A1 Journal article – refereed
Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer

List of Authors: Charalambous A., Giannakopoulou M., Bozas E., Paikousis L.
Publisher: BMJ Publishing Group
Publication year: 2019
Journal: BMJ Open
Journal name in source: BMJ Open
Volume number: 9
Issue number: 1
ISSN: 2044-6055
eISSN: 2044-6055


Objective Cancer treatment is a particularly stressful period for the
patient. The reasons vary and include fear of treatment outcome as well
as treatment induced side effects. The patient frequently experiences
simultaneously various side effects resulting in a diminishing of the
patient's health-related quality of life (HRQoL). The study provides
evidence on the co-occurrence and inter-relations between pain, anxiety,
depression and fatigue in patients with breast and prostate cancer.
Design This paper presents a secondary analysis of the data from a
randomised control trial designed to test the effectiveness of guided
imagery and progressive muscle relaxation on pain, fatigue, anxiety and
depression. Non-parametric bootstrapping analyses were used to test the
mediational model of anxiety, fatigue and depression as parallel
mediators of the relationship between pain and HRQoL. Setting The study
was undertaken at the home setting. Participants In total 208 patients
were included in the study (assigned equally in two groups), referred at
the outpatient clinics of the three participating cancer care centres.
Results The three mediators fully mediate the relationship between pain
and HRQoL indirect effect (IE overall =-0.3839, 95% CI: Lower limit
(LL)=-0.5073 to upper limit (UL)=-0.2825) indicating that patients with
increased pain are likely to have higher levels of anxiety, fatigue and
depression. Gender significantly moderated the mediational effect of
Fatigue Index of Moderated Mediation (IMM=-0.2867 SE=0.1526, LL=-0.6127,
UL=-0.0226) but did not moderate mediational effect of anxiety
(IMM=-0.0709, SE=0.1414, LL=-0.3459, UL=+0.2089). The results show that
the three mediators in a serial causal order fully mediate the
relationship between pain and HRQoL (IE overall =-0.384, 95% CI:
LL=-0.51 to UL=-0.284) and the ratio of the overall indirect effect to
the total effect is 0.8315 (95% CI: LL=0.5683 to UL=1.1718). Conclusion
This work provides evidence that targeting fatigue, anxiety and
depression may have a meaningful effect on pain as a related symptom and
potentially have a positive impact on HRQoL of patients with breast and
prostate cancer.

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Last updated on 2019-03-04 at 09:59