Journal List > J Korean Acad Nurs > v.46(3) > 1003170

Oh and Lee: Effect of Cancer Symptoms and Fatigue on Chemotherapy-related Cognitive Impairment and Depression in People with Gastrointestinal Cancer



The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer.


A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis.


CRCI was directly affected by cancer symptoms (β=.19, p=.004) and fatigue (β=.56, p<.001)(R2=47.2%). Depression was directly affected by fatigue (β=.48, p<.001) and CRCI (β=.27, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI.


Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.

Figures and Tables

Figure 1-A

Path diagram of the hypothetical model.

Figure 1-B

Modified path diagram of the study.

Table 1

Cancer Symptoms, Fatigue, Cognitive Function, and Depression according to General Characteristics of Participants (N=198)


ECOG=Eastern cooperative oncology group.

Table 2

Descriptive Statistics of Cancer Symptoms, Fatigue, Objective Cognitive Function, Perceived Cognitive Decline, and Depression (N=198)

Table 3

Correlations among Cancer Symptoms, Anemia, Fatigue, Objective Cognitive Function, Perceived Cognitive Decline, and Depression (N=198)

Table 4

Total Effect, Direct Effect, and Indirect Effect


SE=Standard error; CR=Critical ratio; SMC=Squared multiple correlations.


This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2014R1A1A2053517)

CONFlCTS OF INTEREST The authors declared no conflict of interest.


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