Identifying predictors of postoperative persistent pain in women with breast cancer: assessments of investigative tools

Abstract

Persistent pain after surgery in breast cancer has a significant impact on the patient’s survival. The value of escalating research on breast cancer in Malaysia cannot be underestimated. However, it is not known how many of these women experience persistent pain after surgery. This study surveyed previously unknown figures on prevalence, and explored the predictive factors of persistent pain women with breast cancer in Malaysia. There were three objectives. First, to assess the reliability of the already established investigative tools, namely, the Brief Pain Inventory, Distress Thermometer, and Resilience scale RS-14; second, to survey the prevalence of persistent pain; and thirdly to identify predictors of persistent pain in women after breast surgery, using the above measures. A test and retest design with no intervention and a recall period of 3 to 7 days was employed for assessment of the investigative tools. A cross-sectional study, with a prospective, correlational design, a retrospective review of medical records was used to identify predictors of persistent pain. These investigations were conducted in two phases –Section A and Section B – using separate data sets, with different inclusion and exclusion criteria. Participants were recruited from the University of Malaya Medical Centre, Malaysia. Descriptive statistics, a stepwise regression model for reliability testing, Cronbach alpha, and factor analysis were used. This study divided pain into categories 0 = no pain, 1–4 = mild pain, 5–6 = moderate pain, and 7–10 = severe pain. Section A: The tools were found reliable. Section B: A total of 123 participants were recruited; 119 participants remained because 4 of them did not meet the inclusion criteria. A total of 43% of the participants had persistent pain (n = 51). Pain interfered with their work, mood, and sleep. Based on a “Yes” answer for pain today (n = 51), data were analysed to determine predictors. The results revealed three predictors: distress, B = –.911, resilience, B = –.444, and pain interference, B = .309. The model was statistically significant, F (3, 41, 44) = 13.827, R2 = 0.267, .381, .467), and adjusted R2 = .250, .351, .467, p = 0.001. Significant P value ≤ .005. Pain prevalence was 43% in this Malaysian population. This study provided empirical evidence which is an important new knowledge to health care systems, health care providers, policy makers, and future research. The impact of persistent pain on work, mood, and sleep are justifiable medical concerns. The results obtained and identified predictors are catalysts for providing extra support for breast cancer women after surgery. Ideally, all women with breast cancer should have very good life satisfaction.