Investigation of factors influencing anxiety and depression symptoms after therapy in 200 patients diagnosed with primary liver cancer

Abstract

BACKGROUND

Patients undergoing interventional therapy for liver cancer experience severe psychological pain and are prone to anxiety and depression.

AIM

To explore factors influencing anxiety and depression symptoms in 200 patients diagnosed with primary liver cancer.

METHODS

Data from 200 individuals diagnosed with primary liver cancer and admitted to the authors’ hospital (January 2022 to January 2024) were divided into 2 groups according to psychological status: Normal (n = 100); and anxiety and depression (n = 100). Through a questionnaire survey of patients and their families, single and multifactor factors of anxiety and depression in the postoperative interventional treatment of patients with primary liver cancer were analyzed.

RESULTS

Univariate analysis revealed no statistical differences between the 2 groups in terms of chronic disease, sex, liver function, Child grade, and age (P > 0.05). However, there were statistical differences in payment method, disease cognition, number of interventional treatments, per capita income, and educational level (P < 0.05). Multivariate logistic regression analysis revealed that educational level, per capita income, disease cognition, payment method, and number of interventional treatments were all independent factors influencing postoperative anxiety and depression symptoms after interventional therapy in patients diagnosed with primary liver cancer, and the comparisons were statistically significant (P < 0.05).

CONCLUSION

Analysis of associated risk factors can strengthen the clinical screening of patients with liver cancer at high risk for postoperative anxiety and depression symptoms and improve their prognosis.

Key Words: Liver cancer; Interventional therapy; Anxiety; Depression; Intervention measures

Core Tip: A positive attitude can significantly benefit patients diagnosed with liver cancer. It helps them better cope with the physical and emotional challenges caused by the disease. Patients with a positive mindset are often more motivated to adhere to treatment plans and maintain a healthier lifestyle. This, in turn, can accelerate the rehabilitation process after treatment and improve overall quality of life.

INTRODUCTION

Primary liver cancer refers to malignant tumors originating in the liver. The reported annual incidence of primary liver cancer in China is 367700, with 316500 deaths, and its morbidity and mortality rank fifth and second, respectively, among malignant tumors[1,2]. Surgical resection remains the preferred treatment for hepatocellular carcinoma; however, most patients are no longer able to receive radical treatment due to advanced disease status. Interventional treatment for liver cancer is a minimally invasive modality involving puncture and catheter placement[3,4]. However, the increasing implementation of interventional therapies in patients diagnosed with liver cancer has invariably led to the emergence of anxiety and depression after surgery. This negative emotion not only seriously affects treatment and is not conducive to disease remission, but also aggravates the disease and reduces treatment compliance[5,6]. Studies have shown that anxiety and depression can negatively affect the long-term survival and quality of life of those affected, highlighting the need for intensive research to investigate this issue. Therefore, it is particularly important to explore and summarize the risk factors for anxiety and depression among patients diagnosed with liver cancer after interventional treatment and implement preventive measures in advance to reduce the incidence of such symptoms.

MATERIALS AND METHODS

General information

Two hundred patients diagnosed with primary liver cancer, who were admitted to the authors’ hospital between January 2022 and January 2024, were identified and divided into 2 groups according to psychological status: Normal (n = 100); and anxiety and depression (n = 100).

Inclusion and exclusion criteria

The inclusion criteria were as follows: Fulfilled the diagnostic criteria for standardized Pathological Diagnosis of Primary Liver cancer (2015 Edition)[7]; complete clinical data; and initial diagnosis. The exclusion criteria were autoimmune disorders, other malignancies, and participation in other clinical trials.

