Anxiety and directed attention in women awaiting breast cancer surgery.

PURPOSE/
OBJECTIVES: To investigate the relationship between anxiety and directed attention (the ability to focus and concentrate) in women awaiting breast cancer surgery and the potential influence of age and extent of anticipated surgery (breast conservation versus mastectomy) on attentional functioning and anxiety.
DESIGN: Descriptive, cross-sectional. SAMPLE AND
SETTING: Convenience sample of 45 women newly diagnosed with localized breast cancer at a Midwestern university medical center.
METHODS: Subjects were assessed approximately 11 days before surgery using objective measures of attention: Digit Span, the Symbol Digit Modalities Test, the Necker Cube Pattern Control Test, the Attentional Function Index (a subjective measure of effectiveness of attentional functioning), and the Tension-Anxiety subscale of the Profile of Mood States. MAIN RESEARCH VARIABLES: Capacity to direct attention, perceived attentional functioning, anxiety level, age, and extent of anticipated breast surgery.
FINDINGS: Level of anxiety was related inversely (r = -0.63, p < 0.01) to perceptions of attentional functioning but not to performance on any objective measures of attention in the pretreatment period. No differences in anxiety level existed in regard to age or extent of anticipated surgery. However, older women (> or = 55 years) showed overall significantly lowered (p < 0.001) performance on the attentional measures than younger women.
CONCLUSIONS: Preoperative anxiety is a clinically significant issue in women newly diagnosed with breast cancer regardless of age and extent of anticipated surgery. Higher anxiety requires use of attentional resources and initially may act to reduce perceptions of effectiveness in attentional functioning. Older women who have high anxiety combined with both subjective and objective decline in attentional functioning may be at particularly high risk for attentional fatigue. IMPLICATIONS FOR NURSING PRACTICE: Women newly diagnosed with breast cancer may experience not only increased anxiety and associated perceptions of decreased attentional functioning but also a subsequent depletion of attentional reserves as a result of the onset of attentional fatigue. Nurses can assess anxiety in women during the preoperative period and assist them in coping with the psychological and cognitive demands associated with this highly stressful period.