purpose: Cognitive symptoms affect cancer survivors' functioning at work. To date, cognitive symptoms trajectories in working cancer survivors and the factors associated with these trajectories have not been examined.

Methods: Data from a heterogeneous group of working cancer survivors (n = 379) of the longitudinal "Work-Life-after-Cancer" study, linked with Netherlands Cancer Registry data, were used. The Cognitive Symptom Checklist-Work was administered at baseline (within the first 3 months after return to work), 6-, 12-, and 18-month follow-up to measure self-perceived memory and executive function symptoms. Data were analyzed using group-based trajectory modeling.

Results: Four trajectories of memory and executive function symptoms were identified. All memory symptoms trajectories were stable and labeled as "stable-high" (15.3% of the sample), "stable-moderately high" (39.6%), "stable-moderately low" (32.0%), and "stable-low" (13.0%). Executive function symptoms trajectories changed over time and were labeled as "increasing-high" (10.1%), "stable-moderately high" (32.0%), "decreasing-moderately low" (35.5%), and "stable-low" (22.4%). Higher symptoms trajectories were associated with older age, longer time from diagnosis to return to work, more quantitative work demands, and higher levels of depressive symptoms at baseline.

Conclusions: In cancer survivors who returned to work, four cognitive symptoms trajectory subgroups were identified, representing different but relatively stable severity levels of cognitive symptoms.

Implications for Cancer Survivors: To identify cancer survivors with higher symptoms trajectories, health care providers should assess cognitive symptoms at baseline after return to work. In case of cognitive symptoms, it is important to also screen for psychological factors to provide appropriate guidance.