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Complex symptom burden and management related to multimodality cancer treatment

4043 - EONS session: When symptom complexity is the norm: a mediation analysis between pain, anxiety, depression and fatigue


22 Oct 2018


Complex symptom burden and management related to multimodality cancer treatment


Supportive Care and Symptom Management;  End-of-Life Care;  Psychosocial Aspects of Cancer

Tumour Site


Andreas Charalambous


Annals of Oncology (2018) 29 (suppl_8): viii698-viii701. 10.1093/annonc/mdy278


A. Charalambous

Author affiliations

  • Nursing Science, Cyprus University of Technology - Nursing Science, 3041 - Limassol/CY


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Abstract 4043


The treatment phase for cancer is a particularly stressful period for the patient. The patient frequently experiences simultaneously various somatic and psychological 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 interrelations between pain, anxiety, depression and fatigue in patients diagnosed with breast and prostate cancer.


Data used for the analysis came from patients (n = 208) recruited in 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 meditational model of Anxiety, Fatigue and Depression as parallel mediators of the relationship between Pain and HRQoL.


The three mediators fully mediate the relationship between Pain and HRQoL (IEoverall=-0.3839, 95% C.I.: LL=-0.5073, UL=-0.2825) indicating that patients with increased Pain are more likely to have higher levels of Anxiety, Fatigue and Depression. Gender significantly moderated the mediational effect of Fatigue (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 (IEoverall=-0.384, 95% C.I.: LL=-0.51, UL=-0.284) and the ratio of the overall indirect effect to the total effect, is 0.8315 (95% CI: LL = 0.5683, UL = 1.1718).


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 cancer and prostate cancer.

Clinical trial identification


Legal entity responsible for the study

Cyprus University of Technology.


Cyprus University of Technology.

Editorial Acknowledgement



The author has declared no conflicts of interest.

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