Postoperative distress and influencing factors in patients with pancreatobiliary cancer

doi:10.21203/rs.3.rs-3427534/v1

Download PDF

Research Article

Postoperative distress and influencing factors in patients with pancreatobiliary cancer

https://doi.org/10.21203/rs.3.rs-3427534/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 23 Jul, 2024

Read the published version in Scientific Reports →

Version 1

posted

You are reading this latest preprint version

Purpose

This study aimed to investigate the distress levels using a distress thermometer (DT) and the factors associated with distress in postoperative patients with pancreatobiliary cancer.

Methods

This study retrospectively investigated 155 patients who underwent surgery for pancreatobiliary cancer between December 1, 2019 and September 30, 2021. DT and problem list were used to measure the distress. Descriptive statistics, t-test, and multivariate logistic regression analysis were used to analyze the data.

Results

Among the 155 patients, 16.8% were in the mild-distress group (n = 26) and 83.2% were in the moderate-to-severe distress group (n = 129). The average DT score was 6.21; the average score for the mild-distress group was 2.46 and that for the moderate-to-severe distress group was 6.97. There were more patients in the moderate-to-severe distress group than in the mild-distress group who responded that they had problems of “sadness” (χ² = 4.538, p < 0.05), “indigestion” (χ² = 10.128, p < 0.001), “eating” (χ² = 6.147, p < 0.013), and “getting around” (χ² = 4.275, p < 0.039). The risk of severe distress was assessed in all patients. Occupation status (odds ratio [OR] = 0.342, 95% confidence interval [CI] = 0.133–0.879, p = 0.026) and indigestion (OR = 5.897, 95% CI = 1.647–21.111, p = 0.006) were independent risk factors for the presence of severe distress.

Conclusion

Patients with pancreatobiliary cancer demonstrated elevated levels of psychological distress. This should alert healthcare providers to be vigilant when evaluating patients for distress and providing appropriate referrals. Patients with pancreatobiliary cancer who are unemployed or have indigestion should be targeted for distress screening and management.

Distress

pancreatobiliary cancer

psychological distress

postoperative patients

pancreatectomy

Distress is effective in identifying cancer and cancer-related physical symptoms and providing effective treatment. It is a general term for unpleasant emotional experiences that are multifactorial, psychological (including cognitive, behavioral, and emotional), social, and spiritual and interfere with the ability to cope [1]. In Canada, distress is the sixth most important vital sign, with the same importance as blood pressure, temperature, heart rate, breathing, and pain [2]. NCCN guidelines suggest measuring distress levels using a distress thermometer (DT) [1]. The DT includes several items on physical, emotional, social, practical, and spiritual concerns. Distress can affect how a patient thinks, feels, and acts. Pancreatobiliary cancer is one of the malignancies with the worst prognosis and many patients suffer from severe psychological distress because they do not have a positive view of treatment [3]. In cases of treatment for pancreatobiliary cancer, especially pancreaticoduodenectomy, surgeries have high morbidity and mortality rates and longer hospital stays, which cause physiological problems [4, 5]. Therefore, in addition to the distress caused by cancer, distress due to surgical treatment has a significant impact on patients’ quality of life [6, 7].

The Mayo Clinic evaluated patients with abdominal symptoms after surgical resection and found that 76% of patients with pancreatic cancer had symptoms of depression and anxiety, compared to 20% of patients with other tumors [8]. Thus, patients with pancreatic cancer correspond to a high-risk group for psychosocial distress. However, few studies have measured distress in patients with pancreatobiliary cancer. The first step toward providing psychosocial support to patients is the assessment of distress [9]. Therefore, this study aimed to investigate the level of distress using a DT and the factors associated with distress in postoperative patients with pancreatobiliary cancer.

This study retrospectively investigated 208 patients who underwent surgery for pancreatobiliary cancer between December 1, 2019 and September 30, 2021. A total of 155 patients were included, excluding those with missing patient information and treatment records and 53 who had difficulty filling out the questionnaire. This study was approved by the Institutional Review Board of Gangnam Severance Hospital (approval no. 3-2021-0449). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Distress measurement

Distress was measured using a DT and Problem List (PL) tools developed by NCCN. The DT, a brief 0–10 visual analog scale, was developed to routinely assess distress level in patients with cancer. Possible problems in multiple domains, including physical, emotional, spiritual, family, and practical (39 problems), were assessed using PL tools.

Patients with a distress score of less than 4 were classified into the mild-distress group, and those with a score of 4 or more were classified into the moderate-to-severe distress group.

