Measurement Issues in the Study of Risk Factors for Deficits in Cognitive Function Related to Chemotherapy

Keller, Ginger P.

Saturday, 29 October 2011

Ginger P. Keller, RN, MS, OCN, CNS
School of Nursing, Oregon Health & Science University, Portland, OR

Learning Objective 1: The learner will be able to identify three problems with use of “off the shelf” neuropsychological tests in a research design.

Learning Objective 2: The learner will be able to identify categorically three means by which biopsychosocial variability might be managed in a research study.

The goal of this presentation is to identify and propose solutions for many of the measurement issues involved in biopsychosocial research. Examples from current a current study of problems with cognitive function (CF) in women receiving chemotherapy for breast cancer (BC) are used. Identified methodological problems in this study include lack of a common definition of CF in this population, lack of pretreatment data, and potential confounds. The specific aims of this presentation are to identify, describe and suggest solutions for a variety of issues to include:

1.) The objective measurement of cognition and cognitive changes in cancer patients. How to adapt neuropsychological assessment, designed as a clinical tool for comparison between a patient’s current level of functioning and the known or estimated level of premobid functioning according to demographic “norms,” to a repeated measurement research tool sensitive to change in function in a high-functioning population of women with BC? How to address problems of practice effect and measurement bias?

2.) The differences between objective and subjective measurement. Research suggests that subjective report is not correlated with objective measures of cognitive problems and that subjective report of cognitive problems is related to depression and anxiety;

3) The control of covariability. Categorically, biopsychosocial research problems such as the one described here involve complex variability; and

4.) The study of psychosocial factors affecting cognition and cognitive changes in cancer patients receiving CTX. Choice of instrumentation for the study is based on specificity to the research question, psychometric properties (specifically in BC), ease of completion, sensitivity to change over time. Measures must be stable enough to detect change over time while discriminating from other responses. Potential confounds exist in the measurement of many variables so the ability of an instrument to distinguish among concepts is an important part of validity.

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