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Proposing and evaluating a model of depression, stress, resilience and spirituality in relation to pain in women with breast cancer: Investigating the mediating role of mindfulness

Published:January 05, 2023DOI:https://doi.org/10.1016/j.ejon.2023.102268

      Highlights

      • Pain is considered as one of the side effects of chemotherapy.
      • In this study, we evaluate and propose a model of pain in Brest cancer patients based on psychological components.
      • Depression, stress, mindfulness and resilience have an effective role on the experience of pain during chemotherapy.

      Abstract

      Background

      Pain experience is one of the most common symptoms of women with breast cancer receiving chemotherapy. It may cause physical and psychological problems and interfere with the treatment process.

      Aims

      This study aimed to examine the relationship between depression, stress, resilience and spirituality on the pain symptoms of breast cancer patients during chemotherapy and explore the potential mediating role of mindfulness in this association.

      Method

      Two hundred and forty women with breast cancer receiving chemotherapy from Shiraz University Hospital, were selected and evaluated by a purposive sampling method. The research instruments were Perceived Stress Scale, Beck Depression Questionnaire-2, Mindfulness, Resilience, Spirituality and Pain Questionnaires. The obtained data was analyzed by SPSS software and MPLUS using Spearman correlation coefficient and path analysis.

      Results

      Based on the findings of direct path analysis, depression, stress, and spirituality showed a significant relationship with mindfulness, but resilience had no significant relationship with mindfulness (p < 0.01). Furthermore, depression, stress, resilience, and mindfulness showed a significant relationship with pain, while spirituality had no significant relationship with pain (p < 0.01). Finally, indirect path analysis revealed mindfulness is a significant mediator of stress and pain (p < 0.05).

      Conclusions

      The present study suggested a model can be useful in better understanding of the psychological components affecting pain in breast cancer patients, after and during their treatments. It also provided an effective framework to develop and investigate pain-focused and non-pharmacological interventions.