Statistical analysis

The clinical characteristics and variables of the DT were compared for any differences, and the significance of the differences was evaluated using a paired t-test.

Continuous variables including age and distress scores are presented as mean ± standard deviation (SD) and were compared using Student’s t-test. Categorical variables, including sex, marital status, education, main caregiver, religion, occupation status, pathological and surgical characteristics, and problem lists, were expressed as counts and percentages and compared using Fisher’s exact test. The results of this model were presented as odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression analysis. All statistical analyses were performed using SPSS software (version 27.0). Values of p < 0.05 were considered statistically significant.

General and clinical characteristics of the patients

A total of 155 patients were included in this study. The age range was 24–86 years, and the average age was 65.0 (± 12.06) years.

Of the patients, 56.1% were males (n = 87) and 43.9% were females (n = 68). Additionally, 81.9% of the patients were married and 38.1% had a college degree or higher. The main caregivers were spouses for 58.1% of the patients; 60.6% of patients had no religion and 55.5% were unemployed.

Regarding pathological findings, the most common types of cancers diagnosed were pancreatic cancer in 62.6% of the patients, biliary tract cancer in 28.4% of the patients, and ampulla of vater cancer in 9.0% of the patients. Regarding the disease stage, 31.6% of the patients were in stage I, 34.8% in stage II, 30.3% in stage III, and 3.2% in stage IV. Moreover, 77.4% of patients underwent pancreaticoduodenectomy, which was the most frequently used surgical method, while 70.3% of patients did not undergo neoadjuvant chemotherapy. The average hospital stay after surgery was 12.23 (± 7.85) days, with a majority of patients (60.0%) falling into the Clavien–Dindo grade < I category. According to DT of all patients, sex (χ² = -2.844. p = 0.005) and occupational status (χ² = 8.759, p = 0.004) were statistically significant (male, 5.71 ± 2.58; female, 6.85 ± 2.29; no occupation, 6.73 ± 2.31; occupation, 5.56 ± 2.62). The number of patients who underwent neoadjuvant chemotherapy was statistically significant (upfront surgery, 6.53 ± 2.42; neoadjuvant chemotherapy, 5.46 ± 2.61; Table 1).

Distress level of patients

The 155 patients were divided into the mild-distress group (n = 26, 16.8%) and moderate-to-severe distress group (n = 129, 83.2%; Fig. 1). The average DT score was 6.21; the average score for the mild-distress group was 2.46 and that for the moderate-to-severe distress group was 6.97 (Fig. 2). There were more patients in the moderate-to-severe distress group, and the DT score was high (> 5 points).

Clinical characteristics of the two groups of patients according to distress severity

Table 3 shows the relationships between the distress groups according to the patients’ PLs. In the mild-distress group, males (76.9%) experienced a higher level of distress than females (23.1%), and in the moderate-to-severe distress group, males (51.9%) and females (48.1%) suffered similar levels of distress (χ² = 5.486, p = 0.019). In the mild-distress group, those with a job suffered more distress than those without a job, and in the moderate-to-severe distress group, those without a job suffered more distress than those with a job (χ² = 7.726, p < 0.005; Table 2).

Among the 36 questions on the PL, the ranks in which the patients answered “yes” to the problem items were “pain” (60.6%), “sleep” (49.7%), “worry” (47.7%), “getting around” (41.3%), “indigestion” (39.4%), “eating” (36.8%), “diarrhea” (23.2%), and “fatigue” (22.6%). The distress scores were analyzed and categorized into the mild- and moderate-to-severe distress groups. In the moderate-to-severe distress group, the distress scores of “pain” (50.0%), “worry” (42.3%), “sleep disorder” (38.5%), “fears” (34.6%) were followed by those of “constipation” (26.9%) and “bathing/dressing” (26.9%). In the mild-distress group, the distress scores of “pain” (62.8%), “sleep” (51.9%), and “worry” (48.8%) were followed by those of “indigestion” (45.0%), “getting around” (45.0%), and “eating” (41.1%).

The PLs were divided into five areas and the rankings were evaluated. Of 155 patients, “insurance/financial” (14.8%), “housing” (8.4%), and “work” (7.1%) were ranked in the practical domain area and “dealing with partner” (5.2%) in the family problems area, followed by “worry” (47.7%), “fears” (38.7%), and “loss of interest in usual activities” (20.6%) in the emotional problems area. Moreover, 2.6% of the patients responded that they had spiritual and religious problems.

In the moderate-to-severe distress group, “insurance/financial” (16.3%), “housing” (7.8%), and “work” (5.4%) were the problems faced in the practical domain area.

