Cognitive and Occupational Function in Survivors of Adolescent Cancer

The number of cancer survivors living in the U.S. is dramatically increasing. Cognitive decline is a commonly reported and burdensome symptom of cancer survivors. In addition, many cancer survivors experience difficulty maintaining employment. This dissertation addresses gaps in the literature of cognitive and occupational function of cancer survivors, with particular emphasis on the understudied population of cancer survivors diagnosed as an adolescent or young adult (AYA). For this dissertation, a series of studies were conducted to 1) explore the association between occupation and symptom burden in breast cancer survivors, 2) synthesize the evidence of cognitive outcomes in survivors of AYA cancer, and 3) describe cognitive and occupational function in survivors of adolescent cancer compared to healthy controls. \ud \ud To address aim one, a secondary analysis of data from early-stage breast cancer survivors explored the relationship between occupation and symptom burden. Breast cancer survivors employed in lower skill level jobs reported greater symptom burden over the first year of anastrozole treatment than women employed at the higher skill level. Survivors employed at lower skill levels had higher levels of fatigue and worse depressive, musculoskeletal, vasomotor, and gastrointestinal symptoms. \ud \ud To address aim two, an integrative review synthesized the current state of science in terms of cognitive outcomes of those diagnosed with cancer as an AYA. Survivors of AYA cancer tended to experience cognitive difficulties; however, to date, no study has focused exclusively on those diagnosed as an AYA or encompassed the entirety of the AYA age range. Future studies are needed because cognitive outcomes of survivors of AYA cancer have been largely neglected. \ud \ud Lastly, a cross-sectional, descriptive comparative study described cognitive and occupational function in survivors of adolescent cancer compared to healthy controls. Survivors of adolescent cancer perceived greater cognitive difficulty than healthy peers, although there were not significant measurable differences in performance on neuropsychological tests. Survivors of adolescent cancer also reported poorer work output than healthy controls. \ud \ud This dissertation contributes to the growing body of literature pertaining to health and well-being of cancer survivors, in particular cognitive and occupational function, and unique considerations needed for those diagnosed with cancer as an AYA