Cognitive workload and its relationship with neurocognitive performance before and after breast cancer chemotherapy

To compare associations between neurocognitive testing and two different self-report paradigms: (1) recall-based (PROMIS Cognitive Function) and (2) real-time, task-specific (NASA-Task Load Index [NASA-TLX]) among 56 patients with breast cancer.

This is a secondary analysis from a phase II, single-arm trial of memantine to prevent cognitive decline among patients receiving chemotherapy for breast cancer (NCT04033419). Before chemotherapy and 4 weeks after their final cycle, participants completed neuropsychological assessment and self-report measures. Memantine was administered between assessments. At pre-chemotherapy, multivariable linear regression evaluated associations between a unit-weighted, composite neurocognitive test score with PROMIS Cognitive Function and NASA-TLX, controlling for age, cancer stage, and cognitive reserve. Explanatory analyses examined associations within individual neurocognitive subtests. Multivariable regression explored the extent to which pre-treatment self-reported cognition predicted post-treatment performance.

Pre-chemotherapy, higher NASA-TLX scores (greater perceived workload) were robustly associated with worse performance (β = -0.31 [-0.50, -0.12], p = .002). Relationships were strongest for executive function: Animal Fluency (IQR = 35): -3.3 (-5.8, -0.8), p = .011; COWA (IQR = 36) = -6.7 (-12.8, -0.7), p = .031; One Touch Stockings (IQR = 31): -0.70 (-1.0, -0.3), p < .001. Pre-treatment NASA-TLX was also associated with post-treatment performance in univariable but not multivariable models. PROMIS Cognitive Function and neurocognitive performance were not associated.

The NASA-TLX and neurocognitive performance were strongly associated, particularly in the executive function domain. Future work involving the NASA-TLX in cancer populations, including its use in everyday contexts, will help clarify whether it may enhance CRCI characterization.