Dynamic screening for anxiety and depression in patients undergoing primary surgery for gastrointestinal cancer.

INTRODUCTION

Anxiety and depression are persistent problems among patients with gastrointestinal (GI) cancers.

AIM: This study aimed to evaluate the efficacy of time-dynamic screening for anxiety and depression in patients undergoing primary surgery for GI cancers.

MATERIALS AND

METHODS

A total of 876 individuals were reviewed. The patients who underwent dynamic screening for anxiety and depression were selected as the screening cohort. A 1:1 propensity-score matching was performed for the controls. The primary end point was 1-year disease-free survival (DFS). Secondary outcomes included inflammatory cytokine levels, leukocyte counts, and scores from the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 item (GAD-7), and the 5-level European Quality of Life Five-dimension (EQ-5D-5L) assessment.

RESULTS

One-year DFS was higher among the screening cohort than the controls (91.4% vs 81.2%; P <⁠0.001). The levels of anxiety and depression decreased over time in the screening cohort, with lower mean (SD) PHQ-9 scores of 8.19 (1.32) 1 month postoperatively and 6.9 (1.33) at 3-month follow-up (P <⁠0.001), and lower mean (SD) GAD-7 scores of 7.73 (3.94) 1 month after surgery and 5.01 (3.31) 3 months postoperatively (P <⁠0.001), as compared with the controls. At 3 months postsurgery, the screening cohort showed better outcomes than the controls in terms of the levels of interleukin-6 (P = 0.003) and tumor necrosis factor α (P <⁠0.001), as well as the CD3+ cell count (P = 0.02), CD4+/CD8+ ratio (P = 0.02), and natural killer cell count (P = 0.006). The patients undergoing screening exhibited greater improvements in the EQ-5D-5L scores over time than the controls (P <⁠0.001). Minor adverse events were observed in 8.2% of the screening cohort.

CONCLUSIONS

Time-dynamic screening for GI cancers effectively reduces anxiety and depression after surgery, improves immune function, and enhances quality of life, thus contributing to a better prognosis at 1 year follow-up.