Utilizing Experimental Cognitive Assessments and Machine Learning to Advance Prediction of Cognitive Impairment in Breast Cancer Survivors: A Preliminary Study

Up to 80% of women breast cancer survivors (BCS), particularly those treated with chemotherapy, report persistent cognitive impairment. Several meta-analyses and empirical studies assessing cancer and chemotherapy-related cognitive impairment (CRCI) in BCS have reported cognitive deficits across many general domains of cognition. Moreover, discrepancies often arise between objectively measured and self-reported impairment, potentially due, in part, to the use of non-specific neuropsychological assessments. Cognitive impairments faced by BCS may only be experienced by a portion of individuals due to the interaction of several contributing factors (e.g., age, fatigue, stress), although this possibility has not been assessed systematically. This study measured cognitive performance using multiple modalities: 1) self-report measures, 2) traditional neuropsychological assessments, and 3) experimental cognitive paradigms. Using machine learning, we generated models to distinguish BCS from healthy aging individuals without breast cancer, and to assess the relative predictive value of these three assessment modalities. We found that self-report measures of fatigue, distractibility, and stress were able to successfully differentiate BCS from healthy control participants. Further, a model combining these self-report measures with measures from experimental cognitive paradigms and neuropsychological assessments increased predictive accuracy; performance on cognitive paradigms ranked more important for prediction than performance on neuropsychological assessments. Although preliminary, results highlight the predictive utility of combining measures from several modalities and indicate that several distinct factors may contribute to CRCI. As the nature of CRCI is complex, this approach may help identify the best combination of assessments and performance metrics to measure subtle cognitive impairments in women BCS.