Psychology Research and Behavior Management (Sep 2020)
An Algorithm to Stratify the Risk of Postoperative Emotional Distress in Cancer Patients with Advanced Metastatic Spinal Disease
Abstract
Wenjing Zheng,1 Mingxing Lei,2 Yaosheng Liu,1 Xin Lu,3 Dan Yu,4 Xin Zhang5 1Department of Orthopedic Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Orthopedic Surgery, The Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China; 3Department of General Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Nursing Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xin ZhangNursing Department, The Fifth Medical Center of Chinese PLA General Hospital, 100 the 4thWest Ring Middle Road, Fengtai District, Beijing 100071, People’s Republic of China+86-10-933045Email [email protected]: We wish (1) to assess what variables are significantly associated with postoperative emotional distress in patients with the metastatic spinal disease after surgery and (2) to develop and validate an algorithm to stratify patients at risk of postoperative emotional distress.Patients and Methods: We retrospectively enrolled 171 patients with the metastatic spinal disease treated with surgery. Twelve potential variables were used to analyze postoperative emotional distress. Postoperative emotional well-being was measured using the Hospital Anxiety and Depression Scales (HADS). Significant variables were included in the algorithm and assigned scores based on odds ratios (ORs) from the multiple logistic regression analysis. The predictive performance of the risk algorithm was validated on the basis of discrimination and calibration.Results: Twenty-six (15.20%) patients had a HADS of 19 points or more. Of all the 12 variables, age (P=0.06), marital status (P=0.02), primary cancer types (P=0.004), and physical well-being (P=0.006) were included in the algorithm. This algorithm ranged from 0 to 24. Higher scores represented higher rates of postoperative emotional distress. Patients were stratified into three risk groups: patients in the group A had scores of 0 to 9 and the rate of postoperative emotional distress was only 1.14%, patient in the group B had scores of 10 to 15 and the rate of postoperative emotional distress was 21.31%, and patient in the group C had scores of 16 to 24 and the rate of postoperative emotional distress was up to 54.55%. The area under the receiver operating characteristic curve (AUROC) for the algorithm was 0.84, and the correct classification rate was 81.3%.Conclusion: Postoperative emotional distress is common in patients with the metastatic spinal disease after surgery. We propose and validate an algorithm that can be used as a potential screening tool to identify patients at high risk of postoperative emotional distress.Keywords: metastatic spinal disease, decompressive surgery, anxiety, depression, emotional distress, risk variables
