Armeana Zgâia1,2, Florina Pop*2, Patriciu Achimaș-Cadariu1,2, Cătălin Vlad1,2, Alexandru Rogobete3, Cosmin Lisencu1,2, Florin Ignat1,2, Gabriel Lazăr 1,2, Mihai Mureșan1, Mihai Ștefan Mureșan1,4, George Ciorogar1,5, Alexandru Irimie1,2
1Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2The Oncology Institute “Prof. Dr. I Chiricuta”, Cluj-Napoca, Romania
3Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
4First Surgery Clinic, Cluj-Napoca, Romania
5Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj-Napoca, Romania
Breast cancer surgery is associated with pre-surgical psychological distress that may have negative effects on post-operative evolution. The aims of our study have been to investigate the effects of pre-operative relaxing technique and psychological counselling (RT and PC) on the post-operative intensity of acute pain, analgesic consumption and psychological symptoms. In a prospective, randomized, open-labeled, controlled trial, with two parallel groups, in a single center, we included 102 patients scheduled for breast cancer either to receive or not to receive RT and PC. Patients were not blindly randomized. RT and PC were performed by a clinical psychologist. Acute post-surgical pain, psychological symptoms and analgesic consumption were assessed at different times post-operatively for a period of 48 hours. Patients in the RT and PC group (PSY-CON Group) had significantly lower intensity of pain in the recovery room, at 2, 8, 12, 24, 30 and 36 hours after surgery (p<0.05) significantly lower consumption of postoperative tramadol and NSAIDs (p<0.05) and fewer psychological symptoms after surgery (p<0.05) than patients in the control group (CONTR Group). The study indicates that pre-operative relaxation technique and psychological counselling decrease the intensity of acute post-surgical pain, post-operative analgesic consumption and psychological symptoms.
Keywords: psychological intervention, breast cancer surgery, pain, analgesic, psychological symptom
Published online: 2016/09/01
Published print: 2016/09/01
Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6-9.
Burish, T. G., Snyder, S. L., & Jenkins, R. A. (1991). Preparing patients for cancer chemotherapy: effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology, 59(4), 518-525.
Burton, M. V., Parker, R. W., Farrell, A., Bailey, D., Conneely, J., Booth, S., & Elcombe, S. (1995). A randomized controlled trial of preoperative psychological preparation for mastectomy. Psycho-Oncology, 4(1), 1-19. doi: 10.1002/pon.2960040102
Cleeland, C. S. (1984). The impact of pain on the patient with cancer. Cancer, 54(11 Suppl), 2635-2641.
Coza, D., Şuteu, O., Nicula, F. A., Blaga, L., Todescu, A., Moldovan, A., . . . Irimie, A. (2014). Cancer report in north-western region of Romania 2010-2011: cancer incidence, mortality, survival, and prevalence. Cluj-Napoca: Casa Cărţii de Ştiinţă.
DeSantis, C. E., Fedewa, S. A., Goding Sauer, A., Kramer, J. L., Smith, R. A., & Jemal, A. (2016). Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA: A Cancer Journal for Clinicians, 66(1), 31-42. doi: 10.3322/caac.21320
Hart, B. B. (1997). Changing expectations: a key to effective psychotherapy. By Irving Kirsch. Brooks/Cole Publishing Co, Pacific Grove, CA, 1990. Pp. xviii + 231. hb. ISBN 0-534-12648-0. Contemporary Hypnosis, 14(3), 195-196. doi: 10.1002/ch.102
Holland, J. C., & Alici, Y. (2010). Management of distress in cancer patients. Journal of Supportive Oncology, 8(1), 4-12.
Iarc, I. A. f. R. o. C. W. H. O. (2012). GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Globocan, 1-6. doi: 10.1002/ijc.27711
Jensen, M. P., & McFarland, C. A. (1993). Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain, 55(2), 195-203.
