Presurgery Psychological Factors Predict Pain, Nausea, and Fatigue One Week After Breast Cancer Surgery

Abstract

Prior to scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of post-surgery symptoms. Previous literature has supported the view that pre-surgery distress and response expectancies are predictive of post-surgery outcomes. However, the contributions of distress and response expectancies to post-surgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate post-surgical setting rather than the longer term. The purpose of the present study was to test the contribution of pre-surgery distress and response expectancies to common post-surgery side effects (pain, nausea, fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that pre-surgery distress uniquely contributed to patients' post-surgery pain severity (P<0.05) and fatigue (P<0.003) one week following surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012) and fatigue (P<0.010) one week following surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea and fatigue. Results highlight the contribution of pre-surgery psychological factors to post-surgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest pre-surgical clinical targets for improving patients' postoperative experiences of side effects.

Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery

“…While our findings are consistent with those of Bodtcher et al(2) and Montgomery et al,(3) they contrast with other studies that found no association(4–6) between age and severity of fatigue in women following breast cancer surgery. In the study by Montgomery et al,(3) mediational analyses demonstrated that preoperative expectations of postoperative levels of fatigue accounted in part for the effects of age on the severity of postoperative fatigue. The authors commented that their findings could be explained by Social Learning Theory which suggests that an individual’s previous experiences with fatigue might shape one’s expectancies for the symptom.…”

“…(1) While over 90% of patients diagnosed with breast cancer will undergo surgery, only a limited number of longitudinal studies have evaluated for preoperative levels of fatigue and changes in fatigue following surgery. (2–5) Across these studies, a variety of demographic (e.g., younger age (3)) and clinical (e.g., partial mastectomy (6), poorer functional status (4, 6)) characteristics, as well as psychological factors (e.g., pre-surgical expectancies for fatigue (3), introversion (5)) were associated with higher levels of fatigue following surgery. In these studies, the length of post-surgical follow-up ranged from one week (3) to one year (6).…”

Psychosocial Issues in Cancer Pain

“…For example, a recent study examined predictors of pain severity and other postsurgical symptoms in women undergoing surgery for breast cancer [20]. Predictors of interest assessed before surgery included emotional distress (tension and anxiety) and response expectancies (eg, "After surgery, how much pain do you about what s/he did well, and point out any areas for improvement) • Applying learned skills to challenging situations (eg, encourage the patient to call his/her provider the next time s/he has a pain flare, and to use learned skills to describe the pain problem and ask for help) Coping with cancer pain: What is effective?…”

Placebo Interventions for Nausea: a Systematic Review

“…It can also contribute to malnutrition and food aversions following chronic treatment with nauseogenic agents [5]. Large variance in nausea between individuals has been noted, with factors such as age, gender, and pretreatment distress being found to predict nausea beyond the basic emetogenicity of the treatment [6,7].…”