In the family problems area, “dealing with children” and “dealing with partner” were the same at (3.9%), and in the emotional problems area, “worry” (48.8%), “fears” (39.5%), and “sadness” (21.7%) were followed by “loss of interest in usual activities” (20.9%). Of these, 3.1% patients responded that they had spiritual or religious concerns. In the physical problems area, “pain” (62.8%), “sleep” (51.9%), “indigestion” (45.0%), and “getting around” (45.0%), followed by “eating” (41.1%), “fatigue” (24.0%), and “diarrhea” (23.3%) were some of the problems faced by the patients (Table 3).

There were more patients in the moderate-to-severe distress group than in the mild-distress group who responded that they had emotional problems of “sadness” (χ² = 4.538, p < 0.05) and physical problems of “indigestion” (χ² = 10.128, p < 0.001), “eating” (χ² = 6.147, p < 0.013), and “getting around” (χ² = 4.275, p < 0.039).

Risk analysis of severe distress using demographic and clinicopathologic features

To identify the factors that affect the patients’ distress levels, “sex,” “occupational status,” “sadness,” “indigestion,” “eating,” and “getting around” were included in the PL. which were statistically significant at the significance level of 0.05 in the univariate analysis and formed into a binary. Logistic regression analysis was performed.

Multivariate analysis of the risk of severe distress was performed for all patients. Occupational status (OR = 0.342, 95% CI = 0.133–0.879, p = 0.026) and indigestion (OR = 5.897, 95% CI = 1.647–21.111, p = 0.006) were independent risk factors for the presence of severe distress (Table 4).

Distress can range from normal emotions, such as embarrassment, sadness, and fear, to problems that can cause psychological and social impairment, such as depression, anxiety, panic, social isolation, and existential and spiritual crises. The prevalence of distress in patients with cancer is reported to be 35–52%, although there are some differences depending on the evaluation period or evaluation tool of distress. In addition, the prevalence of depression, one of the most common types of distress in these patients, is reported to be approximately 15–29% [10].

The DT is widely used to measure stress index in patients with cancer. Many studies have reported the measurement or management of cancer-related distress in other cancers (breast cancer, lung cancer, cervical cancer, hematological malignancy, and colorectal cancer [11–19]. Distress management, such as pain control or emotional support, is important when patients with cancer receive palliative treatments. Moreover, the measurement and management of distress are important for patients with cancer who undergo surgery and adjuvant treatment.

Several studies have reported that the level of distress in patients with pancreatic cancer is relatively high compared to that in other cancer types [20–22]. In addition, the prevalence of depression in patients with pancreatic cancer is more than seven times higher than that in the general population, and the degree of depressive symptoms is known to be more severe [23, 24]. According to a meta-analysis by Barnes et al., approximately 43% of patients with pancreatic cancer reported experiencing depression after diagnosis [25].

The NCCN guidelines suggest an algorithm for requesting appropriate psychosocial support services based on distress levels to distinguish between mild distress (less than 4 points on the DT) and moderate-to-severe distress (more than 4 points on the DT), and recommend interventions by mental health professionals when patients with cancer complain of moderate-to-severe distress [26–28].

In this study, the average distress score of patients with pancreatobiliary cancer was 6.21 ± 2.52 points, and 129 (83%) patients had moderate-to-severe distress with a score of 4 or more that required distress management. In particular, patients with pancreatic cancer correspond to a high-risk group of distress in terms of psychosocial aspects, and several studies have reported that the level of distress in patients with pancreatic cancer is relatively high compared with other cancer types [20, 21].

In a study [29] targeting patients who underwent surgery after first diagnosis of breast cancer, the average distress score of the patients was 5.0 ± 3.0 points, and in a study [17] conducted on patients with esophageal cancer, the average distress score was 4.06 ± 2.04 points. Compared to the results of these studies, the distress of patients with pancreatobiliary cancer in the current study was quite high.

