Perioperative Psychosocial Stressors and Their Short-Term Impact on Patients Undergoing Major Cancer Surgery Samantha Donovan, Shruti Koti, & Gary Deutsch, MD, MPH Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Background • A new cancer diagnosis + surgery are extremely traumatic stressors à together they can evoke considerable emotional reactions.
Figure 1. Patient Information
Summary/Conclusions
2 9
Men
Robotic
Women
• The relationship between these psychological factors and their impact on overall recovery is poorly understood, especially in surgical oncology.
6 10
11
14
Open
• 26.1% screen positive for major depression
Cancer Type
Surgical Approach
Gender
• Patients with high preoperative emotional stress à higher postoperative pain levels.1
Aim: To further elicit the effects of psychosocial stressors on outcomes in surgical oncology patients in order to potentially intervene during the preoperative period.
Results
• 27% in patients with adult cancer in the 1st year after diagnosis.6 • Prevalence of depression among US adults in 2017 was 7.1%.3
9
• 13.1% screen positive for anxiety disorder
8
Laparoscopic
GAD7 Outcomes
Upper GI
Hepatobiliary
Misc
PHQ9 Outcomes
13%
• Lower than previously published data - 37.2% in patients with gastrointestinal cancer at time of diagnosis.7 • Prevalence of anxiety among US adults in 2017 was 18.1%.6
• Average quality of life was rated at 83.85 out of a possible 108 (FACT-G).
26% 74%
87% GAD7>10
GAD7<10
PHQ>10
Quality of life (FACT-G) was inversely proportional with length of stay (p=0.017).
PHQ<10
Figure 2. Higher quality of life leads to shorter post-operative hospital stays
No significant difference between patients who screened positive on PHQ-9/GAD-7 and surgical outcome parameters.
Quality of Life Score Predicts Length of Stay
9 8
Surgical oncology patients who score higher on the FACT-G will have shorter length of stay, less days of IV analgesic use and less complications than patients who score lower on the FACT-G.
Days
Hypothesis
N=20
7 6
Pearson P-Value Correlation -.268 .126
Days of IV Analgesic Use # of -.213 Complications Length of stay -.477
5 4 3
R² = 0.2275
60
80
100
120
FACTG Score
Methods • Prospectively collected, retrospectively reviewed pilot study • January to March 2020 • Inclusion criteria • Malignant diagnosis • Abdominal surgery • Complete psychosocial stressor assessment forms
• Psychosocial assessments via self-report questionnaire.
• Patient Health Questionnaire-9 (PHQ-9)2, Generalized Anxiety Disorder Assessment-7 (GAD-7)3, and Functional Assessment of Cancer Therapy-General (FACT-G)4
• Statistical analyses
• Independent samples t-test for positive versus negative screening on PHQ9 • PHQ-9 score of ≥ 10 is used as a cut off point • Independent samples t-test for positive versus negative screening on GAD7 • GAD7 score of ≥ 10 is used as a cut off point • Linear regression to determine the relationship between FACT-G scores & endpoints
.017*
• Repeating the analysis with an increased sample size • Comparing psychosocial scores between pre-COVID19 and peri-COVID19 patient populations
2 40
Future Directions
.184
•
• Following patients over time to see if scores on psychosocial screens predict survival or recurrence rates
Figure 3. Surgical outcomes in patients by psychosocial screening result Outcomes in Surgical Oncology Patients
•
6.65
7
6.25
6
5.67
4.83
5 4 3 2
2.9
2.3
1.
2.9 2 1
1
1
1
1
0 Days of IV Analgesic
PHQ9 ≥ 10
# of Complications
PHQ9 < 10
GAD7 ≥ 10
Length of Stay
GAD7 < 10
Does the COVID19 pandemic increase the average PHQ9 / GAD7 score or quality of life scores in surgical oncology patients?
Is depression and anxiety linked to poorer long-term mortality in surgical oncology patients?
Resources
Wolmeister, A. S., Schiavo, C. L., Nazário, K. C. K., Castro, S. M. D. J., Souza, A. D., Caetani, R. P., … Stefani, L. C. (2020). The Brief Measure of Emotional Preoperative Stress (BMEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study. Plos One, 15(1). doi: 10.1371/journal.pone.0227441 2. PHQ-9 (Patient Health Questionnaire-9). (n.d.). Retrieved October 02, 2020, from https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 3. GAD-7 (General Anxiety Disorder-7). (n.d.). Retrieved October 02, 2020, from https://www.mdcalc.com/gad-7-general-anxiety-disorder-7 4. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993 Mar;11(3):570-9. doi: 10.1200/JCO.1993.11.3.570. PMID: 8445433. 5. Krebber AM, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121-130. doi:10.1002/pon.3409 6. Major Depression. (n.d.). Retrieved September 26, 2020, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml 7. Sun C, Zhou Y, Wang D, Chen D, Li Y, Chao S, Jiao X. [Impact of depression and anxiety assessment performed in gastrointestinal cancer patients on postoperative depression and anxiety symptom and mental health service visit]. Zhonghua Wei Chang Wai Ke Za Zhi. 2016 May;19(5):571-4. Chinese. PMID: 27215529. 8. Chang, T.-S., Hou, S.-J., Su, Y.-C., Chen, L.-F., Ho, H.-C., Lee, M.-S., … Lee, C.-C. (2013). Disparities in Oral Cancer Survival among Mentally Ill Patients. PLoS ONE, 8(8). doi: 10.1371/journal.pone.0070883 9. Demyttenaere, K., Reed, C., Quail, D., Bauer, M., Dantchev, N., Montejo, A., … Grassi, L. (2010). Presence and predictors of pain in depression: Results from the FINDER study. Journal of Affective Disorders, 125(1-3), 53–60. doi: 10.1016/j.jad.2010.02.106 10. Haun MW, Estel S, Rücker G, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017;6(6):CD011129. Published 2017 Jun 12. doi:10.1002/14651858.CD011129.pub2