Liu Yu, Su Yali, Bai Lixiao, Yang Ailing, Chen Shaohua
School of Nursing, Fujian Medical University, No. 1 Xuefu North Road, Fuzhou, Fujian, 350108, PR China.
Department of Breast Oncology, Beijing Tiantan Hospital, Capital Medical University, South 4th Ring Road West, Beijing, 100050, PR China.
Eur J Oncol Nurs. 2025 Feb;74:102761. doi: 10.1016/j.ejon.2024.102761. Epub 2024 Dec 7.
Psychosomatic symptoms are frequently observed side effects in breast cancer (BC) patients and significantly influence cognitive function. However, limited research has addressed the role of psychosomatic symptoms in the relationship between physical activity and cognitive function. This study aimed to examine the mediating effect of psychosomatic symptoms on the relationship between physical activity and cognitive function in BC patients.
A cross-sectional study was conducted across 10 hospitals in China from April 2022 to February 2023. Cognitive function was assessed using the Functional Assessment of Cancer Therapy-Cognitive Function scale. Exercise frequency, sleep quality, fatigue, anxiety, and depression were measured using the Pittsburgh Sleep Quality Index questionnaire, Cancer Fatigue Scale, Generalized Anxiety Disorder Questionnaire-7, and Patient Health Questionnaire-9, respectively, among 741 BC patients. Correlation analysis and path analysis were performed to explore associations between variables.
The prevalence of cognitive impairment in BC patients was found to be 9.58%. The path model demonstrated the best fit when age was included as a moderating variable, and the association between age and sleep disorders was controlled. Physical activity showed a negative correlation with both psychosomatic symptoms and cognitive impairment (p < 0.05). It exerted a direct impact on cognitive impairment (20.3%, p < 0.001) and an indirect impact mediated through anxiety and depression (6.3%, p < 0.001). The total effect in the model was 38.6% (p < 0.001).
Physical activity has a pivotal role in improving cognitive function in BC patients, both through direct mechanisms and indirectly by reducing anxiety and depression. While enhancements in sleep quality and fatigue levels were observed, their influence on cognitive function did not reach statistical significance, indicating the need for further research. These findings underscore the importance of incorporating psychological symptom management into supportive care plans to aid cognitive recovery. A combination of physical activity and psychological interventions could provide synergistic benefits, potentially boosting cognitive improvement and enhancing the overall quality of life in BC patients.
心身症状是乳腺癌（BC）患者常见的副作用，对认知功能有显著影响。然而，关于心身症状在体力活动与认知功能关系中的作用的研究有限。本研究旨在探讨心身症状在BC患者体力活动与认知功能关系中的中介作用。
2022年4月至2023年2月在中国的10家医院进行了一项横断面研究。使用癌症治疗功能评估-认知功能量表评估认知功能。分别使用匹兹堡睡眠质量指数问卷、癌症疲劳量表、广泛性焦虑障碍问卷-7和患者健康问卷-9对741例BC患者的运动频率、睡眠质量、疲劳、焦虑和抑郁进行测量。进行相关分析和路径分析以探索变量之间的关联。
发现BC患者认知障碍的患病率为9.58%。当将年龄作为调节变量纳入并控制年龄与睡眠障碍之间的关联时，路径模型显示出最佳拟合。体力活动与心身症状和认知障碍均呈负相关（p < 0.05）。它对认知障碍有直接影响（20.3%，p < 0.001），并通过焦虑和抑郁介导产生间接影响（6.3%，p < 0.001）。模型中的总效应为38.6%（p < 0.001）。
体力活动在改善BC患者的认知功能方面具有关键作用，既通过直接机制，也通过减轻焦虑和抑郁间接发挥作用。虽然观察到睡眠质量和疲劳水平有所改善，但它们对认知功能的影响未达到统计学意义，表明需要进一步研究。这些发现强调了将心理症状管理纳入支持性护理计划以促进认知恢复的重要性。体力活动和心理干预相结合可能会产生协同效益，有可能促进认知改善并提高BC患者的整体生活质量。
