The impact of chemotherapy for breast cancer on managing daily tasks: a longitudinal study of cognitive, psychosocial and safety outcomes in the home and workplace

BACKGROUND. Breast cancer is the most common type of cancer in women in the UK and is often treated with chemotherapy. Psychosocial side effects (anxiety, depression and fatigue) and cognitive side effects (memory and concentration difficulties) are frequently reported by breast cancer patients. Following recent advances in screening and treatment technology for the disease, survivorship rates have increased. Therefore, women are able to continue or resume their daily tasks during and following treatment. The impact of chemotherapy-related psychological side effects on quality of life and work ability are documented, however the impact on safety outcomes has currently been overlooked in this patient population. Evidence from other research fields suggests that anxiety, depression, fatigue and cognitive difficulties are associated with increased risk of accidents and injuries. OBJECTIVES. This research provides longitudinal self-report data on psychosocial well-being, cognitive function, quality of life, work ability and accident frequency outcomes. METHOD. A mixed-methods, prospective, longitudinal approach was employed. Breast cancer patients about to undergo chemotherapy treatment (n = 60) completed questionnaires at pre-treatment baseline, and again four months (follow-up time 1), eight months (follow-up time 2), and twelve months (follow-up time 3) later. A treatment control group of breast cancer patients receiving radiotherapy (n = 56), and an age-matched healthy control group (n = 58) were assessed at comparable intervals. In addition, a subsample of participants from the chemotherapy group (n = 11), radiotherapy group (n = 6), and healthy control group (n = 15) kept personal solicited diaries for a four-month period to capture the lived experience of managing daily tasks. The diary data were examined using thematic analysis. The combination of the quantitative and qualitative approaches added breadth and depth to the study with the aim of obtaining a realistic and comprehensive understanding of the impact of chemotherapy for breast cancer on patients daily lives. RESULTS. Chemotherapy patients reported a subtle decline in psychosocial well-being, cognitive function and quality of life, and encountered more accidents, particularly at mid-chemotherapy. CONCLUSION. It is important that healthcare professionals, breast cancer patients, relatives and employers are aware of the temporal fluctuations associated with chemotherapy-related side effects, particularly potential safety outcomes. Interventions could be developed to help patients manage their daily tasks in the home and in the workplace safely

Explaining Strategic Coordination: Cognitive Hierarchy Theory, Strong Stackelberg Reasoning, and Team Reasoning

In common interest games, players generally manage to coordinate their actions on mutually optimal outcomes, but orthodox game theory provides no reason for them to play their individual parts in these seemingly obvious solutions and no justification for choosing the corresponding strategies. A number of theories have been suggested to explain coordination, among the most prominent being versions of cognitive hierarchy theory, theories of team reasoning, and social projection theory (in symmetric games). Each of these theories provides a plausible explanation but is theoretically problematic. An improved theory of strong Stackelberg reasoning avoids these problems and explains coordination among players who care about their co-players’ payoffs and who act as though their co-players can anticipate their choices. Two experiments designed to test cognitive hierarchy, team reasoning, and strong Stackelberg theories against one another in games without obvious, payoff-dominant solutions suggest that each of the theories provides part of the explanation. Cognitive hierarchy Level-1 reasoning, facilitated by a heuristic of avoiding the worst payoff, tended to predominate, especially in more complicated games, but strong Stackelberg reasoning occurred quite frequently in the simpler games and team reasoning in both the simpler and the more complicated games. Most players considered two or more of these reasoning processes before choosing their strategies