Protocol

A questionnaire developed by the hospital was used to collect information from patients diagnosed with primary liver cancer and their families. In addition, medical records were consulted, and related risk factors affecting postoperative anxiety and depression symptoms after interventional therapy were analyzed. The questionnaire survey addressed the following: General information, such as age, sex, educational level, payment method, per capita income, interventional treatment, and frequency of chronic diseases. The Disease Cognition Scale was used to assess patient understanding of the disease. This scale comprises 2 dimensions, disease cognition and nursing cognition, with a total score of 100 points. The disease cognition dimension primarily evaluates patient understanding of the etiology, symptoms, treatment methods, and prognosis of primary liver cancer. The nursing cognition dimension focuses on patient knowledge of postoperative care measures, identification of complications, and self-management abilities. The scale is scored as follows. A total score ≥ 60 points indicates that patients have a good level of cognition regarding the disease and nursing, and are able to understand disease-related information well and cooperate with nursing measures. A total score < 60 points indicates that the patients have a poor level of cognition and require further health education and guidance. Through this assessment, the study was able to more accurately understand the extent of patient disease cognition and provide a basis for subsequent health education and psychological interventions. This assessment tool holds significant value in clinical nursing, and contributes to improved patient treatment adherence and quality of life.

Statistical analysis

Statistical analysis was performed using SPSS version 20.0 (IBM Corp., Armonk, NY, United States). Quantitative data with a normal distribution were compared using the t-test. Data are expressed as mean ± SD. Qualitative data, expressed as percentage (%), were compared using the χ² test. Differences with P < 0.05 were considered to be statistically significant.

RESULTS

Comparison of general characteristics between the 2 groups

Univariate analysis revealed no statistical differences between the 2 groups in terms of chronic disease, sex, liver function, Child grade, and age (P > 0.05). However, there were statistical differences in payment method, disease cognition, number of interventional treatments, per capita income, and educational level (P < 0.05) (Table 1).

Table 1 Comparison of general data between the 2 groups, n (%).

Variable	Normal (n = 100)	Abnormal (n = 100)	χ2 (t)	P value
Sex			0.081	0.777
Male	47 (47.00)	45 (45.00)
Female	53 (53.00)	55 (55.00)
Age, years, mean ± SD	55.97 ± 3.96	56.57 ± 3.95	1.073	0.285
Education			4.005	< 0.001
Primary school	13 (13.00)	34 (34.00)
Middle school	35 (35.00)	40 (40.00)
University and above	52 (52.00)	26 (26.00)
Income			5.695	< 0.001
< 1000 RMB	13 (13.00)	44 (44.00)
1000-4000 RMB	50 (50.00)	50 (50.00)
> 4000 RMB	37 (37.00)	6 (6.00)
Disease cognition			34.621	< 0.001
Bad	21 (21.00)	62 (62.00)
Good	79 (79.00)	38 (38.00)
Payment method			2.088	0.037
Employee medical insurance	32 (32.00)	23 (23.00)
Medical insurance for urban residents	27 (27.00)	26 (26.00)
New rural cooperative	33 (33.00)	29 (29.00)
Own expense	8 (8.00)	22 (22.00)
Combined chronic diseases			-1.366	0.172
None	36 (36.00)	30 (30.00)
1	47 (47.00)	43 (43.00)
2	13 (13.00)	22 (22.00)
≥ 3	4 (4.00)	5 (5.00)
Number of interventional treatments			-3.660	< 0.001
1-2	34 (34.00)	25 (25.00)
3	56 (56.00)	32 (32.00)
4-5	10 (10.00)	43 (43.00)
Child classification of liver function			0.352	0.553
B	67 (67.00)	63 (63.00)
C	33 (33.00)	37 (37.00)

Multivariate logistic regression analysis of anxiety and depression symptoms after interventional therapy in patients diagnosed with primary liver cancer

Multivariate logistic regression analysis (results summarized in Table 2) revealed that educational level, per capita income, disease cognition, payment method, and number of interventional treatments were all independent factors influencing postoperative anxiety and depressive symptoms in patients diagnosed with primary liver cancer, and the comparison was statistically significant (P < 0.05) (Table 3).

Table 2 Assignments.

Variable	Assignment
Education level	0 = “primary school”; 1 = “middle school”; 2 = “university and above”
Income per capita	0 = “1000”; 1 = “1000-4000”; 2 = “4000”
Disease cognition	0 = “bad”; 1 = “good”
Payment method	0 = “employee medical insurance”; 1 = “medical insurance for urban residents”; 2 = “new rural cooperative”; 3 = “at one’s own expense”
Number of interventional treatments	0 = “1-2”, 1 = “3”, 2 = “4-5”

Table 3 Results of multivariate logistic regression analysis.