The measurement of distress severity comprised practical, family, emotional, physical, and spiritual factors. In particular, the distress measurements in our study showed differences in scores of physical problems. In the moderate-to-severe distress group, a statistically significant difference in the scores of physical problems (indigestion, eating) were observed. Rates of discomfort due to physical problems, such as pain and sleep disorders, were higher in the moderate-to-severe distress group than in the mild-distress group. These results indicate the complexity of pancreaticoduodenectomy, which involves resecting multiple organs, creating multiple anastomosis sites, and can result in postoperative digestive function changes and frequent complications related to eating disorders, such as delayed gastric emptying. Furthermore, in the emotional domain, “sadness” was higher in the moderate-to-severe distress group than in the mild-distress group. These results suggest the importance of evaluating not only physical problems but also psychological problems because patients with pancreatic cancer are more likely to experience depression than patients with other cancers. In particular, patients with pancreatic cancer experience psychological distress due to physical symptoms, such as pain, digestive problems, cachexia, and fatigue. However, in clinical settings, medical staff are unable to identify patients’ distress in a timely manner, and fail to implement appropriate evaluations and interventions for psychological problems.

There were no significant differences in postoperative complications between the two groups. Therefore, even in the absence of severe pancreatectomy complications, such as pancreatic fistula and delayed gastric emptying after surgery, surgical stress has a significant effect on patients’ distress score. Unlike other patients with cancers, patients with pancreatobiliary cancer often need to continue chemotherapy after major surgery; therefore, stress management is important for improved quality of life of such patients. In addition, in other studies, in the case of pancreatobiliary cancer surgery, the stress index was high even before surgery; therefore, it is important to assess and manage stress after surgery. To the best of our knowledge, cancer-related distress is known to affect recurrence. Therefore, cancer-related distress not only affects the quality of life but also the survival rate due to cancer [30–32].

In our study, the patients who received neoadjuvant treatment showed differences in distress scores. Patients who received neoadjuvant treatment had lower DT scores than those who underwent upfront surgery. This is important because the prevalence of neoadjuvant treatments for pancreatobiliary cancer is increasing. However, there have been no studies on the distress experienced by patients with pancreatobiliary cancer who undergo neoadjuvant treatment compared to that experienced by patients who undergo upfront surgery. We assumed that patients who received neoadjuvant therapy had lower distress scores than those who received upfront surgery because they had overcome the emotional stress of cancer diagnosis much earlier.

Our study showed that many patients experienced severe distress after surgery, and that most factors affecting distress were physical problems. In the case of pancreatic biliary cancer, which has a poor prognosis, many patients believe that their emotional problems will have the greatest impact on their suffering. However, our data showed that the patients’ physical problems contributed to greater suffering after complicated pancreatobiliary cancer surgeries. Therefore, this study underscores the importance of proactively managing physical problems (pain control, rehabilitation, dietary habits, and nutritional support) in patients undergoing pancreatobiliary cancer surgery.

This study had some limitations. We were unable to evaluate the preoperative distress scores of the patients. However, considering the great impact of surgery for pancreatobiliary cancer, the postoperative score was sufficient to allow patients to assess their distress levels and consider distress management. As the number of patients receiving neoadjuvant chemotherapy, which is considered a strength of this study, was small, it is necessary to conduct more prospective studies.

In conclusion, our results highlight that patients with pancreatobiliary cancer often exhibit higher stress levels than those who undergo surgery for other cancers; therefore, the approach used in this study holds significance. These results can serve as basic data for identifying individuals with higher distress levels and for implementing psychosocial interventions. Future studies should actively monitor distress indices in patients with pancreatobiliary cancer and strive to improve their quality of life.

Approval was obtained from the ethics committee of Gangnam Severance Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Funding

No funding was received to assist with the preparation of this manuscript.

Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

This study was approved by the Institutional Review Board of Gangnam Severance Hospital (approval no. 3-2021-0449).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent to Publish