Johnston, M., & Vogele, C. (1993). Benefits of psychological preparation for surgery: A meta-analysis. Annals of Behavioral Medicine, 15(4), 245-256.
Katz, J., Poleshuck, E. L., Andrus, C. H., Hogan, L. A., Jung, B. F., Kulick, D. I., & Dworkin, R. H. (2005). Risk factors for acute pain and its persistence following breast cancer surgery. Pain, 119(1-3), 16-25. doi: 10.1016/j.pain.2005.09.008
Kornblith, A. B., & Ligibel, J. (2003). Psychosocial and sexual functioning of survivors of breast cancer. Seminars in Oncology, 30(6), 799-813.
Li, X. M., Yan, H., Zhou, K. N., Dang, S. N., Wang, D. L., & Zhang, Y. P. (2011). Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast Cancer Research and Treatment, 128(2), 411-419. doi: 10.1007/s10549-011-1533-z
Montgomery, G. H., & Bovbjerg, D. H. (2004). Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer. Health Psychology, 23(4), 381-387. doi: 10.1037/0278-6220.127.116.111
Montgomery, G. H., Bovbjerg, D. H., Schnur, J. B., David, D., Goldfarb, A., Weltz, C. R., . . . Silverstein, J. H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute, 99(17), 1304-1312. doi: 10.1093/jnci/djm106
Montgomery, G. H., David, D., Goldfarb, A. B., Silverstein, J. H., Weltz, C. R., Birk, J. S., & Bovbjerg, D. H. (2003). Sources of anticipatory distress among breast surgery patients. Journal of Behavioral Medicine, 26(2), 153-164.
Montgomery, G. H., Hallquist, M. N., Schnur, J. B., David, D., Silverstein, J. H., & Bovbjerg, D. H. (2010). Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: response expectancies and emotional distress. Journal of Consulting and Clinical Psychology, 78(1), 80-88. doi: 10.1037/a0017392
Montgomery, G. H., Schnur, J. B., Erblich, J., Diefenbach, M. A., & Bovbjerg, D. H. (2010). Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. Journal of Pain and Symptom Management, 39(6), 1043-1052. doi: 10.1016/j.jpainsymman.2009.11.318
Oldenmenger, W. H., de Raaf, P. J., de Klerk, C., & van der Rijt, C. C. (2013). Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review. Journal of Pain and Symptom Management, 45(6), 1083-1093. doi: 10.1016/j.jpainsymman.2012.06.007
Osteen, R. T., & Karnell, L. H. (1994). The National Cancer Data Base report on breast cancer. Cancer, 73(7), 1994-2000.
Polomano, R. C., Dunwoody, C. J., Krenzischek, D. A., & Rathmell, J. P. (2008). Perspective on pain management in the 21st century. Journal of Perianesthesia Nursing, 23(1 Suppl), S4-14. doi: 10.1016/j.jopan.2007.11.004
R Development Core Team. (2015). R: A Language and Environment for Statistical Computing: R Foundation for Statistical Computing, Vienna, Austria.
Rodriguez, C. S. (2001). Pain measurement in the elderly: a review. Pain Management Nursing, 2(2), 38-46. doi: 10.1053/jpmn.2001.23746
Saunders, D. C. M. (2006). Cicely Saunders: selected writings 1958-2004: Oxford University Press.
Steliarova-Foucher, E., O’Callaghan, M., Ferlay, J., Masuyer, E., Rosso, S., Forman, D., . . . Comber, H. (2014). The European Cancer Observatory: A new data resource. European Journal of Cancer, 51(9), 1131-1143. doi: 10.1016/j.ejca.2014.01.027
Syrjala, K. L., & Chapko, M. E. (1995). Evidence for a biopsychosocial model of cancer treatment-related pain. Pain, 61(1), 69-79.
Tatrow, K., & Montgomery, G. H. (2006). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. Journal of Behavioral Medicine, 29(1), 17-27. doi: 10.1007/s10865-005-9036-1