Clarifying symptom experiences and management strategies for breast cancer survivors with cardiotoxicity: A mixed-methods analysis - Project Summary/ Abstract Cardiotoxicity, or cardiovascular complications from cancer treatment, is a significant problem facing the growing population of breast cancer survivors (BCS), leading to the expansion of cardio-oncology programs across the United States. BCS already face significant symptom challenges, such as fatigue, anxiety, and cognitive impairment, but these symptoms remain understudied in those with cardiotoxicity. Limited qualitative evidence suggests that BCS with cardiotoxicity perceive fatigue and anxiety as distinct from their known cancer treatment- related symptoms. Cognitive impairment in BCS with cardiotoxicity is also not well understood. A recent quantitative study revealed significantly worse objective cognitive functioning in BCS with cardiovascular disease compared to those without, but did not explore perceived cognitive impairment. There is also a significant gap in understanding how BCS with cardiotoxicity monitor and manage their symptoms, which is essential to develop patient-centered behavioral interventions, such as a symptom monitoring tool, that builds on their strengths while addressing their unmet needs. A systematic comparison of fatigue, anxiety, perceived cognitive impairment, and health-related quality of life in BCS with and without cardiotoxicity is urgently needed to clarify their symptom experiences. The proposed convergent mixed-methods study (N=96, QUANT-Qual) aims to address this gap through its primary aim: to examine the differences between BCS with (n=48) and without cardiotoxicity (n=48) on fatigue, anxiety, perceived cognitive impairment, and health-related quality of life considering cardiovascular risk factors (i.e., age, cancer treatment history, obesity, smoking status, menopausal status, comorbidities, and physical inactivity) as covariates. The secondary aim is to develop a conceptual framework for how BCS experience, monitor, and manage their symptoms through semi-structured interviews. Quantitative and qualitative data from BCS with cardiotoxicity will be integrated using a merging approach and a joint display of data. The study will take place at Moffitt Cancer Center and Sarasota Memorial Healthcare System, both of which have established cardio-oncology programs. Findings will guide future longitudinal research and behavioral interventions to improve symptom management, facilitate early detection of worsening cardiotoxicity, and break the cycle of its progression. The proposed study aligns with the National Institute of Nursing Research's mission to optimize health by reducing symptoms, severity, and progression of cardiotoxicity for BCS. The fellowship training plan will provide the applicant with mentorship in cardio-oncology, symptom science, quality of life, and mixed-methods research, supporting future grant proposals, publications, and a long-term research program dedicated to improving the quality of life for BCS experiencing cardiotoxicity and advancing cardio-oncology care as an independent nurse scientist.
