Washington University in St Louis School of Medicine, St Louis, MO.
Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, PA.
JCO Oncol Pract. 2022 Sep;18(9):e1407-e1416. doi: 10.1200/OP.21.00905. Epub 2022 Jun 1.
Patients with cancer are at risk for anxiety and depression; however, the patterns and predictors of symptoms in an orthopedic oncology population have not been studied.
We retrospectively reviewed Patient-Reported Outcomes Measurement Information System scores of all adult patients who underwent palliative surgery for metastatic cancer, resection of a sarcoma, or nononcologic total joint arthroplasty at a single institution from 2015 to 2020. Backward stepwise linear regression was used to determine risk factors for perioperative anxiety and depression.
Postoperative anxiety and depression were more prevalent in patients with metastatic disease than localized cancer or nononcologic conditions ( < .001 and < .001, respectively). Worse preoperative pain and function were associated with higher preoperative anxiety (β = .321, = .001; β = -.236, = .012, respectively) and depression (β = .245, = .009; β = -.279, = .003, respectively). Worse preoperative anxiety, preoperative depression, and postoperative pain were associated with higher postoperative anxiety (β = .204, = .012; β = .260, = .001; β = .447, < .001, respectively). Worse preoperative depression and postoperative pain also predicted higher postoperative depression (β = .542, < .001; β = .325, < .001, respectively).
Anxiety and depression were most prevalent in patients with metastatic disease. Compared with total joint arthroplasty patients, patients with cancer less frequently experienced postoperative improvements in anxiety and depression. Worse preoperative pain and function were independently associated with greater preoperative anxiety and depression. Providers should maintain awareness of the relationship between mental and physical health to optimize outcomes.
癌症患者有焦虑和抑郁的风险；然而，骨科肿瘤患者的症状模式和预测因素尚未得到研究。
我们回顾性分析了 2015 年至 2020 年在一家机构接受姑息性手术治疗转移性癌症、肉瘤切除术或非肿瘤性全关节置换术的所有成年患者的患者报告的结果测量信息系统评分。采用向后逐步线性回归法确定围手术期焦虑和抑郁的危险因素。
与局限性癌症或非肿瘤性疾病相比，转移性疾病患者术后焦虑和抑郁更为常见（均<0.001）。术前疼痛和功能越差，术前焦虑（β=0.321， =0.001；β=-0.236， =0.012，分别）和抑郁（β=0.245， =0.009；β=-0.279， =0.003，分别）越高。术前焦虑、术前抑郁和术后疼痛越差，与术后焦虑越高相关（β=0.204， =0.012；β=0.260， =0.001；β=0.447，<0.001，分别）。术前抑郁和术后疼痛越差也预测术后抑郁越高（β=0.542，<0.001；β=0.325，<0.001，分别）。
焦虑和抑郁在转移性疾病患者中最为常见。与全关节置换术患者相比，癌症患者术后焦虑和抑郁的改善程度较低。术前疼痛和功能越差，与术前焦虑和抑郁的相关性越强。提供者应保持对精神和身体健康之间关系的认识，以优化结果。
