Health-related Quality Of Life,Anxiety,and Depression Among Patients With Stomach Cancer After Chemotherapy

Objective:Gastric cancer remains a major public health issue as a high morbidity and mortality in China.Chemotherapy can be regarded as the most commonly treatment used in patients with advanced gastric cancer.This study was designed to investigate the status of quality of life(QOL),anxiety and depression,and relation to self-efficacy and social support after chemotherapy so as to provide a theoretical basis to further improve medical level and the QOLin patientsand to alleviate their psychological impairment such as anxiety or depression.Methods:We conducted a cross-sectional study including 50 hospitalized patients diagnosed with gastric cancer from Medical Oncology in Changzhi Medical College affiliated Peace Hospital fromJune 2016 to December2016.Participants were required to provide socio-demographic and disease-related or treatment-related information.Patients also completed Quality of Life Instruments for Cancer Patients-Stomach Cancer(QLICP-ST),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)to assess their quality of lifeand mental health disorders such as anxiety or depression.General Self-efficacy Scale(GSES)and Social Support Questionnaire(SSQ)were also required to complete.All patients finished these questionaires one week before chemotherapy and one week after four cycles of chemotherapy.Results:1.The univariate analysis of QOLin patients with gastric cancer after chemotherapy showed that scores of psychological function in patients with chemotherapy alone(59.2 ± 7.2)were higher than those with chemotherapy after surgery(54.2 ± 8.7).During chemotherapy,patients with gastrointestinal reactions(68.5 ± 8.9)had higher scores of psychological function than that of the nonresponders(51.9 ± 5.0).Patients with neurotoxicity had a higher score in psychiatric function(68.0 ± 8.4),general module(65.4 ± 6.8)and total quality of life(68.1 ± 6.1)than those without neurotoxicity(55.2±7.6,55.8±5.9,60.0±6.1).the scores of patients with KPS score higher than 80 points(54.3 ± 10.2)were significantly higher than those KPS score less than 80 points(46.0 ± 8.4).Results from multivariate regression analysis showed that the higher values of general module(b=0.330,p=0.001),specific module(b=0.321,p=0.002)and total score of QOL(b=0.370,p < 0.001)before chemotherapy,the higher scores in these scales after chemotherapy.The scores in the general module after chemotherapy would be increased with the higher scores in general module before chemotherapy(b=0.330,p=0.001).2.The univariate analysis of anxiety in patients with gastric cancer after chemotherapy indicated that the anxiety score was lower in patients with neurotoxicity(41.0 ± 2.0)than those without neurotoxicity(53.3 ± 9.2).The scores of patients with KPS scoreless than80 points(54.9±10.5)were significantly higher than those KPS score higher than 80 points(48.0±5.5).Multivariate regression analysis indicated that the degree of anxiety after chemotherapy would be aggravated while there was a higher anxiety beforechemotherapy(b=0.374,p=0.006).The higher objective support after chemotherapy,the lower score of anxiety after chemotherapy(b=-0.311,p=0.008).3.The influential factors analysis of depressionin patientswithgastric cancer after chemotherapyshowed that the depression scorein patients with neurotoxicity(47.9 ± 5.6)was lower than those without neurotoxicity(58.3 ± 8.2).Multivariate regression analysis showed thatthe degree ofdepressionafter chemotherapy would be aggravated while there was a higher depression before chemotherapy(b=0.408,p<0.001).The higher subjective support after chemotherapy,the lower score of depression after chemotherapy(b=-0.006,p=0.088).Conclusions:1.The QOL including general modules,specific modules and total QOLin patients with gastric cancer after chemotherapywas positively correlated with the QOL before chemotherapy.Treatment-related factors such as treatment,gastrointestinal reactions,neurotoxicity or other adverse reactions,KPS scores were associated with some domains of QOL.Therefore,choosingan appropriate therapeutic regimen according to the QOL before chemotherapy will be helpful for patients to have a more objective understanding of the disease and to improve their acceptance and awareness of the disease;In addition,timely and effective intervention in patients with existing tumor-related symptoms before chemotherapy can reduce the incidence of complications and improve the QOLin patients with gastric cancer after chemotherapy.2.The anxiety and depression in patients with gastric cancer after chemotherapy were positively correlated with anxiety and depressionbefore chemotherapy,but negatively correlated with social support in post-chemotherapy.Thus,accurately assessing the mental state,giving effective guidence and intervention,as well as improving patients' subjective and objective social support in gastric cancer patients with anxiety or depression before chemotherapywill help alleviate the anxiety and depression and eliminate the patients' psychological disorders.