Bath Natalie M, Khatri Rakhsha, Quinn Patrick L, Kim Joanne, Dillhoff Mary, Ejaz Aslam, Hays John, Noonan Anne, Huang Emily, Kim Alex, Pawlik Timothy M, Cloyd Jordan M
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.
J Cancer Surviv. 2025 Apr 29. doi: 10.1007/s11764-025-01781-w.
Imaging is often an essential component of cancer surveillance following curative-intent surgery but can be distressing for some patients. While this phenomenon has been studied among patients undergoing active cancer treatment and screening, the frequency and severity of "scanxiety" among patients undergoing surveillance after curative-intent cancer surgery is poorly understood.
A cross-sectional mixed-methods analysis of patients with a history of resected gastrointestinal (GI) or hepatopancreatobiliary (HPB) cancer undergoing routine cancer surveillance was conducted. After their imaging was completed but before meeting with their provider, patients completed the Impact of Events Scale-revised (IES-r) and the Hospital Anxiety and Depression Scale (HADS) anxiety subscale surveys. IES-r and HADS-anxiety scores ≥ 24 (scale 0-88) and ≥ 11 (scale 0-22), respectively, were considered clinically meaningful. Semi-structured interviews were conducted among a convenience sample of patients, which were subsequently transcribed and then coded using an inductive approach.
Among 101 participants, mean age was 62 ± 13.9 years old and 52% were male. The most common diagnoses were cancers of the pancreas (23.8%), appendix (20.8%), and colon & rectum (20.8%). Mean time since surgery was 30.7 ± 28.0 months. Overall IES-r and HADS scores were 12.1 ± 14.7 and 5.2 ± 4.7, respectively. On multivariable linear regression analysis, a previous mental health diagnosis was associated with increased HADS, total IES, and all IES subscale scores whereas older age was associated with lower HADS and total IES scores (all p < 0.05). African American race, public insurance, and longer distance traveled were associated with increased IES hyperarousal scores. Qualitative analysis highlighted the psychological symptoms associated with surveillance imaging, its impact on daily living, and primary coping strategies.
In this cross-sectional study of patients with resected GI and HPB cancers, symptoms of anxiety and post-traumatic stress around the time of routine cancer surveillance were common but relatively mild. A prior mental health diagnosis and younger age may be risk factors for greater symptomatology.
Future research should work to identify which patients are at highest risk for surveillance-associated anxiety so that patient-centered interventions can be designed and studied in this growing patient population.
成像检查通常是根治性手术后癌症监测的重要组成部分，但对一些患者来说可能会造成困扰。虽然这种现象已在接受积极癌症治疗和筛查的患者中得到研究，但对于接受根治性癌症手术后监测的患者中“扫描焦虑症”的频率和严重程度，人们了解甚少。
对有切除的胃肠道（GI）或肝胰胆（HPB）癌病史并正在接受常规癌症监测的患者进行了横断面混合方法分析。在他们完成成像检查后但在与医生会面之前，患者完成了事件影响量表修订版（IES-r）和医院焦虑抑郁量表（HADS）焦虑分量表调查。IES-r和HADS焦虑评分分别≥24（0-88分）和≥11（0-22分）被认为具有临床意义。对方便抽样的患者进行了半结构化访谈，随后对访谈内容进行转录，并采用归纳法进行编码。
101名参与者的平均年龄为62±13.9岁，52%为男性。最常见的诊断是胰腺癌（23.8%）、阑尾癌（20.8%）以及结直肠癌（20.8%）。自手术以来的平均时间为30.7±28.0个月。总体IES-r和HADS评分分别为12.1±14.7和5.2±4.7。在多变量线性回归分析中，既往心理健康诊断与HADS、IES总分以及所有IES子量表评分升高相关，而年龄较大与HADS和IES总分较低相关（所有p<0.05）。非裔美国人种族、公共保险以及更长的行程距离与IES高唤醒评分升高相关。定性分析突出了与监测成像相关的心理症状、其对日常生活的影响以及主要应对策略。
在这项对切除了GI和HPB癌症患者的横断面研究中，常规癌症监测前后的焦虑和创伤后应激症状很常见，但相对较轻。既往心理健康诊断和较年轻的年龄可能是症状更严重的危险因素。
未来的研究应致力于确定哪些患者在监测相关焦虑方面风险最高，以便能针对这一不断增长的患者群体设计并研究以患者为中心的干预措施。