      Keywords

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      References

        • Asghari P.
        • Roshani K.
        • MehriAdriany M.
        The relationshiP between religious beliefs and oPtimism whit sPiritual health students of Azad university of Ahvaz.
        New Find. Psychol. 2010; 7: 27-39
        • Bair M.J.
        • Robinson R.L.
        • Katon W.
        • Kroenke K.
        Depression and pain comorbidity: a literature review.
        Arch. Intern. Med. 2003; 163: 2433-2445
        • Boing L.
        • Vieira M.d.C.S.
        • Moratelli J.
        • Bergmann A.
        • de Azevedo Guimarães A.C.
        Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy–a systematic review and meta-analysis.
        Maturitas. 2020; 141: 71-81
        • Bower J.E.
        • Crosswell A.D.
        • Stanton A.L.
        • Crespi C.M.
        • Winston D.
        • Arevalo J.
        • Ma J.
        • Cole S.W.
        • Ganz P.A.
        Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial.
        Cancer. 2015; 121: 1231-1240
        • Carlson L.E.
        • Doll R.
        • Stephen J.
        • Faris P.
        • Tamagawa R.
        • Drysdale E.
        • Speca M.
        Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer.
        J. Clin. Oncol. 2013; 31: 3119-3126
        • Cayoun B.
        • Simmons A.
        • Shires A.
        Immediate and lasting chronic pain reduction following a brief self-implemented mindfulness-based interoceptive exposure task: a pilot study.
        Mindfulness. 2020; 11: 112-124
        • Chaar E.A.
        • Hallit S.
        • Hajj A.
        • Aaraj R.
        • Kattan J.
        • Jabbour H.
        • Khabbaz L.R.
        Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study.
        Support. Care Cancer. 2018; 26: 2581-2590
        • Chinh K.
        • Secinti E.
        • Johns S.A.
        • Hirsh A.T.
        • Miller K.D.
        • Schneider B.
        • Storniolo A.M.
        • Mina L.
        • Newton E.V.
        • Champion V.L.
        Relations of mindfulness and illness acceptance with psychosocial functioning in patients with metastatic breast cancer and caregivers.
        Oncol. Nurs. Forum 47, 739-752. 2020;
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J. Health Soc. Behav. 1983; 24
        • Connor K.M.
        • Davidson J.R.
        Development of a new resilience scale: the Connor‐Davidson resilience scale (CD‐RISC).
        Depress. Anxiety. 2003; 18: 76-82
        • Costa W.A.
        • Monteiro M.N.
        • Queiroz J.F.
        • Gonçalves A.K.
        Pain and quality of life in breast cancer patients.
        Clinics. 2017; 72: 758-763
        • Covic T.
        • Adamson B.
        • Spencer D.
        • Howe G.
        A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study.
        Rheumatology. 2003; 42: 1287-1294
        • Durán A.
        • Extremera N.
        • Rey L.
        • Fernández-Berrocal P.
        • Montalbán F.M.
        Predicting academic burnout and engagement in educational settings: Assessing the incremental validity of perceived emotional intelligence beyond perceived stress and general self-efficacy.
        Psicothema. 2006; 18: 158-164
        • Ellison C.W.
        • Smith J.
        Toward an integrative measure of health and well-being.
        J. Psychol. Theol. 1991; 19: 35-45
        • Flanigan M.
        • Wyatt G.
        • Lehto R.
        Spiritual perspectives on pain in advanced breast cancer: a scoping review.
        Pain Manag. Nurs. 2019; 20: 432-443
        • Fong T.C.
        • Ho R.T.
        Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: a moderated mediation analysis.
        Psycho Oncol. 2020; 29: 894-901
        • Gabriel I.
        • Creedy D.
        • Coyne E.
        Quality of life and associated factors among adults living with cancer and their family caregivers.
        Nurs. Health Sci. 2021; 23: 419-429
        • Ikeuchi K.
        • Ishiguro H.
        • Nakamura Y.
        • Izawa T.
        • Shinkura N.
        • Nin K.
        The relation between mindfulness and the fatigue of women with breast cancer: path analysis.
        Biopsychosoc. Med. 2020; 14: 1-9
        • Invernizzi M.
        • de Sire A.
        • Venetis K.
        • Cigna E.
        • Carda S.
        • Borg M.
        • Cisari C.
        • Fusco N.
