Preoperative Uncertainty And Its Influencing Factors In Patients With Esophageal Cancer

Esophageal Cancer(EC)is one of the common gastrointestinal malignant tumors in clinic,which is featured with low five-year survival rate and high recurrence rate posing a serious threat to human health.So far,surgery is the main treatment for esophageal cancer.However,large number of studies at home and abroad has shown that the high level of perioperative uncertainty in illness of cancer patients can cause anxiety,depression and other negative emotions.Thus,the recovery process could be influenced due to impaired clinical decision-making and low follow-up compliance of patients.Besides,most of the present studies on disease uncertainty in esophageal cancer patients focus on postoperative and chemoradiotherapy,while there are few studies on preoperative uncertainty,and its level remains unclear.Therefore,this study investigated the status quo of preoperative disease uncertainty in patients with esophageal cancer in the department of thoracic Surgery of The Affiliated Hospital of North Sichuan Medical College and analyzed its influencing factors.The results could be evidence for clinical medical staff in guidance on reducing preoperative disease uncertainty,relieving patients’ anxiety,depression and other adverse emotions,and promoting patients’ postoperative rehabilitation.Objective:To investigate preoperative uncertainty in illness,social support and the present situation of anxiety of esophageal cancer patients,explore the correlation between uncertainty and social support,anxiety level,and analyze influencing factors of preoperative uncertainty so that to reduce the preoperative uncertainty in esophageal cancer patients,improve the patients’social support,and provide guidance for alleviating patients’ anxiety and other adverse emotions.Methods:Convenience sampling method was used to select patients underwent esophageal cancer resection in the Department of Thoracic Surgery of The Affiliated Hospital of North Sichuan Medical College from April 2021 to November 2021 as the study subjects,and face-to-face questionnaire survey was conducted among the patients meeting the inclusion criteria.The survey tools included general data questionnaire,Adult Disease Uncertainty Scale,self-rating anxiety Scale and social support Scale.SPSS25.0 statistical software was used to analyze the questionnaire data.Counting data were statistically described by frequency and percentage,and measurement data were statistically described by mean±standard deviation.T test and one-way anOVA were used to analyze differences between groups.Correlation analysis was conducted by Pearson correlation analysis.Multivariate linear regression analysis was used for multivariate analysis.Results:1.The total score of disease uncertainty in 307 patients with esophageal cancer ranged from 64 to 114 points,with a score of 85.24±8.16 points.20.85%patients had a high level of disease uncertainty,and 79.15%patients had a medium level of disease uncertainty.The score of ambiguity dimension and complexity dimension was 53.19±5.89 and 32.05±3.46 respectively.2.The total score of patients’ social support ranged from 12 to 51 points,with a score of 34.03±9.75 points.24.43%of patients had low social support,60.59%had medium social support,and 14.98%had high social support.The total score of objective support dimension,subjective support and support utilization dimension was 9.39±3.17,18.50±5.28 and 6.17±2.06 respectively.3.The total score of patients’ anxiety ranged from 49.25-79.25 points,with a score of 63.59±6.64 points.1.62%of patients had no anxiety,24.76%had mild anxiety,50.49%had moderate anxiety,and 23.13%had severe anxiety;The total score of mental anxiety was 32.20±4.29;The total score of somatic anxiety was 31.3 9±3.77.4.The results of single factor analysis show that the main factors influencing the patients with preoperative disease uncertainty include:age,marital status,place of residence,culture level,occupation,medical payment,family income per head,whether living with family members,whether to accept preoperative chemoradiotherapy,whether with other diseases,family history and pathological staging(P<0.05).5.Pearson correlation analysis showed that there was a positive correlation between disease uncertainty and anxiety(R=0.304,P<0.01),a negative correlation between social support and disease uncertainty(R=-0.440,P<0.01),and a negative correlation between social support and anxiety(R=-0.394,P<0.01).6.Multivariate analysis showed that patients with age≥60 years old,farmer occupation,lower social support,not underwent preoperative radiotherapy and chemotherapy,family per capita annual income<10000 yuan,not living with their family members,pathological stage,complicated with other diseases and no family history had higher disease uncertainty(P<0.05).Conclusion:1.Preoperative disease uncertainty level of esophageal cancer patients is generally high while social support is at a relatively low level;patients’anxiety level is generally high.2.Patients with higher preoperative disease uncertainty showed higher anxiety level,and lower social support level was associated with higher preoperative disease uncertainty level and anxiety level.3.Patients with specific conditions like advanced age,farmers,low social support,not receiving preoperative chemoradiotherapy,low family income,not living with family members,terminal-stage cancer,complications with other diseases and no family history shall be paid special attention by medical staff to improve their ability of psychological adjustment and adaptation and to reduce the level of uncertainty in illness by strengthening health education and psychological nursing.