Pain Symptom Cluster's (SC) Effect on the Psychoneurological SC and Performance in Advanced Breast Cancer

Monday, 30 October 2017: 2:45 PM

Kawther Ismail Hamash, PhD, MSN, BSN
Nursing, Indiana University-Purdue University-Fort Wayne, Fort Wayne, IN, USA
Wendy Umberger, PhD
College of Nursing, Kent State University, Kent, OH, USA
Aynur Aktas, MD
Academic Advancement, Emory University School of Nursing, Atlanta, GA, USA
Thomas Declan Walsh, MD, MSc
Survivorship, Genetics, Navigation, and Integrative Oncology Departments, Levine Cancer Institute, Charlotte, NC, USA
Vinay Kumar Cheruvu, PhD, MS, MSc
Biostatistics, Environmental Health Sciences, and Epidemiology, Kent State University, Kent, OH, USA


Background: Breast cancer is associated with the occurrence of multiple symptoms, which can lead to negative consequences on the patient's physical status, social life, and psychological and financial status. Symptoms that are correlated with each other are known as Symptom Cluster (SC). Pain, fatigue, depression, sleep disturbances, anxiety, nausea, vomiting, constipation, and other symptoms are reported frequently in samples of women with breast cancer (Kirkova, Ryibicki, Walsh, Aktas, Davis, & Karafa, 2011). These symptoms have negative effect on performance status (PS) in different stages of breast cancer. Depression, anxiety, and sleep disturbances are often reported in the psychoneurological SC. Examining the effect of SCs on performance status (PS) in advanced stages of breast cancer can alleviate their effect on performance and thereby improve a patient’s quality of life.

Aim: This study examined the effect of the pain SC on one or more symptoms of the psychoneurological SC and PS in advanced breast cancer.

Design: This study was a secondary analysis of 86 women diagnosed with advanced breast cancer who represented a subsample of a previous large 1000 patient cross-sectional study. Setting/participants: A de-identified complete data profile of 86 women diagnosed with advanced breast cancer who were referred to a palliative care center at a large tertiary medical center in northeast Ohio was included in this study.

Results: Logistic Regression was conducted to examine the effect of pain, constipation, and the psychoneurological symptoms on PS. The Odds Ratio (OR) of the effect of the psychoneurological SC on PS was not significant at the 90% CI (OR = .46, CI = .17 – 1.29), indicating the psychoneurological SC had no significant effect on the PS. Constipation showed a significant effect on the psychoneurological SC but not on PS (OR: 3 [1.18 – 7.62]). The effect of pain on the psychoneurological SC showed no significant differences (OR = 1.56, CI = .66 – 3.69). Although statistically not significant, the study results showed that severe pain increases the risk of having poor psychoneurological symptoms and increases the risk of having poor PS.

Conclusions: The differences in the sample characteristics, disease stage, instruments used, and statistical tests can lead to differences in studying the effect of SCs on PS. The findings of this study show that patients reporting constipation experienced worse psychoneurological symptoms compared with patients who did not report constipation. The significant effect of constipation on the psychoneurological symptoms highlighted the importance of managing all symptoms identified in SC rather than individual symptoms to reduce the severity of other SCs or symptoms identified in other clusters