Patients signed informed consent regarding publishing their data.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [So Young Jun], [Hyung Sun Kim]. The first draft of the manuscript was written by [So Young Jun] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Riba MB, Donovan KA, Ahmed K et al (2023) NCCN Guidelines(R) Insights: Distress Management, Version 2.2023. J Natl Compr Canc Netw 21:450–457. https://doi.org/10.6004/jnccn.2023.0026
Bultz BD, Carlson LE (2005) Emotional distress: the sixth vital sign in cancer care. J Clin Oncol 23:6440–6441. https://doi.org/10.1200/JCO.2005.02.3259
Yeo TP, Fogg RW, Shimada A, Marchesani N, Lavu H, Nevler A, Hegarty S, Brody JR, Yeo CJ (2023) The Imperative of Assessing Quality of Life in Patients Presenting to a Pancreaticobiliary Surgery Clinic. Ann Surg 277:e136-e143. https://doi.org/10.1097/SLA.0000000000005049
Clancy TE, Ashley SW (2005) Pancreaticoduodenectomy (Whipple operation). Surg Oncol Clin N Am 14:533–552, vii. https://doi.org/10.1016/j.soc.2005.05.006
Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy–a comparative study. Int J Surg 10:475–479. https://doi.org/10.1016/j.ijsu.2012.06.003
Ekman H, Pettersson A, Jakobsson L, Garmy P (2020) A cross-sectional study of distress: A cancer response. Nurs Open 7:850–856. https://doi.org/10.1002/nop2.460
VanHoose L, Black LL, Doty K, Sabata D, Twumasi-Ankrah P, Taylor S, Johnson R (2015) An analysis of the distress thermometer problem list and distress in patients with cancer. Support Care Cancer 23:1225–1232. https://doi.org/10.1007/s00520-014-2471-1
Fras I, Litin EM, Bartholomew LG (1968) Mental symptoms as an aid in the early diagnosis of carcinoma of the pancreas. Gastroenterology 55:191–198
Zebrack B, Kayser K, Sundstrom L, Savas SA, Henrickson C, Acquati C, Tamas RL (2015) Psychosocial distress screening implementation in cancer care: an analysis of adherence, responsiveness, and acceptability. J Clin Oncol 33:1165–1170. https://doi.org/10.1200/JCO.2014.57.4020
Irwin MR (2013) Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Curr Psychiatry Rep 15:404. https://doi.org/10.1007/s11920-013-0404-1
Sherry V, Guerra C, Ranganathan A, Schneider SM (2017) Metastatic Lung Cancer and Distress: Use of the Distress Thermometer for Patient Assessment. Clin J Oncol Nurs 21:379–383. https://doi.org/10.1188/17.CJON.379-383
Sun H, Lv H, Zeng H, Niu L, Yan M (2022) Distress Thermometer in breast cancer: systematic review and meta-analysis. BMJ Support Palliat Care 12:245–252. https://doi.org/10.1136/bmjspcare-2021-002960
Lam WW, Bonanno GA, Mancini AD, Ho S, Chan M, Hung WK, Or A, Fielding R (2010) Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psychooncology 19:1044–1051. https://doi.org/10.1002/pon.1658
Lee Jung Lim KKS (2011) The Relationships between Stigma, Distress, and Quality of Life in Patients with Lung Cancer. J Korean Oncol Nurs 11:237–246
Albrecht TA, Rosenzweig M (2012) Management of Cancer Related Distress in Patients with a Hematological Malignancy. J Hosp Palliat Nurs 14:462–468. https://doi.org/10.1097/NJH.0b013e318268d04e
Seok JH, Choi WJ, Lee YS, Park CS, Oh YJ, Kim JS, Chang HS (2013) Relationship between Negative Mental Adjustment to Cancer and Distress in Thyroid Cancer Patients. Yonsei Medical Journal 54:658–664. https://doi.org/10.3349/ymj.2013.54.3.658
Ju YH, Kim, Yeon Hee, Kim, Jeong Hye (2018) Distress and Quality of Life in Patients with Esophageal Cancer. Asian Oncol Nurs 18:40–46
Lu DH, Andrae B, Valdimarsdottir U, Sundstrom K, Fall K, Sparen P, Fang F (2019) Psychologic Distress Is Associated with Cancer-Specific Mortality among Patients with Cervical Cancer. Cancer Research 79:3965–3972. https://doi.org/10.1158/0008-5472.Can-19-0116
Muzzatti B, Bomben F, Flaiban C, Piccinin M, Annunziata MA (2020) Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients. Bmc Cancer 20. https://doi.org/ARTN 758 1186/s12885-020-07272-8
Clark KL, Loscalzo M, Trask PC, Zabora J, Philip EJ (2010) Psychological distress in patients with pancreatic cancer–an understudied group. Psychooncology 19:1313–1320. https://doi.org/10.1002/pon.1697
Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28. https://doi.org/10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co;2-6
Park HY (2019) Emotional Support and Palliative Care for Distressed Patients Suffering from Pancreatic Cancer. Korean J Gastroenterol 74:95–100. https://doi.org/10.4166/kjg.2019.74.2.95
Bettison TM, Nahm CB, Gill AJ, Mittal A, Malhi GS, Samra JS (2018) Understanding the Pathophysiology of Psychological Distress and Pancreatic Cancer: A Systematic Review. Pancreas 47:376–381. https://doi.org/10.1097/MPA.0000000000001016
Jia L, Jiang SM, Shang YY, Huang YX, Li YJ, Xie DR, Huang KH, Zhi FC (2010) Investigation of the incidence of pancreatic cancer-related depression and its relationship with the quality of life of patients. Digestion 82:4–9. https://doi.org/10.1159/000253864
Barnes AF, Yeo TP, Leiby B, Kay A, Winter JM (2018) Pancreatic Cancer-Associated Depression: A Case Report and Review of the Literature. Pancreas 47:1065–1077. https://doi.org/10.1097/MPA.0000000000001148
Al-Shaaobi A, Alahdal M, Yu S, Pan H (2021) The efficiency of distress thermometer in the determination of supporting needs for cancer inpatients. Libyan J Med 16:1957199. https://doi.org/10.1080/19932820.2021.1957199
KIM JH (2019) Update on distress management for cancer patients. Journal of the Korean Medical Association 62(3):167–173
Holland JC, Andersen B, Breitbart WS et al (2013) Distress management. J Natl Compr Canc Netw 11:190–209. https://doi.org/10.6004/jnccn.2013.0027
Sang shin Lee HdR, Jungmin Woo (2018) Distress and Associated Factors in Patients with Breast Cancer Surgery: A Cross-Sectional Study. Korean Psychosomatic Society 26(2):77–85
Hamer M, Chida Y, Molloy GJ (2009) Psychological distress and cancer mortality. J Psychosom Res 66:255–258. https://doi.org/10.1016/j.jpsychores.2008.11.002
Batty GD, Russ TC, Stamatakis E, Kivimaki M (2017) Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 356:j108. https://doi.org/10.1136/bmj.j108
Ochoa-Arnedo C, Prats C, Travier N, Marques-Feixa L, Flix-Valle A, de Frutos ML, Domingo-Gil E, Medina JC, Serra-Blasco M (2022) Stressful Life Events and Distress in Breast Cancer: A 5-Years Follow-Up. Int J Clin Health Psychol 22:100303. https://doi.org/10.1016/j.ijchp.2022.100303

