The Effect of Constipation on the Psychoneurological Cluster and Performance in Advanced Breast Cancer Women

Monday, 18 November 2019: 2:45 PM

Kawther Ismail Hamash, PhD
School of Nursing, Indiana University-Fort Wayne, Fort Wayne, IN, USA
Wendy Umberger, PhD, APRN, BC, PMHCNS-BC
College of Nursing, Kent State University, Kent, OH, USA
Aynur Aktas, MD
Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
Thomas Declan Walsh, MD, MSc, MB, BCh, BAO
Survivorship, Genetics, Navigation, and Integrative Oncology Departments, Levine Cancer Institute, Charlotte, NC, USA
Vinay Kumar Cheruvu, PhD, MS, MSc, PGD-MISCA
Biostatistics, Environmental Health Sciences, and Epidemiology, Kent State University, Kent, OH, USA

Background: Pain, depression, sleep disturbances, anxiety, and constipation are common symptoms in women with breast cancer. These symptoms can affect performance status negatively. In advanced breast cancer, pain and constipation were highly prevalent (Locasale, Datto, Margolis, Tack, Coyne, 2015; Younes & Tawalbeh, 2017). Similarly, depression, anxiety, and sleep disturbances were reported in Symptom Clusters. Examining the effect of the most powerful symptoms within SCs on Performance would help alleviate their negative effect and improve patient’s quality of life (Ferrel, Coyle, Paice, 2015; Koloski, Jones, Wai, Gill, Byles, & Talley, 2013; Nguyen, Yates, Annoussamy, Truong, 2016; Stromgren, Niemann, Tange, 2014).

Objective: This study examined the individual effect of pain and constipation on the presence of psychoneurological SC (i.e., depression, anxiety, and sleep disturbances) and on performance status in advanced breast cancer.

Methods and Design: This study was a secondary analysis of a data set that involved 86 women diagnosed with advanced breast cancer who represented a subsample of a previous large 1000 patient cross-sectional study.

Setting/participants: De-identified complete data set of 86 women diagnosed with advanced breast cancer who were referred to a palliative medicine program at a tertiary medical center were included in this study.

Results: Logistic Regression analysis examined the effect of pain and constipation on the psychoneurological SC and performance status. Constipation showed a significant effect on the psychoneurological SC but not on performance level (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). The study results showed that severe pain can increase the risk of having poor psychoneurological symptoms and increase the risk of having poor performance status. The Odds Ratio (OR) of the effect of the psychoneurological SC on performance status was not significant at the 90% CI (OR = .46, CI = .17 – 1.29), indicating that in this study the psychoneurological SC had no significant effect on the performance level.

Conclusions: Constipation led to experience worse psychoneurological symptoms compared with patients who didn’t report constipation. The significant effect of Constipation on the psychoneurological symptoms highlight the importance of addressing the effect of coexisting symptoms comprehensively.

Implications for Practice: Health professionals should assess constipation concurrently with Pain. This may help in managing the co-occurring symptoms, reduce the severity of other symptoms, and improve the patient’s performance status.

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