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Work challenges and cancer-related cognitive impairment: level of education accounts for unmet needs beyond cognitive impairment severity

Year: 2026

Type: article

Abstract: Purpose Cancer-related cognitive impairment (CRCI) can impact cancer survivors’ return to work and occupational functioning for many years following the completion of cancer treatment. Understanding the characteristics of CRCI-related occupational difficulties and unmet supportive care needs is critical for the development of effective interventions. Within occupational roles, a higher level of education is typically associated with greater cognitive load and different demands. The objective of this study was to examine whether the level of education accounted for CRCI-related (a) occupational difficulties and (b) occupational unmet supportive care needs, beyond the contributions of perceived cognitive functioning and employment level. Methods A cross-sectional design was utilised using a sub-section of an existing self-reported dataset involving 358 employed cancer survivors, comprising demographic and clinical data, as well as data from MASCC COG-IMPACT and PROMIS Cog tools. Hierarchical multiple linear regression models were used for hypothesis testing. Results After accounting for perceived cognitive functioning and employment level, highest level of education did not account for a significant amount of unique variance in CRCI-related occupational difficulties ( R 2 Change = 0.004, F Change (1, 354) = 3.26, p = .147). However, after accounting for perceived cognitive functioning and employment level, highest level of education did account for a significant amount of unique variance in CRCI-related occupational unmet needs ( R 2 Change = 0.011, F Change (1, 354) = 4.75, p = .030). Conclusion Theoretical explanations of findings, including compensatory accommodations such as role adjustment and differences in the availability of occupational support, are provided. It is proposed that those with higher levels of education may not have access to appropriate levels of supportive care as it relates to CRCI in occupational settings, thus potentially informing future interventions. It is proposed that individuals with higher levels of education may experience gaps in supportive care for CRCI, particularly in relation to maintaining work performance and meeting occupational expectations. This suggests that future interventions should consider strategies to better support cognitive functioning in workplace contexts for cancer survivors.

Source: Supportive Care in Cancer

DOI: 10.1007/s00520-026-10420-8