Longitudinal Analysis of Mental Disorder Burden Among Elderly Patients With Gastrointestinal Malignancies

Exergame-based rehabilitation for cancer patients undergoing abdominal surgery: Effects on pain, anxiety, depression, and fatigue - A pilot study

PURPOSE

This study aimed to determine the efficacy of an exergame rehabilitation program on pain, anxiety or depression, and fatigue in oncology patients undergoing abdominal surgery.

METHODS

The randomized controlled trial evaluated the efficacy of exergame rehabilitation on Pain, Anxiety, Depression, and Fatigue in oncology patients undergoing abdominal surgery. Patients were recruited from October 2022-March 2023 and were randomly assigned to the intervention group (postoperative traditional rehabilitation plus an exergame rehabilitation program) or control group (postoperative traditional rehabilitation). Data were collected at three different times: on admission, in the first 48 h, and on the 7th day after surgery. Primary outcomes were evaluated and monitored with different validated instruments: numeric rating scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS) to assess the level of anxiety and depression, and the Fatigue Assessment Scale (FAS) to assess physical and psychological fatigue. The length of stay and program completion were secondary outcomes.

RESULTS

A total of 128 postoperative patients were recruited. Of these, 58 patients were excluded from the study due to clinical complications related to the surgical procedure (n = 53) or healthcare staff-related reasons (n = 5). Both the control and intervention groups were the same size (n = 35). Lower pain scores were observed on the 7th postoperative day in the group subject to the "exergame rehabilitation program" (p = 0.006). No statistically significant differences were observed for anxiety and depression between the 2 groups. Regarding fatigue, statistically significant differences were observed on admission (p = 0.03), which disappeared 48 h after surgery (p = 0.143). Differences between the groups were observed again on the 7th day after surgery (p = 0.005).

CONCLUSIONS

The intervention using exergames was effective in reducing the postoperative pain of the patient undergoing major abdominal surgery and in restoring the levels of fatigue before surgical intervention. However, no differences were observed for anxiety or depression. Future studies with larger samples should be carried out.

Factors associated with radiological misstaging of pancreatic ductal adenocarcinoma: A retrospective observational study

PURPOSE

Accurate staging of disease is vital in determining appropriate care for patients with pancreatic ductal adenocarcinoma (PDAC). It has been shown that the quality of scans and the experience of a radiologist can impact computed tomography (CT) based assessment of disease. The aim of the current study was to evaluate the impact of the rereading of outside hospital (OH) CT by an expert radiologist and a repeat pancreatic protocol CT (PPCT) on staging of disease.

METHODS

Patients evaluated at the our institute's pancreatic multidisciplinary clinic (2006 to 2014) with OH scan and repeat PPCT performed within 30 days were included. In-house radiologists staged disease using OH scans and repeat PPCT, and factors associated with misstaging were determined.

RESULTS

The study included 100 patients, with a median time between OH scan and PPCT of 19 days (IQR: 13-23 days.) Stage migration was mostly accounted for by upstaging of disease (58.8 % to 83.3 %) in all comparison groups. When OH scans were rereviewed, 21.5 % of the misstaging was due to missed metastases, however, when rereads were compared to the PPCT, occult metastases accounted for the majority of misstaged patients (62.5 %). Potential factors associated with misstaging were primarily related to imaging technique.

CONCLUSION

A repeat PPCT results in increased detection of metastatic disease that rereviews of OH scans may otherwise miss. Accessible insurance coverage for repeat PPCT imaging even within 30 days of an OH scan could help optimize delivery of care and alleviate burdens associated with misstaging.

