Investigation And Countermeasures On Differences Between Urban And Rural Areas And Anxiety Among Patients Undergoing Colorectal Cancer Surgery

ObjectiveTo investigate demographic information(including sex,age,residence,economic conditions),disease-related characteristics and lifestyle among colorectal cancer patients.To explore risk factors of colorectal cancer,clinical characteristics of patients from urban and rural areas and influencing factors of anxiety and negative emotions,and put forward corresponding measures in prevention,early diagnosis and treatment of colorectal cancer in order to provide a reliable clinical basis.To provide references for colorectal cancer patients in terms of emotional intervention and to improve their surgical outcomes and quality of life.Method317 patients undergoing colorectal cancer surgery were included in the study.This study was conducted in gastrointestinal surgery ward of a tertiary care teaching hospital between January 1,2016 and December 31,2016 in Jinan City.Self-designed questionnaires were used to collect demographic information.Questionnaire of disease-related characteristics was formulated by referring to medical records to collect patients' clinical characteristics.Self-rating Anxiety Scale(SAS)was used to evaluate patients' psychological status,and Social Support Rating Scale(SSRS)was used to assess total social support,objective support,subjective support and supportive utilization of patients.SPSS 19.0 software was used to perform statistical analysis and t test,chi-square test and Spearman correlation analysis were conducted.ResultsThere were 317 patients undergoing colorectal cancer surgery in this study,including 191 patients from urban area and 126 from rural areas in the ratio of 1.52:1.Mean age is 59.67 ± 12.93 years old,ranging 18-89.A majority of patients(148 cases)are between 36 and 60 years old.1.Urban and rural differences among colorectal cancer patients1.1 Demographic information between groups:Rural patients undergoing colorectal cancer surgery are at a younger age(P<0.05).Of which,rural patients under 35 account for 7.10%,while urban patients account for 3.10%.There are statistically significant differences in medical payment,education,occupation and household income in urban and rural areas(P<0.05).The consumption of fresh eggs,fruits,milk and fish in urban patients is higher than their counterparts in rural area(P<0.05).Egg consumption in rural patients is higher than that in urban patients(P<0.05).Urban patients prefer exercise as their hobbies(P<0.05).1.2 Clinical data between groups:There are significant differences in visit time,weight loss,disease awareness,most concerned questions on hospitalization,presence or absence of complications and follow-up treatment between groups(P<0.05)here is no statistically significant difference in operation,pathology and tumor staging between urban and rural areas.But more urban patients are at early tumor stage.2.Anxiety influencing factors in patients with colorectal cancer surgery2.1 Of 317 patients included,58 patients are anxious and 259 are non-anxious.Comparison in general demographic information between groups:67.20%anxious patients are between 36 and 60 years old with non-anxiety patients over 60 years old accounting for 53.90%;Proportion of single and divorced patients in anxiety group is 3.40%separately,and non-anxiety group account for 0.40%.There are significant differences in age and marital status between patients in anxiety and non-anxiety group(P<0.05).No statistically significant difference is showed in medical payment,education,occupation,income and residence between groups.2.2 Comparison in clinical data between groups:Differences in preoperative treatment,disease diagnosis,surgical procedures,underlying diseases and follow-up treatment is statistically significant between anxious and non-anxious patients(P<0.05).There is also no statistically significant difference between groups in pathologic type,tumor stage,postoperative complications and disease awareness.2.3 Logistic regression is performed to determine age,surgical precedures,underlying disease as independen influencing factors for anxiety.3.Comparison in Urban and Rural differences among Anxious Patients with Colorectal Cancer Surgery.3.1 In this study,there are 58 patients with anxiety,including 31 in urban area and 27 in rural area.Comparison in general demographic information between groups:Female anxious patients in urban and rural areas account for 54.80%and 25.90%,respectively(P<0.05).There are statistically significant differences in educational level,occupation and family monthly income between urban and rural patients(P<0.001).Differences in age and marital status between groups are not significant.3.2 Comparison in clinical data between groups:Anxious patients with rectal cancer in urban and rural areas account for 71.00%and 92.60%,repectively.Urban patients pay more attention and learn more about disease awareness than rural patients.Urban patients are most concerned about treatment effect(51.60%),while rural patients concern prognosis and recurrence most(44.40%).There are statistically significant differences in disease diagnosis,illness awareness and most concerned issue(P<0.05).There is no significant difference between groups in basic diseases treatment,surgical procedures,pathological types,tumor stage,preoperative treatment and follow-up treatment(P>0.05).4.Social support for colorectal cancer patients.4.1 The scores of social support,objective support and support utilization are significantly higher among urban patients(P<0.05),while subjective support score is not statistically significant(P>0.05).4.2 The objective support score of urban anxious patients is significantly higher than that of rural patients(P<0.05).There is no significant difference in social support scores,subjective support points and supportive utilization(P>0.05).4.3 The total score and support utilization of the stomatal patients are significantly lower than those of non-stomatal patients(P<0.05).Objective support and subjective support between groups are not statistically significant(P>0.05).4.4 Anxiety scores are negatively correlated with social support scores.Conclusion1.Patients suffer from colorectal cancer at a younger age with a majority of patients between 36 and 60 years old.Rural patients show obvious much younger age tendency.Urban patients have higher income,lead a healthier lifestyle and have better medical behaviors and physical condition than rural patients.There is also higher proportion of urban patients with early stage of tumor staging with better disease awareness than rural patients.2.Age,underlying disease and surgical procedures are independent influencing factors for anxiety among colorectal cancer patients.Patients(aged under 60)with underlying diseases and Ostomy are more vulnerable to anxiety.3.In terms of anxious patients with colorectal cancer between Urban and rural areas,urban women are the majority,and urban patients are better-educated with higher household incomes.Rural anxious patients have higher incidence of rectal cancer than urban patients.They concern disease prognosis and recurrence most,while urban patients pay more attention on treatment effect.4.Social support:Ostomy patients show poor social support.Urban patients obtain better social support,and anxious patients score lower in social support.