Health status, anxiety, and depressive symptoms following complicated and uncomplicated colorectal surgeries.

PURPOSE: The purpose of this study was to evaluate the impact of complications following colorectal surgery on anxiety, depressive symptoms, and health status. Previously, very few studies examined the psychological impact of complications following colorectal surgery. Also, in clinical practice, little attention is paid to the psychological impact of complications. METHODS: Patients undergoing colorectal surgery were evaluated prospectively preoperatively and postoperatively at 3 days, 6 weeks, and 1 year, using the Center for Epidemiological Studies-Depression (CES-D), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36) questionnaires. Patient data and complications were prospectively recorded. Postoperative CES-D, STAI, and SF-36 scores in patients with minor and severe complications were compared to scores of patients without complications using a general linear model. RESULTS: Of 218 patients, 130 (59.6%) had complications. Colorectal surgery significantly increased depressive symptoms and anxiety levels in the same amount in all patient subgroups. Furthermore, it also lowered all domains of health status in all patient subgroups, but not equally. Patients with a severely complicated postoperative course had a larger postoperative decrease in health status, most notably at 6 weeks postoperatively with the largest effects in the physical-, mental-, social-, and vitality domains compared with the other subgroups. CONCLUSIONS: Colorectal surgery has a profound effect on depressive and anxiety symptoms, as well as nearly all domains of health status. Occurrence of severe complications increases the negative effect of colorectal surgery on most domains of health status but do not specifically increase depressive symptoms or anxiety levels. At 6 weeks, these effects are most notable, but at 1 year, they have faded.

Chemotherapy and cognitive complaints in women with breast cancer.

BACKGROUND: Results of existing studies are inconclusive concerning the relationship between chemotherapy and subjective cognitive functioning (SCF). The aim of this study was to evaluate SCF of breast cancer (BC) patients and to find predictors of impaired SCF. Both satisfaction and frequency of complaints about SCF were measured. METHODS: BC patients who were about to receive chemotherapy (N = 74) and patients with a benign breast disease (BBD) (N = 63) participated. Before chemotherapy started (Time 1) and 3 months after ending chemotherapy (and at comparable moments for the BBD group) (Time 2), women completed validated questionnaires concerning the frequency of complaints and satisfaction with SCF, fatigue, perceived stress, anxiety, and depressive symptoms. RESULTS: No differences were found between the BBD and BC patients concerning the frequency of complaints about SCF across time. Satisfaction with SCF decreased across time in BC patients but remained stable across time in BBD patients (p < 0.001; p = 0.003 after controlling for state anxiety and perceived stress). Correlation coefficients between the satisfaction and the frequency of complaints about SCF ranged between -0.26 and -0.49. Depressive symptoms and satisfaction with SCF (Time 1) predicted the frequency of complaints about SCF (Time 2). Diagnosis, frequency of complaints about SCF, and state anxiety (Time 1) predicted satisfaction with SCF (Time 2). CONCLUSIONS: BC patients do not differ in the frequency of complaints about SCF compared with BBD patients, but their satisfaction with SCF decreased after treatment. Psychological factors predicted the frequency of complaints about SCF. Psychological factors and diagnosis predicted satisfaction with SCF.

Subjective cognitive dysfunction in breast cancer patients: a systematic review.

OBJECTIVE: Results from studies examining subjective cognitive dysfunctioning (SCD) in breast cancer (BC) patients are unclear. Therefore, this review examined (i) the prevalence of SCD, (ii) the differences between (treatment) groups in SCD, (iii) the course of SCD, (iv) the relationship of SCD with psychological factors, and (v) the relationship between SCD and objective cognitive dysfunctioning (OCD). METHODS: Through a systematic literature search, we identified 27 studies concerning SCD in BC patients. The methodological quality of these studies was examined according to predefined criteria. The methodological limitations and heterogeneity across studies were taken into account. RESULTS: Eight studies were graded of high, 12 of moderate, and seven of low quality. Twenty-one to 90% of the patients reported SCD. The comparison between different (treatment) groups, at different time points of the cancer trajectory, rendered inconclusive evidence regarding the relation of SCD to the cancer itself, chemotherapy, and hormonal therapy. SCD and OCD were unrelated, but SCD was associated with psychological distress, fatigue, and health status. CONCLUSIONS: SCD does exist in BC patients, but it remains unclear if this is more commonly found in BC patients than in the general population. It is inconclusive if SCD is developed post-treatment or already exists pretreatment. Since there is a relationship between SCD and anxiety and depression, SCD may be more indicative of emotional distress instead of OCD. Attention toward SCD in future research is warranted in order to draw valid conclusions regarding SCD in BC patients.