Table 1

Distress Score according to demographic and clinical characteristics of patients (n = 155)
Variables	Categories	Total (N = 155)	Distress score	t or F (p) Scheffé
Variables	Categories	n(%)	M ± SD	t or F (p) Scheffé
Demographic characteristics
Age (year)	20–59	41(26.5)	6.31 ± 2.722	0.791 (0.455)
	60–69	54(34.8)	5.87 ± 2.68
	≥ 70	60(38.7)	6.45 ± 2.21
Sex	Male	87(56.1)	5.71 ± 2.58	-2.844 (0.005)
Sex	Female	68(43.9)	6.85 ± 2.29	-2.844 (0.005)
Marital status	Unmarried/divorced	28(18.1)	6.41 ± 2.44	-0.466 (0.642)
Marital status	Married	127(81.9)	6.17 ± 2.54	-0.466 (0.642)
Education	≤Middle school graduation	39(25.2)	6.67 ± 2.75	0.877 (0.418)
	High school graduation	57(36.8)	6.01 ± 2.24
	≥University graduation	59(38.1)	6.10 ± 2.62
Main caregiver	Spouse	90(58.1)	6.20 ± 2.72	0.160 (0.852)
	Children	52(33.5)	6.14 ± 2.31
	Others	13(8.4)	6.58 ± 1.93
Religion	No	94(60.6)	6.43 ± 2.46	1.855 (0.175)
Religion	Yes	61(39.4)	5.87 ± 2.60	1.855 (0.175)
Occupational status	No	86(55.5)	6.73 ± 2.31	8.759 (0.004)
Occupational status	Yes	69(44.5)	5.56 ± 2.62	8.759 (0.004)
Clinical characteristics
Type of cancer	Pancreatic cancer	97(62.6)	6.14 ± 2.53	1.672 (0.191)
	Bile duct cancer	44(28.4)	5.99 ± 2.52
	Ampullar of vater cancer	14(9.0)	7.36 ± 2.21
Diagnostic Stage	I	49(31.6)	6.61 ± 2.26	0.699 (0.554)
	II	54(34.8)	5.60 ± 2.68
	III	47(30.3)	6.00 ± 2.61
	IV	5(3.2)	6.60 ± 2.41
Type of surgery	PD	120(77.4)	6.20 ± 2.42	1.636 (0.183)
	DP	26(16.8)	6.12 ± 2.67
	Total pancreatectomy	7(4.5)	5.71 ± 3.35
	HPD	2(1.3)	10.0 ± 0.0
Neoadjuvant chemotherapy	No	109(70.3)	6.53 ± 2.42	6.050 (0.015)
Neoadjuvant chemotherapy	Yes	46(29.7)	5.46 ± 2.61	6.050 (0.015)
CD grade	<I	93(60.0)	6.24 ± 2.47	0.038 (0.846)
CD grade	≥ II	62(40.0)	6.16 ± 2.60	0.038 (0.846)

