Page 67 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Evaluation of biopsychosocial factors

risk of premature mortality in the cancer population as a (BPI), 30-36 and the Short-Form Health Survey 36, version 2
consequence of severe biopsychosocial impairment. (SF-36v2). 37,38
The impact of psychological variables remains a key The HADS evaluates depression and anxiety through
focus of clinical research, largely due to the complexity a total of 14 items, with seven items assessing depression
of oncological pathology. In this context, it is essential (HADS-D) and seven assessing anxiety (HADS-A). Each
to conduct a comprehensive patient assessment using a item is rated on a scale from 0 to 3, with a maximum score
biopsychosocial approach, alongside multimodal therapy. of 21 for both anxiety and depression. Scores between 0
Given these considerations, studies aimed at identifying and 8 indicate no anxiety or depression, while scores above
and quantifying the psychological factors that influence 9 are considered positive for anxiety or depression. Scores
pain perception and affect the overall progression of between 14 and 21 indicate moderate-to-severe anxiety or
the underlying disease can provide valuable insights for depression. 28,29
improving the holistic treatment of cancer patients. The BPI measures pain intensity across two dimensions:
The present study aims to (i) evaluate the role of sensory and reactive. The tool assesses the interference of
self-sufficiency and marital status in the prevalence of pain in the patient’s QoL, as well as the quality of pain,
psychological distress, such as anxiety and depression; the patient’s perception of the pain’s etiology, and pain
(ii) examine the relationship between depression/anxiety relief. The sensory dimension assesses pain intensity or
and mortality; and (iii) assess statistical collinearity severity, while the reactive dimension evaluates how pain
among three questionnaires regarding the dimensions of interferes with daily activities. To capture the variability of
depression and anxiety, pain, and QoL. pain over time, four items were included to measure the
“worst,” “least,” “average,” and “current pain.” In addition,
2. Materials and methods seven items were selected to assess how pain interferes
with ADL, including general activity, walking, work,
2.1. Procedures and participants mood, enjoyment of life, relationships, and sleep. The pain
This article presents a multifactorial, prospective, interference subdimensions were further categorized into
observational, and cross-sectional study following affective and activity-related dimensions. The affective
strengthening the reporting of observational studies in subdimensions are denoted as relationship, enjoyment
epidemiology (STROBE) guidelines and approved by of life, and mood, while the activity subdimensions are
27
the Ethics Committees of both Coimbra Hospital and designated as Walking, Activity (general), and Work. 32,33,36,39
the University of Coimbra, Portugal (Approval Number: The SF-36v2 evaluates QoL through 8 dimensions,
Ref.n.CES-0222). which are grouped into two components: physical health
A total of 120 cancer patients were observed over the (physical function, physical performance, pain, and
course of 1 year at the Portuguese Chronic Pain Unit. general health) and mental health (vitality, social function,
All participants provided written informed consent. The emotional performance, and mental health). Scores for
inclusion criteria of the recruited patients were (i) having each dimension are presented on a scale from 0 (worst
an oncologic pathology; (ii) minimum age: 18 years old; health status) to 100 (best health status). The SF-36 also
(iii) capability to provide informed consent (written or includes a health transition scale that measures changes in
oral); and (iv) capability to provide information to complete general health, scored from 1 (very much better) to 5 (very
the questionnaires. Three questionnaires were completed much worse). 37,38
by the patient or helped by a familiar or healthcare 2.3. Statistical analyses
professional. The data used for all clinical study described
in this article is related to the total of 120 patients. There Data from the validated questionnaires (HADS, BPI, and
®
was a posterior phase of the study that included more SF-36v2) were transferred to the IBM Statistical Package
®
13 patients, in exactly the same conditions and rules, and for the Social Sciences Statistics version 26 and analyzed
those complimentary numbers were used just to reinforce using version 20.0. The statistical analysis was conducted
the collinearity of the questionnaires. with a significance level of 0.05 (P < 0.05).
Spearman’s correlation was used to assess the relationship
2.2. Instruments
between the results of the questionnaires. The correlation
Parameters such as pain, anxiety, depression, ADL, and between the questionnaires and demographic parameters
QoL were assessed using three validated questionnaires was calculated using Pearson’s correlation coefficients
for the Portuguese population: the Hospital Anxiety and (Pcc). A Wilcoxon rank-sum test (Mann-Whitney test) was
Depression Scale (HADS), 28,29 the Brief Pain Inventory performed to examine the relationship between the HADS

Volume 3 Issue 2 (2025) 61 doi: 10.36922/jcbp.4097