消化器がんの一次手術を受ける患者における不安とうつ病の動的スクリーニング

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

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

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.

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.

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.