Many patients with cancer may experience anxiety before a surgery. If not properly managed, the preoperative anxiety can adversely affect postoperative recovery and patient outcomes. A recent research study suggested that a multidisciplinary team approach can help alleviate preoperative anxiety in patients preparing for colorectal stoma surgery.
Impacts of Anxiety on Patients with Cancer
Clinically significant anxiety is common among patients with cancer, and it may have some unique impacts on cancer care and outcomes. For example, advanced cancer patients with anxiety disorders have less trust in their physicians, are less comfortable asking questions about their health, and feel less able to understand the medical information that their physicians share with them.1
In cancer patients with preoperative anxiety, there are higher rates of adverse outcomes including postoperative nausea and vomiting, unplanned overnight admission, and urgent care visits within 30 days.2 Research also showed that preoperative anxiety is likely to cause postoperative delirium in cancer patients.3
In addition, poorly managed preoperative anxiety may lead to an increase in postoperative pain level, which, if not adequately managed, may slow postoperative recovery, increase the length of stay in hospital, and lead to increases in postoperative complications and opioid consumption.4
Management of Preoperative Anxiety
Preoperative anxiety is commonly managed using pharmacologic interventions with a range of medication classes and agents, primarily antidepressants, benzodiazepines, and nonbenzodiazepine anxiolytics.5 The medications may have side effects because sometimes the agents can worsen fatigue and concentration, complicate alcohol abuse, and have paradoxical reactions in elderly patients.5
There are also a variety of nonpharmacologic interventions that can manage anxiety symptoms in patients with cancer and reduce side effects of medication. For example, research studies show that yoga, music therapy, and walking exercises may be used to alleviate anxiety symptoms in cancer patients.6,7,8
For surgical patients with or without cancer, preoperative education delivered by nurses or other health professionals can also reduce anxiety and postoperative complications. Information about general anesthesia and resolving patients’ worries about unknown terms, for example, “unconsciousness caused by anesthesia,” are believed to be beneficial.9
Multidisciplinary Team Approach in Cancer Anxiety Management
Surgery resulting in temporary or permanent stoma is a standard treatment for colorectal cancer, but it may cause preoperative anxiety for the patients due to concerns about issues such as body image changes, leakage, noises, odors, embarrassment, and skin irritation. In a recent study, researchers tried to examine the efficacy of a multidisciplinary team approach on anxiety and distress among patients preparing for colorectal stoma surgery.
Eighteen patients were assessed for anxiety 1 week before surgery, and 3 to 4 days after the surgery. The multidisciplinary treatment team consisted of oncology nurse navigator, behavioral health nurse practitioner, ostomy nurse, social worker, dietitian, and surgeon.
The treatment team members each has a unique role in managing the patient’s anxiety:
- behavioral health nurse provides counseling regarding the feelings of having an ostomy
- ostomy nurse educates patients on how to care for the ostomy
- social worker coordinates patient care needs
- dietitian advises on nutritional needs for stoma health
- surgeon educates the patient regarding possible side effects
It is worth noting that the oncology nurse navigator on the treatment team played an important role by interacting with other team members to be certain that care was provided.
A significant decrease in anxiety was detected pre-surgery to post-surgery—researchers observed decreases related to fear, nervousness, fatigue, and problems with sleep. At discharge, study participants indicated they were satisfied with the education provided on the stoma care, the resources provided, the attention given to their anxiety, and their involvement in decision-making.
➤ To learn more about this original research study, read The Effect of a Multidisciplinary Stoma Team on Anxiety and Distress in Patients Undergoing Colorectal Stoma Surgery from the recent issue of Journal of Oncology Navigation & Survivorship (JONS), a publication that features topics related to patient navigation and survivorship care, offering original research, best practices, interviews, case reports, study highlights, and more.
- Spencer R, Nilsson M, Wright A, et al. Anxiety Disorders in Advanced Cancer Patients: correlates and predictors of end-of-life outcomes. Cancer. April 1, 2010. 116(7):1810-1819.
- Majumdar JS, Vertosick EA, Cohen B, et al. Preoperative Anxiety in Patients Undergoing Outpatient Cancer Surgery. Asia Pacific Journal of Oncology Nursing. Oct-Dec, 2019. 6(4):440-445.
- Wada S, Inoguchi H, Sadahiro R, et al. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: a prospective observational cohort study. World Journal of Surgery. January, 2019. 43(1):134-142.
- Tola YO, Chow KM, Liang W. Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: a systematic review. Journal of Clinical Nursing. 2021;30:3369-3384.
- Traeger L, Greer JA, Fernandez-Robles C, et al. Evidence-Based Treatment of Anxiety in Patients with Cancer. Journal of Clinical Oncology. April 10, 2012. 30(11):1197-1205.
- Hardoerfer K, Jentschke E. Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients. Oncol Research and Treatment. 2018;41(9):526-532.
- Rossetti A, Chadha M, Torres BN, et al. The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy. International Journal of Radiation Oncology, Biology Physics. September 1, 2017. 99(1):103-110.
- Chen HM, Tsai CM, Wu YC, et al. Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. British Journal of Cancer. February 3, 2015. 112(3):438-445.
- Stamenkovic DM, Rancic NK, Latas MB, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiologica. November, 2018;84(11):1307-1317.