Published online Nov 19, 2026. doi: 10.5498/wjp.124191
Revised: August 17, 2026
Accepted: October 8, 2026
Published online: November 19, 2026
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Patients with liver cancer undergoing targeted therapy combined with transarterial chemoembolization (TACE) may experience substantial psychological distress, anxiety, depression, and suicide-related risk. Risk-stratified psychological care may help address these problems by matching the intensity of psychological support to patients’ assessed risk levels; however, evidence regarding structured stepped psychological interventions in this population remains limited.
To evaluate the short-term effects of a stepped psychological intervention on psychological distress and suicide risk in patients with liver cancer receiving targeted therapy combined with TACE.
This single-center, unregistered randomized controlled trial included 98 patients with liver cancer who received targeted therapy combined with TACE between April 2024 and November 2025. Participants were randomly assigned in a 1:1 ratio to a control group (n = 49), which received routine nursing care, or a stepped psychological intervention group (n = 49), which received risk-stratified psychological assessment and stepped psychological care in addition to routine care. Psychological distress, suicide risk, anxiety, and depression were assessed using the Distress Thermometer (DT), Nurses’ Global Assessment of Suicide Risk (NGASR), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), respectively. Treatment adherence, nursing satisfaction, and safety-related events were evaluated as secondary outcomes. Exploratory multivariable logistic regression analyses were performed to identify factors associated with significant psychological distress (DT ≥ 4) and high suicide risk (NGASR ≥ 5) at the 4-week follow-up. To minimize potential overadjustment and mediator bias, only baseline or prerandomization covariates were included in these models.
At the 4-week follow-up, DT, NGASR, SAS, and SDS scores decreased in both groups, with greater reductions observed in the stepped psychological intervention group. The intervention group had higher treatment adherence than the control group (95.92% vs 77.55%, P = 0.007) and higher nursing satisfaction (95.92% vs 75.51%, P = 0.004). Safety-related events were recorded in 2 of 49 patients (4.08%) in the intervention group and 9 of 49 patients (18.37%) in the control group (P = 0.025). In exploratory multivariable analyses, allocation to the stepped psychological intervention group was associated with lower odds of significant psychological distress at 4 weeks after adjustment for baseline DT score, tumor stage, and family support [adjusted odds ratio (OR) = 0.31, 95%CI: 0.12-0.78, P = 0.014]. Higher baseline DT scores and advanced tumor stage were associated with higher odds of psychological distress, whereas good family support was associated with lower odds. Similarly, intervention-group allocation was associated with lower odds of high suicide risk after adjustment for baseline NGASR score, tumor stage, and family support (adjusted OR = 0.27, 95%CI: 0.0-0.79, P = 0.018). Higher baseline NGASR scores and advanced tumor stage were associated with higher odds of suicide risk, whereas good family support was ass
In this single-center, unregistered randomized controlled trial, patients allocated to a stepped psychological intervention showed greater short-term improvements in psychological distress, suicide risk, anxiety, and depression than those receiving routine nursing care. Exploratory analyses also suggested associations with better treatment adherence and nursing satisfaction and fewer recorded safety-related events. However, these findings should be interpreted cautiously because of the small sample size, short follow-up period, lack of prospective trial registration, and limitations in the assessment of secondary outcomes. Larger, prospectively registered multicenter trials using validated outcome measures, independent outcome assessment, and longer follow-up are needed to confirm these findings.
Core Tip: This study adopted a stepwise psychological intervention for patients with liver cancer receiving trans arterial chemoembolization plus targeted therapy. This tiered intervention relieves psychological distress and suicide risk, improves treatment compliance, and reduces the incidence of ward safety events. Poor mood and advanced tumor stage are high-risk factors.