Characterizing surveillance-associated anxiety following curative-intent surgery for gastrointestinal cancer: a mixed methods approach

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PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. IMPLICATIONS FOR CANCER SURVIVORS: 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.

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