Occurrences of depression and anxiety in patients with carcinoma of large intestine and the clinical manifestation

Xinping ZHANG; Chengze YU; Shuang ZHANG

ABSTRACT

BACKGROUND:

Major psychological problems in patients with carcinoma of large intestine(CLI) were depression and anxiety. Are these bad moods correlated with the pathological stages, the pathological classification and the clinical manifestation of CLI?

OBJECTIVE:

This study was designed to investigate the relationship between the depression and anxiety state and the clinical manifestations in CLI patients.

DESIGN:

A comparative observation on patients was conducted in this study.

SETTING:

This study was conducted at the Department of General Surgery, General Hospital of Shenyang Military Area Command(MAC) of Chinese PLA and the Department of General Surgery, the 307 Hospital of the Chinese PLA.

PARTICIPANTS:

This study was conducted in the General Surgery Department of the General Hospital of Shenyang Military Area Command of Chinese PLA from February 2002 to February 2003. Totally 79 inpatients and outpatients were diagno sed as CLI by pathological examination. Their informed consents were obtained. Among them, 68 were accordant with the inclusion criteria, 51 males and 17 females; 21 with an age ≥55 years and 47 with an age ＜ 55 years; 39 with an average course of disease≥10 weeks and 29 with an average course of disease ＜10 weeks; 49 in Dukes A-C stages of CLI and 19 in Dukes D stage; 13 with a cancer of anal canal, 55 with a nonanal-canal cancer; 42 with a squamous cell carcinoma and 26 with a nonsquamous carcinoma; 40 with a serum level of carcinoembryonic antigen(CEA) ≥30 μg/L and 28 with it ＜30μg/L; 44 with a serum level of interleukin-8 (IL-8)≥90ng/L and 24 with it＜90 ng/L.

METHODS:

Sixty-eight patients with CLI received self-rating depression scale(SDS) and self-rating anxiety scale(SAS) testing made by Zung in one week before treatment. Statistical analysis of the scores was performed according to the classifications of age, sex, course of disease, pathological stages, types of carcinoma, and serum level of CEA and IL-8 respectively.MAIN OUTCOME

MEASURES:

① The occurrence of depression and anxiety in CLI patients(standard scores of SDS and SAS were ≥50 ). ②The relationship between the standard scores of SDS and SAS and the various variables as age, sex, course of disease, pathological stages, types of carcinoma and serum level of CEA and IL-8.

RESULTS:

Totally 68 patients with CLI entered the statistical analysis procedure. ① The incidence of depression and anxiety(standard score ≥50) were 48% (33/68) and 43% (29/68) in patients with CLI. ② In patients with an age ＜55, male patients, and patients with a course of disease ≥10weeks, the standard scores of SDS(46.51 ±9.82, 47.74 ± 14.25, 48.38 ± 11.73) and SAS(44.28 ±11.24, 45.06±13.27, 45.78±12.59) were significantly higher than those in patients with an age ≥55,female, and with a course of disease ＜10 weeks(SDS 43.27 ±10.06, 42.63±10.06, 42.19±14.34;SAS 41.65±12.77, 41.22±10.89, 42.30±10.21) (t=2.192-2. 329, P ＜0.05). In patients in Dukes D stage of carcinoma, those with a cancer of anal canal and those with a nonsquamous carcinoma, the standard SDS scores(48.04±12.71, 47.23±9.85, 48.06±14.32) and SAS scores (44.96±10.13, 45.17±12.34, 45.28±14.38) were significantly higher than those in patients with Dukes A-C stages of carcinoma, with nonanal canal cancer, and with a squamous cell carcinoma(SDS 43.42±11.97,44.05±12.14, 44.36±10.57; SAS 42.23±13.04, 42.39±11.09,43.14±10.60) (t=2.136-2.298, P ＜0.05).In patients with serum level of CEA ≥30 μg/L and with IL-8 level ≥90 g/L,the standard scores of SDS(48.27±11.69, 49.04±12.24) and SAS(44.94±13.34,45.26±12.70) were significantly higher than those in patients with CEA ＜30μg/L and IL-8 ＜90 ng/L( SDS 43.48±12.76, 44. 15±13.61;SAS 41.47±10.58, 41.71±14.53) (t =2. 248-2. 314, P＜0.05).

CONCLUSION:

It is showed that those patients with these variables as a longer course of disease, an older age, male, a more advanced Dukes staging,and higher levels of CEA and IL-8 are prone to depression and anxiety.