• Kawther Ismail Hamash, Wendy Umberger, Aynur Aktas, Declan Walsh, and Vinay K Cheruvu.
• From the Nursing Department, Indiana University-Fort Wayne (IUFW), Fort Wayne, IN, USA. Electronic address: Khamash@iu.edu.
• Pain Manag Nurs. 2018 Dec 1; 19 (6): 627-636.

BackgroundPain, depression, anxiety, sleep disturbances, and constipation were reported in different symptom clusters at different stages of breast cancer. Managing symptom clusters rather than individual symptoms can improve performance status.AimThe study examined the effect of pain symptom cluster (pain and constipation) on performance when mediated by the psychoneurological symptom cluster (depression, anxiety, and sleep disturbances) using age as a moderator.DesignA secondary analysis.SettingsPalliative care center at a tertiary medical center in northeast Ohio.ParticipantsEighty-six women diagnosed with advanced breast cancer.MethodA quantitative cross-sectional approach.ResultsOrdinal logistic regression showed that pain symptom cluster did not have a significant mediation effect on performance. Odds ratio indicated that subjects with pain symptom cluster were 63% more likely to be bedridden (odds ratio = 1.63, confidence interval = .69-3.84). Women who reported pain symptom cluster were 5% more likely to have psychoneurological symptom cluster (odds ratio = 1.05, confidence interval = .400-2.774). Stratified analysis of age showed no differences in performance. Post-hoc analysis showed that the components of pain symptom cluster had a significant effect on psychoneurological symptom cluster (odds ratio: 3 [1.18-7.62]).ConclusionsPain, constipation, depression, anxiety, and sleep disturbances were highly prevalent in women with advanced breast cancer. However, they tended to cluster in different symptom clusters. Although some findings were not significant, they all supported the direction of the tested hypotheses. Variations in symptom clusters research, including methodology, instruments, statistical tests, and chosen symptom cluster correlation coefficient, should be addressed.Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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