        Quality of Life interventions in breast cancer survivors: state of the art in targeted rehabilitation strategies.
        Anti Cancer Agents Med. Chem. 2022; 22: 801-810
        • Jo S.A.
        • Park M.H.
        • Jo I.
        • Ryu S.H.
        • Han C.
        Usefulness of Beck depression inventory (BDI) in the Korean elderly population.
        Int. J. Geriatr. Psychiatr. 2007; 22: 218-223
        • Kamijo Y.
        • Miyamura T.
        Spirituality and associated factors among cancer patients undergoing chemotherapy.
        Jpn. J. Nurs. Sci. 2020; 17e12276
        • Langford D.J.
        • Eaton L.
        • Kober K.M.
        • Paul S.M.
        • Cooper B.A.
        • Hammer M.J.
        • Conley Y.P.
        • Wright F.
        • Dunn L.B.
        • Levine J.D.
        A high stress profile is associated with severe pain in oncology patients receiving chemotherapy.
        Eur. J. Oncol. Nurs. 2022; 58102135
        • Langford D.J.
        • Paul S.M.
        • Cooper B.
        • Kober K.M.
        • Mastick J.
        • Melisko M.
        • Levine J.D.
        • Wright F.
        • Hammer M.J.
        • Cartwright F.
        Comparison of subgroups of breast cancer patients on pain and co-occurring symptoms following chemotherapy.
        Support. Care Cancer. 2016; 24: 605-614
        • Leung L.
        • Han H.
        • Martin M.
        • Kotecha J.
        Mindfulness-based stress reduction (MBSR) as sole intervention for non-somatisation chronic non-cancer pain (CNCP): protocol for a systematic review and meta-analysis of randomised controlled trials.
        BMJ Open. 2015; 5e007650
        • Li X.-M.
        • Xiao W.-H.
        • Yang P.
        • Zhao H.-X.
        Psychological distress and cancer pain: results from a controlled cross-sectional survey in China.
        Sci. Rep. 2017; 7: 1-9
        • Liesto S.
        • Sipilä R.
        • Aho T.
        • Harno H.
        • Hietanen M.
        • Kalso E.
        Psychological resilience associates with pain experience in women treated for breast cancer.
        Scandinavian J. Pain. 2020; 20: 545-553
        • Lindsay E.K.
        • Creswell J.D.
        Mechanisms of mindfulness training: monitor and acceptance theory (MAT).
        Clin. Psychol. Rev. 2017; 51: 48-59
        • Macía P.
        • Barranco M.
        • Gorbeña S.
        • Iraurgi I.
        Expression of resilience, coping and quality of life in people with cancer.
        PLoS One. 2020; 15e0236572
        • Majedi H.
        • Dehghani S.S.
        • Soleyman-Jahi S.
        • Meibodi S.A.E.
        • Mireskandari S.M.
        • Hajiaghababaei M.
        • Tafakhori A.
        • Mendoza T.R.
        • Cleeland C.S.
        Validation of the Persian version of the brief pain inventory (BPI-P) in chronic pain patients.
        J. Pain Symptom Manag. 2017; 54 (e132): 132-138
        • Melzack R.
        Pain–an overview.
        Acta Anaesthesiol. Scand. 1999; 43: 880-884
        • Michaelides A.
        • Zis P.
        Depression, anxiety and acute pain: links and management challenges.
        PGM (Postgrad. Med.). 2019; 131: 438-444
        • Nijs J.
        • Wijma A.J.
        • Leysen L.
        • Pas R.
        • Willaert W.
        • Hoelen W.
        • Ickmans K.
        • van Wilgen C.P.
        Explaining pain following cancer: a practical guide for clinicians.
        Braz. J. Phys. Ther. 2019; 23: 367-377
        • Olsson Möller U.
        • Beck I.
        • Rydén L.
        • Malmström M.
        A comprehensive approach to rehabilitation interventions following breast cancer treatment-a systematic review of systematic reviews.
        BMC Cancer. 2019; 19: 1-20
        • Opsomer S.
        • Lauwerier E.
        • De Lepeleire J.
        • Pype P.
        Resilience in advanced cancer caregiving. A systematic review and meta-synthesis.
        Palliat. Med. 2022; 36: 44-58
        • Park S.
        • Sato Y.
        • Takita Y.
        • Tamura N.
        • Ninomiya A.
        • Kosugi T.
        • Sado M.
        • Nakagawa A.
        • Takahashi M.
        • Hayashida T.
        Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer—a randomized controlled trial.
        J. Pain Symptom Manag. 2020; 60: 381-389
        • Safaei M.
        • Shokri O.
        Assessing Stress in Cancer Patients: Factorial Validity of the Perceived Stress Scale in Iran.
        2014
