Chemotherapy-Related Cognitive Impairment and Quality of Life in Bulgarian Women with Breast Cancer: Pilot Study

Dobrev N, Pesheva P, Petkova D and Mihaylova DM

Published on: 2025-12-06

Abstract

Background

Chemotherapy-related cognitive impairment (CRCI), often referred to as “chemobrain”, is a frequent and clinically significant consequence of cancer treatment. Despite the growing body of international evidence, data on CRCI among women with breast cancer from Eastern Europ-and Bulgaria in particular-are absent. Understanding the cognitive and quality-of-life (QoL) consequences of treatment in this population is essential for improving survivorship care.

Objectives

To compare perceived cognitive functioning and quality of life in three groups of Bulgarian women: (1) breast cancer survivors treated with chemotherapy, (2) breast cancer patients who had not received chemotherapy, and (3) healthy controls. This study represents the first pilot, single-center investigation of CRCI in Bulgaria.

Methods

A cross-sectional pilot study was conducted with 62 women. Participants completed a sociodemographic questionnaire and the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog v3). Statistical analyses included Kruskal-Wallis tests, Mann-Whitney U tests, Spearman correlations, and linear regression modeling to identify predictors of QoL.

Results

Women who had received chemotherapy reported significantly greater perceived cognitive impairments compared with both non-chemotherapy patients and healthy controls. The chemotherapy group demonstrated the lowest scores across cognitive domains, particularly memory, concentration, and mental acuity. FACT-Cog QoL impact scores were also significantly reduced. Age, educational level, and employment status showed moderating effects on cognitive and QoL outcomes. Regression analysis revealed that perceived cognitive impairment was a significant independent predictor of reduced quality of life.

Conclusions

This study provides the first evidence of chemotherapy-related cognitive difficulties among Bulgarian women with breast cancer. The findings confirm the negative association between cognitive complaints and quality of life and highlight the relevance of sociodemographic factors. As a pilot, single-center investigation, the study lays the groundwork for future longitudinal, multicenter, and multimodal research aimed at identifying mechanisms, risk factors, and intervention opportunities.