Limitations of standard memory assessments in breast cancer survivors.

Objectives: Breast cancer is the most commonly diagnosed cancer in women worldwide, and treatments like chemotherapy are often linked to post-treatment cognitive impairments, including memory deficits. Standardized episodic memory tests may fail to capture the nuanced, real-world aspects of memory, potentially underestimating impairments in cancer survivors. This study seeks to investigate the impact of cancer treatment on episodic memory in breast cancer survivors (BCS) by comparing standard cognitive measures with ecologically valid measures of naturalistic memory, which may capture the subtle memory impairments. Methods: BCS at least 6 months post-treatment (n=45) and non-cancer control (NC; n=43), aged 30 to 65, completed two cognitive tasks to assess episodic memory (Taler Stories and Verbal Paired Associates, VPA) and two questionnaires to assess perceived cognitive workload (National Aeronautics and Space Administration Task Load Index) and perceived episodic and semantic memory abilities (Survey of Autobiographical Memory). Results: BCS recalled fewer verbatim and gist details for the Taler Stories than NC, with impairments in gist memory persisting during delayed recall. However, no memory deficits were evident on the VPA task in BCS compared to NC. BCS reported greater cognitive effort during the story recall tasks, but no group differences emerged for the VPA task. BCS also self-reported heightened subjective difficulties with episodic and semantic memory compared to NC, which was consistent with poorer performance on the Taler Stories. Conclusions: Impaired performance on complex naturalistic memory, despite similar VPA memory task performance, suggests that standard assessments may not fully capture everyday memory challenges faced by BCS.