Attentional fatigue and restoration in individuals with cancer.

Abstract

Attentional fatigue is manifested as a decline in the capacity to direct attention with reduced effectiveness in functioning. Typically, attentional fatigue follows intense exertion of mental effort. Despite the intense mental demands experienced by individuals with cancer, little is known about the problem of attentional fatigue or nursing interventions that might conserve or restore attention. The study examined whether there was a pattern of decline in attentional capacity over the initial phase of treatment in women with breast cancer, and further if such change influenced quality of life. Also, the effect of an intervention aimed at restoring directed attention was explored. Thirty two volunteers with localized breast cancer were tested with repeated measures at four key points during the three month period following surgery (testing intervals averaged 3, 18, 60 and 90 days). Multidimensional assessment of attentional capacity was conducted at each observation using a battery of six tests of directed attention. Subjective experience of attentional functioning and perceptions of quality of life also were measured. Following the first observation, subjects were randomly assigned to receive the experimental restorative intervention (n = 16) or no intervention (n = 16). The intervention involved an individualized plan and contract for regular participation in activities thought to restore attention. Subjects showed significant attentional deficits for an extended period following either mastectomy or breast conservation surgery. Overall, significant improvement in attention was not observed until 60 days following surgery. Subjects who received intervention showed a pattern of consistent gain in attentional capacity and functioning throughout the study. In contrast, the nonintervention control group showed a pattern of inconsistent performance over time. Perceived changes in quality of life were closely related to perceived changes in attentional functioning. The sustained decline of attentional capacity following surgery for breast cancer most likely reflects fatigue of directed attention. The pattern of consistent gain in attentional capacity seen in the intervention group suggests that nurses may effectively intervene to help individuals with cancer restore attention. The findings provide a framework for further study of attentional deficits and restorative interventions in individuals with life-threatening illness such as cancer.