Abstract PD6-03: Pilot project assessing the impact of self-care techniques on post-surgical pain, fatigue, and inflammation

Abstract

Abstract More than one third of women diagnosed with breast cancer experience significant emotional distress, which may then effect pain perception, wound healing, quality of life (QOL), and return to physical function. Several studies have shown that physical and cognitive relaxation strategies may relieve perioperative anxiety, leading to improved postoperative pain and QOL. One hundred women from Brooke Army Medical Center with non-metastatic breast cancer, planning to undergo surgery as initial treatment, were randomly assigned using an intention-to-treat model to either the treatment as usual group (TAU; n = 49) or TAU plus a self-care toolkit (SCT; n=51). The SCT included audio-recordings of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis), an acupressure anti-nausea wristband, and a workbook with instructions for use of the tools plus a section to journal the cancer experience. Pain, anxiety, nausea, sleep, fatigue, global health, and QOL were assessed using the Defense and Veterans Pain Rating Scale (DVPRS), the 10-cm Visual Analog Scale (VAS), and the NIH PROMIS-57 subscales. Data was collected at baseline (T1), immediately prior to surgery (T2), within 10 hours post-operatively (T3), and approximately two weeks post-surgery (T4). Two inflammatory blood markers (ESR and CRP) were measured at T1, T2, and T4. Due to diurnal variability of ESR and CRP, laboratory draws were generally collected prior to 10:00 AM. Categorical variables and frequency counts were analyzed using Chi-Squared or Fisher's Exact tests, whichever was most appropriate. Means and standard deviations were used as summary statistics for continuous variables and analyzed using Student's t-test, ANOVA, and/or Wilcoxon's Test. For data measured at two time points, the delta change in values was calculated to detect within-group differences in SCT and TAU using Wilcoxon's rank sum test or paired t-test. For factors measured at more than two time points, a two-way repeated measures ANOVA was implemented with a Bonferroni corrected post-hoc analysis to determine between-group differences at each time point. Between T1 and T4, there were significant between group differences in PROMIS-57 scores of Pain Interference, Fatigue, and Satisfaction With Social Roles, favoring the SCT group compared to TAU (p=0.005, p=0.023, and p=0.021, respectively). There was a significant mean change in DVPRS scores from T2 to T3, with the SCT group having significantly smaller increases in post-operative pain (p=0.008) and in post-operative ESR (p=0.0197) compared with the TAU group. Clinically significant reductions in anxiety occurred in the SCT group during the main intervention period. These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government. Citation Format: Setlik RF, Inman A, Peacock K, Aden J, Paat C, Stoerkel E, Bellanti D, Walter J. Pilot project assessing the impact of self-care techniques on post-surgical pain, fatigue, and inflammation [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-03.