Variable	β	SE	Wald χ2	OR (95%CI)	P value
Education level	0.869	0.672	6.234	2.410 (1.050-3.597)	< 0.050
Income	0.913	0.853	5.314	2.667 (1.786-3.636)	< 0.050
Disease cognition	1.021	0.594	4.910	2.328 (1.238-3.531)	< 0.050
Payment method	0.961	0.721	5.399	3.811 (2.714-4.911)	< 0.050
Number of interventional treatments	1.412	0.614	6.447	4.464 (3.513-5.415)	< 0.050

SE: Standard error; OR: Odds ratio; CI: Confidence interval.

DISCUSSION

Primary liver cancer refers to a malignant tumor originating in the liver, which is usually caused by the malignant transformation of liver cells or bile duct epithelial cells in the liver, and is also one of the main causes of death[7,8]. Surgery, including liver tumor resection and liver transplantation, is the most effective way to treat primary liver cancer; however, most patients do not have the opportunity to undergo surgery at the time of diagnosis[9]. Currently, the primary treatment for middle and advanced primary liver cancer is interventional therapy, which can prolong the survival of patients as much as possible. However, due to the influence of various factors, patients are prone to anxiety and depression after interventional therapy, which seriously and negatively affect treatment and rehabilitation[10]. Therefore, to improve the prognosis of patients diagnosed with primary liver cancer, timely prevention of risk factors for postoperative anxiety and depression symptoms after interventional therapy is necessary.

Multivariate logistic regression analysis revealed that educational level, per capita income, disease cognition, payment method, and number of interventional treatments were all independent factors for postoperative anxiety and depression symptoms in patients diagnosed with primary liver cancer, and the comparison was statistically significant (P < 0.05). The main reasons for these findings are as follows. First, education level and degree of disease cognition. Due to the lack of knowledge regarding interventional therapy among patients with primary liver cancer, treatment measures and common adverse reactions in the treatment process can lead to anxiety, depression, and other emotions[11]. Second, per capita income and payment methods. Economic stress is an important factor affecting mental health[12,13]. Economic difficulties may lead to psychological problems including anxiety and depression. Due to long-term concerns regarding livelihood/occupation and increasing pressure, patients may feel helpless and desperate, and the long-term backlog of negative emotions gradually erodes mental health. Third, number of interventions. Interventional therapy is an invasive treatment modality for liver cancer. As a stressor, it can cause sympathetic nerve excitation, increase catecholamine secretion, and may cause side effects such as bleeding, fever, abdominal pain, irritability and irritability, leading to different degrees of negative mood[14]. Repeated interventional treatments seriously affect the self-confidence of patients and their families, leading to anxiety and depression.

Health education

Before interventional therapy, patients were educated about primary liver cancer and interventional therapy using videos, pictures, and one-on-one explanations. Their questions were answered patiently, and free brochures covering disease risk factors, complication identification, and postoperative care were provided.

Psychological care

Physicians communicated with patients to highlight the importance of a positive attitude toward surgery, encouraged them to express concerns, and introduced successful treatment cases and common adverse reactions.

Pain management

Patients were educated about the causes and management of pain using videos and pictures. For mild to moderate pain, soothing music was played in the ward and, for severe pain, strong opioids were used.

Financial assistance

Medical staff consider patients’ financial situations and ensure access to the necessary treatments without increasing their burden. Medical assistance funds were established to support low-income patients. The generalizability of our results is limited by the regional nature of the sample population, which was drawn from a single center. This limitation may affect the applicability of the results to broader populations because regional differences in access to healthcare, socioeconomic status, and cultural attitudes can influence the prevalence and management of anxiety and depression. For example, patients from different regions may have varying levels of disease awareness and access to mental health resources, which could affect their psychological resilience and treatment outcomes.

CONCLUSION

Educational level, per capita income, disease cognition, payment method, and frequency of interventional therapy were risk factors for postoperative anxiety and depression symptoms in patients diagnosed with primary liver cancer. Analysis of related risk factors can strengthen the clinical screening of patients at high risk for postoperative anxiety and depression symptoms and improve prognosis.