Chronic pain in breast cancer survivors is linked with an impairment on emotion-based decisions and fatalistic time orientation

Abstract After breast cancer diagnosis, individuals have to cope with various psychological, social, and physical consequences. One such consequence is chronic pain, which can persist even after the completion of active treatments and detrimentally impact quality of life. The published literature highlights the impact of chronic pain on cognitive functions and on decision-making processes. However, little is known about the imbalance in decision-making among cancer survivors suffering from chronic pain. This study aims to explore the cognitive impairment associated with risky decision-making in breast cancer survivors experiencing chronic pain, using the Iowa Gambling Task (IGT). Sixty women voluntarily participated in this prospective, cross-sectional study. Among them, twenty had a history of breast cancer and exhibited a significant level of chronic pain, twenty had previously received a cancer diagnosis but did not experience chronic pain, and twenty had not been diagnosed with cancer. The results revealed that women with chronic pain tend to make significantly more disadvantageous choices in the IGT compared to the other groups. Moreover, participants with chronic pain tend to believe that circumstances will change regardless of their efforts to achieve something. This way of thinking may contribute to reinforcing the observed imbalance in decision-making. Our hypothesis suggests that chronic pain may trigger a “ Cascade Effect ”, exerting multiple influences on decision-making and behaviors. The cognitive overload provoked by chronic pain in breast cancer survivors may not only affect individual cognitive functions, but also have a “ Cascade Effect ” on other psychological dimensions.