N.M. Bath1, R. Khatri1, P. Quinn1, J. Kim2, M. Dillhoff1, J. Hays3, A. Noonan3, A. Ejaz4, E. Huang1, A. Kim5, T. Pawlik1, J.M. Cloyd1 1Ohio State University, Surgery, Columbus, OH, USA 2Ohio State University, Biomedical Informatics, Columbus, OH, USA 3Ohio State University, Medicine, Columbus, OH, USA 4University Of Illinois At Chicago, Surgery, Chicago, IL, USA 5University Of Texas Southwestern Medical Center, Surgery, Dallas, TX, USA
Introduction: Imaging is an essential component of cancer surveillance following curative-intent surgery, particularly for those patients at elevated risk for recurrence, but can be distressing for some patients. While this phenomenon has been studied in patients undergoing active cancer treatment and screening, the frequency and severity of “scanxiety” in 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. Distress was measured after undergoing cross-sectional imaging but before meeting with providers using the Impact of Events Scale-revised (IES-r) and the Hospital Anxiety and Depression Scale (HADS) surveys. HADS and IES-r scores above 11 (scale 0-22) and 24 (scale 0-88), respectively, are 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, the mean age was 62 years old and 52% were male. The most common diagnoses were cancers of the pancreas (23.8%), appendix (20.8%), and colorectal (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, previous mental health diagnosis was associated with significantly increased HADS, total IES, and all IES subscale scores whereas older age was associated with significantly lower HADS and total IES scores. 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.
Conclusion: In this cross-sectional study of patients with resected GI and HPB cancers, “scanxiety” was common but relatively mild during routine cancer surveillance. A prior mental health diagnosis and younger age may be risk factors for greater distress. Future research should work on identifying which patients are at highest risk for surveillance-associated distress so that patient-centered interventions can be designed and studied in this growing patient population.