Effectiveness of group cognitive behaviour theraphy pre-mastectomy in reducing postoperative pain among newly diagnosed breast cancer patients in a public hospital in Malaysia

Cancer is one of the leading causes of death worldwide. The increasing trend of cancer cases is evident in Malaysia. The Malaysian National Cancer Registry reported breast cancer is the most common type for females where one in eight Malaysian women is likely to be diagnosed with breast cancer by the age of 75. The first line of treatment for breast cancer is surgery and postoperative pain is one of the side effects. Majority of breast cancer patients find the diagnosis terminal the most stressful experience in their lifetime. Stress may emanate from misperception about cancer treatment and lack of skills to be holistically prepared before undergoing treatment. The objectives of the present study were to develop an intervention plan of Group Cognitive Behaviour Therapy (CBT), implement it and evaluate its effectiveness on newly diagnosed breast cancer patients. This a single randomized controlled trial executed under Surgical and Outpatient clinic in Hospital Kuala Lumpur with a total of 70 newly diagnosed breast cancer patients. The patients who met specific inclusion criteria and consented to join the study, were randomly allocated to either intervention Group CBT or wait-list control group Treatment as Usual (TAU). The Group CBT comprises four sessions with targeted psychological skills, and information was implemented preoperatively. The evaluation of effectiveness on the intervention was observed on postoperative pain as primary outcome at six timepoints include baseline, immediate postoperation on first, second, and third day, postoperation first and third month follow-up. The evaluation on intervention effect for secondary outcomes include anxiety and depressive symptoms, pain catastrophizing and surgical fear, were observed at four timepoints include baseline, immediate postoperation third day, postoperation first month and third month follow-up. The measures used in the study were validated and pre-tested among breast cancer survivors. Data analyses were performed using SPSS independent t-test and chi square tests to compare sociodemographic and clinical characteristics at baseline. Two-way repeated measures ANOVA tests were reported in the significance of p-value less than 0.05 and effect size by Cohen’s d guide to indicate the effectiveness of the intervention. The findings in the present study revealed a significant reduction in Postoperative pain score across time points until postoperation third-month follow-up, with a small effect size (p= 0.0001, ηp2 = 0.250). The Group CBT was also impactful in reducing Anxiety symptoms with large effect size (p= 0.0001, ηp2 = 0.870), Depressive symptoms (p= 0.0001, ηp2 = 0.745) with medium effect size, Pain catastrophizing (p= 0.0001, ηp2 = 0.764) with medium effect size, and Surgical fear (p= 0.0001, ηp2 = 0.829) with large effect size. There was no significant interaction of group and time for Postoperative pain (p=0.153), whereas interaction effects were observed in anxiety and depressive symptoms, pain catastrophizing and surgical fear. The improved outcomes resemble the effectiveness of Group CBT in reducing postoperative pain as well as psychological states of anxiety and depressive symptoms, pain catastrophizing and surgical fear. This suggests that prior implementation of Group CBT before mastectomy was helpful in preparing patients holistically for optimal postoperative care. The effects, however, were only assessed up to three months following mastectomy.

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