Cancer-Related Cognitive Impairment: Examining the Perspectives of Survivors and Speech-Language Pathologists

Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Rob Lyerla, Ph.D., MGIS,

Second Advisor

Kieran Fogarty, Ph.D.

Third Advisor

Karen Flynn, Ed.D., CCC-SLP


Health sciences, oncology, speech language pathology


Scientific advancements have led to significant improvements in cancer treatment and increased survival rates. However, cancer survivors often experience long-term effects, including cognitive impairments known as cancer-related cognitive impairment (CRCI). CRCI is a common and distressing side effect that affects affected individuals’ quality of life. The discipline of speech-language pathology (SLP) is well-positioned to assess and treat CRCI. Still, there is a gap in determining the most effective support for cancer survivors with CRCI. This mixed methods, three-paper dissertation implements exploratory, cross-sectional survey design to examine how speech-language pathologists and survivors view CRCI symptoms, its impact on daily functioning, and what characterizes individuals who seek help for CRCI.

The first study explored speech-language pathologists (SLPs) knowledge, training, and attitudes toward assessing and treating CRCI and investigated the impact of professional experience on their knowledge and attitudes. The results found that most participants considered providing cognitive-communication services for individuals with CRCI within the scope of practice and ethical responsibility of SLPs. Over half of the participants reported completing CRCI-specific training, with self-study indicated as the most common method. Most expressed comfort with the idea of treating individuals with CRCI, and almost all participants considered it a medical necessity. Regarding the impact of professional experience, there was a significant difference in comfort ratings, with SLPs with more than 20 years of experience reporting the highest comfort levels.

The second study investigated the prevalence of cognitive-communication deficits among adult cancer survivors using the Cognitive Communication Checklist for Acquired Brain Injury (CCCABI). It also explored the relationship between these deficits and social participation and satisfaction. Results indicate self-reported impairment across various cognitive-communication domains, with the most significant difficulties reported in functional daily communication. Participants also reported challenges with social participation and decreased social satisfaction, suggesting a potential impact of cognitive-communication deficits.

The third study investigated the help-seeking behaviors employed by survivors and the interventions or supports discussed during patient-provider interactions. Furthermore, it examined the relationship between cognitive-communication scores and help-seeking behaviors, as well as whether age, gender, educational level, and health insurance status predict CRCI-specific help-seeking behaviors. The results indicate that many survivors report CRCI but do not seek help for their symptoms. Among those who sought help, participants were most likely to seek help from a healthcare provider but also sought help from personal connections and through independent searching. Through qualitative thematic analysis, four major themes were identified from free-text responses of participants who did not seek help. These themes include "Impact of CRCI," "Lack of Awareness and Reluctance to Seek Help," "Lack of Validation Regarding CRCI," and "Coping, Support, and Hope."

Improved knowledge of cancer-related cognitive impairment, including the impact on social participation, social satisfaction, and help-seeking behaviors, in speech-language pathology is essential for bridging the research to practice gap and guiding future investigations. This three-paper dissertation aims to foster a comprehensive approach to meeting the needs of cancer survivors while empowering speech-language pathologists to offer specialized care and assistance for the cognitive-communication difficulties linked to CRCI.

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