        • Sharif S.P.
        • Lehto R.H.
        • Amiri M.
        • Ahadzadeh A.S.
        • Nia H.S.
        • Haghdoost A.A.
        • Fomani F.K.
        • Goudarzian A.H.
        Spirituality and quality of life in women with breast cancer: the role of hope and educational attainment.
        Palliat. Support Care. 2021; 19: 55-61
        • Shergill Y.
        • Rice D.B.
        • Khoo E.-L.
        • Jarvis V.
        • Zhang T.
        • Taljaard M.
        • Wilson K.G.
        • Romanow H.
        • Glynn B.
        • Small R.
        Mindfulness-based Stress Reduction in Breast Cancer Survivors with Chronic Neuropathic Pain: a Randomized Controlled Trial.
        Pain Res Manag, 2022 (2022:4020550)
        • Smith A.
        • Leeming A.
        • Fang Z.
        • Hatchard T.
        • Mioduszewski O.
        • Schneider M.
        • Ferdossifard A.
        • Shergill Y.
        • Khoo E.
        • Poulin P.
        Mindfulness-based stress reduction alters brain activity for breast cancer survivors with chronic neuropathic pain: preliminary evidence from resting-state fMRI.
        J. Cancer Surviv. 2021; 15: 518-525
        • Sung H.
        • Ferlay J.
        • Siegel R.L.
        • Laversanne M.
        • Soerjomataram I.
        • Jemal A.
        • Bray F.
        Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA A Cancer J. Clin. 2021; 71: 209-249
        • Tamura S.
        Factors related to resilience, anxiety/depression, and quality of life in patients with colorectal cancer undergoing chemotherapy in Japan.
        Asia-Pacif. J. Oncol. Nurs. 2021; 8: 393-402
        • Tatrow K.
        • Montgomery G.H.
        Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis.
        J. Behav. Med. 2006; 29: 17-27
        • Toivonen K.
        • Charalambous A.
        • Suhonen R.
        Supporting spirituality in the care of older people living with dementia: a hermeneutic phenomenological inquiry into nurses' experiences.
        Scand. J. Caring Sci. 2018; 32: 880-888
        • Toledo G.
        • Ochoa C.Y.
        • Farias A.J.
        Religion and spirituality: their role in the psychosocial adjustment to breast cancer and subsequent symptom management of adjuvant endocrine therapy.
        Support. Care Cancer. 2021; 29: 3017-3024
        • Tomfohr L.M.
        • Pung M.A.
        • Mills P.J.
        • Edwards K.
        Trait mindfulness is associated with blood pressure and interleukin-6: exploring interactions among subscales of the Five Facet Mindfulness Questionnaire to better understand relationships between mindfulness and health.
        J. Behav. Med. 2015; 38: 28-38
        • Vakilzadeh P.
        • Nakhaee N.
        The reliability and validity of the Persian version of the brief pain inventory in cancer patients.
        J. Rafsanjan Univ. Med. Sci. 2006; 5: 253-258
        • Van den Beuken-van Everdingen M.
        • De Rijke J.
        • Kessels A.
        • Schouten H.
        • Van Kleef M.
        • Patijn J.
        Prevalence of pain in patients with cancer: a systematic review of the past 40 years.
        Ann. Oncol. 2007; 18: 1437-1449
        • Variawa M.L.
        • Scribante J.
        • Perrie H.
        • Chetty S.
        The prevalence of chronic postmastectomy pain syndrome in female breast cancer survivors.
        South. Afr. J. Anaesth. Analg. 2016; 22: 14-19
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
        Pain. 2000; 85: 317-332
        • Waddell G.
        Biopsychosocial analysis of low back pain.
        Bailliere. Clin. Rheumatol. 1992; 6: 523-557
        • Walach H.
        • Buchheld N.
        • Buttenmüller V.
        • Kleinknecht N.
        • Schmidt S.
        Measuring mindfulness—the Freiburg mindfulness inventory (FMI).
        Pers. Indiv. Differ. 2006; 40: 1543-1555
        • Westland J.C.
        Lower bounds on sample size in structural equation modeling.
        Electron. Commer. Res. Appl. 2010; 9: 476-487
        • Würtzen H.
        • Dalton S.O.
        • Elsass P.
        • Sumbundu A.D.
        • Steding-Jensen M.
        • Karlsen R.V.
        • Andersen K.K.
        • Flyger H.L.
        • Pedersen A.E.
        • Johansen C.
        Mindfulness significantly reduces self-reported levels of anxiety and depression: results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer.
        Eur. J. Cancer. 2013; 49: 1365-1373