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Title: Understanding the neurocognitive mechanisms and improving cognitive and emotional health in female survivors of breast cancer
Author: Swainston, Jessica
ISNI:       0000 0004 9353 668X
Awarding Body: Birkbeck, University of London
Current Institution: Birkbeck (University of London)
Date of Award: 2020
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Breast cancer is the most prevalent cancer in women worldwide with incidence on the increase. Despite this, as a result of earlier detection and improvements in medical treatment outcomes, survival rates are improving. However, the longer term side effects of breast cancer can adversely affect an individual’s social, cognitive and emotional functioning, profoundly impairing quality of life. As such, the primary aim of the present PhD thesis was to better understand the mechanisms involved in cognitive and emotional vulnerability in breast cancer and to develop and assess the efficacy of interventions that could better the lives of women in survivorship post diagnosis. Findings from Experiment 1 firstly indicate that targeted neurocognitive interventions can improve cognitive control and processing efficiency in breast cancer survivors, establishing that this population is receptive to treatments that provoke brain neuroplasticity. Secondly, it demonstrates that as a result of engaging top down attentional control processes, such interventions can result in sustained reductions in emotional vulnerability. Following on, using an expressive writing intervention, Experiment 2 indicates a relationship between the use of words thought to reflect cognitive reappraisal, as well as affectively negative words, with improvements in perceived cognitive function, emotional vulnerability and quality of life. That said, refinement of expressive writing paradigms is required to optimise transfer outcomes. Experiment 3 outlines an intervention study demonstrating how both mindfulness meditation training, adaptive working memory training, and a combined course of both, can result in reductions in anxious symptomatology compared to an active control condition. As a means to further understand the neurocognitive mechanisms affected by breast cancer, Experiment 4 adopts a neural approach exploring how breast cancer survivors respond to making cognitive errors in comparison to healthy controls. Findings indicated that whilst performance effects were absent, neural differences were found between groups, indicating that compensatory processes were required in order to function efficiently. Finally, whilst a large body of research now indicates that chemotherapy affects cognitive functioning post treatment, less is known about the effects of the estrogen reducing hormone therapy Tamoxifen, which is widely administered to breast cancer survivors for five to ten years post diagnosis. Study 5 employed qualitative methods to explore the lived experience of taking Tamoxifen in the absence of chemotherapy. Findings indicate that for this subset of breast cancer survivors, cognitive deficits are also present, and can greatly diminish quality of life. Overall, findings have critical implications for informing researchers, clinicians and the breast cancer population alike on the underlying mechanisms surrounding cognitive and emotional vulnerability in breast cancer.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available