PD = Pancreaticoduodenectomy; DP = Distal pancreatectomy; HPD = Hepato-Pancreaticoduodenectomy;

CD = Clavien-Dindo classification

Table 2

Demographic and clinical characteristics of patients in the mild-distress and moderate-to-severe distress groups (n = 155)
Variables	Categories	Mild-distress group (n = 26)	Moderate-to-severe distress group(n = 129)	χ 2 or t (p)
Variables	Categories	N(%) or M ± SD	N(%) or M ± SD	χ 2 or t (p)
Demographic characteristics
Age (year)		65.27 ± 8.86	64.94 ± 12.60	0.118 (0.906)
	20–59	7(26.9)	34(26.4)	2.272 (0.321)
	60–69	12(46.2)	42(32.6)
	≥ 70	7(26.9)	53(41.1)
Sex	Male	20(76.9)	67(51.9)	5.486 (0.019)
Sex	Female	6(23.1)	62(48.1)	5.486 (0.019)
Marital status	Unmarried/divorced	3(11.5)	25(19.4)	0.899 (0.416)†
Marital status	Married	23(88.5)	104(80.6)	0.899 (0.416)†
Education	≤Middle school graduation	4(15.4)	35(27.1)	2.396 (0.302)
	High school graduation	9(34.6)	48(37.2)
	≥University graduation	13(50.0)	46(35.7)
Main caregiver	Spouse	19(73.1)	71(55.0)	4.241 (0.120)†
	Children	7(26.9)	45(43.3)
	Others	0(0.0)	13(10.1)
Religion	No	14(53.8)	80(62.0)	0.605 (0.437)
Religion	Yes	12(46.2)	49(38.0)	0.605 (0.437)
Occupational status	No	8(30.8)	78(60.5)	7.726 (0.005)
Occupational status	Yes	18(69.2)	51(39.5)	7.726 (0.005)
Clinical characteristics
Type of cancer	Pancreatic cancer	17(65.4)	80(62.0)	1.032 (0.597)†
	Bile duct cancer	8(30.8)	36(27.9)
	Ampullar of vater cancer	1(3.8)	13(10.1)
Diagnostic Stage	I	6(23.1)	43(33.3)	2.878 (0.411)†
	II	12(46.2)	42(32.6)
	III	8(30.8)	39(30.2)
	IV	0(0.0)	5(3.9)
Type of surgery	PD	17(65.4)	103(79.8)	3.604 (0.308)†
	DP	7(26.9)	19(14.7)
	Total pancreatectomy	2(7.7)	5(3.9)
	HPD	0(0.0)	2(1.6)
Neoadjuvant chemotherapy	No	15(57.7)	94(72.9)	2.388 (0.122)
Neoadjuvant chemotherapy	Yes	11(42.3)	35(27.1)	2.388 (0.122)
Postoperative LOS		10.04 ± 5.21	12.67 ± 8.23	-1.565 (0.120)
CD grade	<I	17(65.4)	76(58.9)	0.377 (0.539)
CD grade	≥ II	9(34.6)	53(41.1)	0.377 (0.539)

PD = Pancreaticoduodenectomy; DP = Distal pancreatectomy; HPD = Hepato-Pancreaticoduodenectomy;