Influence of reminiscence therapy on mental health and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer

Reminiscence therapy (RT) attenuates psychological disorders in cancer patients. This study aimed to evaluate the effect of RT on anxiety, depression, spiritual well-being, and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer. A total of 222 elderly patients with unresectable, metastatic gastrointestinal cancer were randomized into RT group (RT plus usual care, n=112) or control group (usual care, n=110) with a 6-month intervention. Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), and Quality of Life Questionnaire-Core 30 (QLQ-C30) were evaluated at month (M)0, M1, M3, and M6. Concerning the primary outcome, HADS-A score at M6 decreased in the RT group compared to the control group (P=0.005). As to secondary outcomes, the RT group showed decreased HADS-A scores at M3, anxiety rate at M3, HADS-D scores at M3 and M6, depression rate at M6, as well as greater FACIT-Sp scores at M1, M3, and M6 vs the control group (all P<0.050). Additionally, QLQ-C30 global health score was elevated at M1 (P=0.046) and M6 (P=0.005), functions score was greater at M6 (P=0.038), and symptoms score was lower at M3 (P=0.019) in the RT group than in the control group. Subgroup analysis revealed that the addition of RT was more effective for patients with anxiety or depression at baseline. In summary, RT alleviated anxiety and depression, and improved the spiritual well-being and quality of life within 6 months in elderly patients with unresectable, metastatic gastrointestinal cancer.

Anxiety and depression during 3-year follow-up period in postoperative gastrointestinal cancer patients: prevalence, vertical change, risk factors, and prognostic value

BACKGROUND

Anxiety and depression are common issues in gastrointestinal cancer, bringing negative impacts on patients' quality of life and long-term prognosis. This study aimed to identify the prevalence, longitudinal variation, risk factors, and prognostic value of anxiety and depression in postoperative gastrointestinal cancer patients.

METHODS

A total of 320 gastrointestinal cancer patients after surgical resection (210 colorectal cancer (CRC) patients and 110 gastric cancer (GC) patients) were enrolled in this study. During the 3-year follow-up period, Hospital Anxiety and Depression Scale (HADS)-anxiety (HADS-A) and HADS-depression (HADS-D) scores were determined at baseline, 12th month (M12), 24th month (M24), and 36th month (M36).

RESULTS

The prevalence of anxiety and depression at baseline was 39.7% and 33.4% in postoperative gastrointestinal cancer patients, respectively. Female (vs. male), single/divorced/widowed (vs. married), CRC (vs. GC), hypertension, higher TNM stage, neoadjuvant chemotherapy, and postoperative complications were independent risk factors of anxiety or depression in patients with gastrointestinal cancer (all P < 0.050). Furthermore, anxiety (P = 0.014) and depression (P < 0.001) were associated with shortened overall survival (OS); after further adjustment, depression was independently linked with shortened OS (P < 0.001), while anxiety was not. During the follow-up period, HADS-A score (from 7.78 ± 3.180 to 8.57 ± 2.854, P < 0.001), HADS-D score (from 7.23 ± 2.711 to 8.01 ± 2.786, P < 0.001), anxiety rate (from 39.7 to 49.2%, P = 0.019), and depression rate (from 33.4 to 42.6%, P = 0.023) were all gradually increased from baseline to M36.

CONCLUSION

Anxiety and depression gradually exacerbate and relate to poor survival in postoperative gastrointestinal cancer patients.

Effect Evaluation of Comfort Nursing Materials Assisted Nursing for Patients with Advanced Malignant Tumor

In order to explore the effect of comfort care on patients with advanced malignant tumors assisted by bioceramics, 82 patients with advanced malignant tumors admitted to a cancer hospital were selected as the research object control group: 26 males and 15 females and the observation group: 25 males and 16 females. The control group was given routine care, and the observation group was given comfort care on the basis of the control group. The quality of life (QLQ-C30 functional scale) and nursing satisfaction before and after nursing were compared between the two groups. The results of the study indicate that after care, the physical, role, emotional, cognitive, social, general health, and symptom scores of the observation group were significantly higher than those of the control group, the nursing satisfaction degree of the observation group was 97.56%, which was significantly higher than that of the control group of 82.93%, and the difference was statistically significant (P < 0.05). Comfortable care has a definite effect on the care of patients with advanced malignant tumors; it can improve the overall comfort and satisfaction of patients, effectively reduce adverse events, and improve the quality of life of patients.