| Objective:To investigate the prevalence of depression and anxiety in gastric cancer patients and the association between depressive, anxious symptoms and postoperative short-term outcomes after gastrectomy.Methods:Patients were prospectively recruited from the general surgery department of Qingdao university affiliated hospital from February,2015 to October,2015 with established inclusion and exclusion criteria.PHQ-9 and GAD-7 were used to assess depressive and anxious symptoms pre-operatively. Demographic and clinical variables and information about morbidity and postoperative hospital length of stay were gathered from medical records, through clinic interview and follow-up periods. Unadjusted analysis and multivariate logistic regression were adopted to measure the association between depressive and anxious symptoms and postoperative short-term outcomes, with morbidity within 30 days and prolonged postoperative hospital length of stay as dependent variables and age, BMI, surgical approach, extent of excision etc. as independent variables.Results:A total of 244 among 248 patients with gastric cancer seeking for treatment completed pre-operative PHQ-9 and GAD-7 scale when admitted. The point prevalence of depression was 31.6%, anxiety 42.2%. The proportion of none/mild symptomatology was 68.4%, moderate 18.0%, moderate to severe 8.2%, severe 5.3% for depressive symptoms and none 57.8%, mild 26.2%, moderate to severe 9.8% severe 6.1% for anxious symptoms. Comorbid depression with anxiety was observed in 15.7%(32/204) patients. The correlation between depressive and anxious symptoms was not statistically significant(r=-0.015,p=0.820). 204 patients were included into the final analysis and assigned into depressive group/non depressive group and anxious group/non anxious group respectively. More women, higher ASA classification, longer postoperative hospital length of stay were observed in depressive group in compare with non depressive group, and less women, lower ASA classification and shorter postoperative hospital length of stay were observed in anxious group in compare with non anxious group, but none of these differences was statistically significant. In the unadjusted analysis, surgery with curative-intent(OR, 4.25; 95%Cl, 0.87 to 20.61; p=0.073), total gastrectomy(OR, 3.13; 95%Cl, 1.71 to 5.73; p=0.000) and depressive symptoms(OR, 2.54; 95%Cl, 1.42 to 4.54; p=0.002) were associated with greater odds of morbidity within 30 days while age(OR, 1.03; 95%Cl, 1.00 to 1.06; p=0.033), BMI(OR, 1.11; 95%Cl, 1.01 to 1.21; p=0.036), total gastrectomy(OR, 3.78; 95%Cl, 2.02 to 7.06; p=0.000), multi-organ combined excision(OR, 9.09; 95%Cl, 1.96 to 42.18; p=0.005) and depressive symptoms(OR, 2.13; 95%Cl, 1.18 to 3.86; p=0.012) were associated with prolonged hospital length of stay. After adjusting for age, BMI, extent of excision, multi-organ combined excision and intent of surgery, depressive symptoms still showed an significant association with greater odds of morbidity(OR, 1.55; 95%Cl, 1.08 to 2.23, p=0.017) and prolonged hospital length of stay(OR, 2.15; 95%Cl, 1.09 to 4.24,p=0.028).Conclusion:The prevalence of depression and anxiety is high among patients with gastric cancer. Preoperative depressive symptoms predict adverse short-term outcomes after gastrectomy, including greater risk of morbidity within 30 days and prolonged hospital length of stay. Relevant clinical departments should emphasize the assessment and intervention of psychiatric problems among cancer patients. |
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