LOS = Length of Hospital stay; CD = Clavien-Dindo classification

Table 3

Problem lists in the mild-distress and moderate-to-severe distress groups (n = 155)
Variables	Total (N = 155)	Mild-distress group (n = 26)		Moderate-to-severe distress group(n = 129)		χ 2 or t (p)
Variables	N(%) or M ± SD	N(%)	Ranking	N(%)	Ranking	χ 2 or t (p)
Practical domain
Child-care	5(3.2)	1(3.8)	11	4(3.1)	25	0.039(1.000)†
Housing	13(8.4)	3(11.5)	9	10(7.8)	21	0.404(0.459)†
Insurance/Financial	23(14.8)	2(7.7)	10	21(16.3)	14	1.263(0.370)†
Transportation	3(1.9)	1(3.8)	11	2(1.6)	26	0.601(0.426))†
Work	11(7.1)	4(15.4)	8	7(5.4)	22	3.255(0.090)†
Family problems
Dealing with children	5(3.2)	0(0.0)	12	5(3.9)	24	1.041(0.590)†
Dealing with partner	8(5.2)	3(11.6)	9	5(3.9)	24	2.596(0.132)†
Ability to have children	0(0.0)	0(0.0)	12	0(0.0)	27	-
Emotional problems
Depression	27(17.4)	2(7.7)	10	25(19.4)	12	2.055(0.254)†
Nervousness	23(14.8)	3(11.5)	9	20(15.5)	15	0.269(0.768)†
Worry	74(47.7)	11(42.3)	2	63(48.8)	3	0.370(0.543)
Fears	70(38.7)	9(34.6)	4	51(39.5)	6	0.221(0.638)
Sadness	28(18.1)	1(3.8)	11	28(21.7)	9	4.538(0.050)†
Loss of interest in usual activities	32(20.6)	5(19.2)	7	27(20.9)	10	0.038(0.845)
Spiritual/religious concerns	4(2.6)	0(0.0)	12	4(3.1)	25	0.828(1.000)†
Physical problems
Constipation	32(20.6)	7(26.9)	5	22(19.4)	12	0.752(0.386)
Diarrhea	36(23.2)	6(23.1)	6	30(23.3)	8	0.00(1.000)
Indigestion	61(39.4)	3(11.5)	9	58(45.0)	4	10.128(0.001)
Eating	57(36.8)	4(15.4)	8	53(41.1)	5	6.147(0.013)
Nausea	28(18.1)	2(7.7)	10	26(20.2)	11	2.271(0.168)†
Mouth sores	15(9.7)	0(0.0)	12	15(11.6)	18	3.347(0.077)†
Feeling swollen	17(11.0)	1(3.8)	11	16(12.4)	17	1.623(0.309)†
Pain	94(60.6)	13(50.0)	1	81(62.8)	1	1.483(0.223)
Tingling in hands/feet	14(9.0)	4(15.4)	8	7(7.8)	21	1.534(0.256)†
Sleep	77(49.7)	10(38.5)	3	67(51.9)	2	1.572(0.210)
Fatigue	35(22.6)	4(15.4)	8	31(24.0)	7	0.925(0.336)
Sexual	2(1.3)	0(0.0)	12	2(1.6)	26	0.408(1.000)†
Skin dry/itchy	24(15.5)	5(19.2)	7	19(14.7)	16	0.335(0.558))†
Appearance	15(9.7)	3(11.5)	9	12(9.3)	20	0.124(0.719)†
Memory/concentration	21(13.5)	2(7.7)	10	19(14.7)	16	0.915(0.531)†
Nose dry/congested	15(9.7)	3(11.5)	9	12(9.3)	20	0.124(0.719)†
Breathing	14(9.0)	1(3.8)	11	13(10.1)	19	1.023(0.467)†
Fevers	6(3.9)	0(0.0)	12	6(4.7)	23	1.258(0.590)†
Changes in urination	27(17.4)	5(19.2)	7	22(17.1)	13	0.071(0.780)†
Bathing/dressing	29(18.7)	7(26.9)	5	22(17.1)	13	1.386(0.271)†
Getting around	64(41.3)	6(23.1)	6	58(45.0)	4	4.275(0.039)
†Fisher’s exact test

Table 4

Factors influencing moderate-to-severe distress
Variables	Univariable model		Multivariable model (Stepwise)
Variables	OR (95% CI)	P	OR (95% CI)	P
Sex(ref: male)	0.324(0.122–0.860)	0.024	-
Occupational status(ref:no)	0.291(0.118–0.718)	0.007	0.342(0.133–0.879)	0.026
Sadness(ref:no)	6.931(0.899–53.416)	0.063
Indigestion(ref:no)	6.263(1.791–21.906)	0.004	5.897(1.647–21.111)	0.006
Eating(ref:no)	3.836(1.249–11.774)	0.019	-
Getting around(ref:no)	2.723(1.026–7.227)	0.044	-
CI = confidence interval; OR = odds ration; ref = reference.

No competing interests reported.

Download PDF

Journal Publication

published 23 Jul, 2024

Read the published version in Scientific Reports →

Version 1

posted

You are reading this latest preprint version

Postoperative distress and influencing factors in patients with pancreatobiliary cancer

Status:

Journal Publication

Version 1

Abstract

Purpose

Methods

Results

Conclusion

Figures

Introduction

Methods

Distress measurement

Statistical analysis

Results

General and clinical characteristics of the patients

Distress level of patients

Clinical characteristics of the two groups of patients according to distress severity

Risk analysis of severe distress using demographic and clinicopathologic features

Discussion

Declarations

References

Tables

Additional Declarations

Status:

Journal Publication

Version 1