How well patients recover from cancer surgery may be influenced by more than their medical conditions and the operations themselves. Family conflicts and other non-medical problems may raise their risk of surgical complications, a Mayo Clinic study has found. Addressing such quality-of-life issues before an operation may reduce patients' stress, speed their recoveries and save health care dollars, the research suggests. The study specifically looked at colon cancer patients, and found that patients with a poor quality of life were nearly three times likelier to face serious postoperative complications.
The findings are published in the Journal of Gastrointestinal Surgery.
"We know that quality of life is a very complex thing, but we can now measure it and work with it almost like blood pressure," says lead author Juliane Bingener, M.D., a gastroenterologic surgeon at Mayo Clinic in Rochester. "We can say, 'This is good, this is in the normal range, but this one here, that is not good, and maybe we should do something.'"
Quality of life as measured in the study is about more than happiness and how well people feel physically, Dr. Bingener says. It also includes the financial, spiritual, emotional, mental and social aspects of their lives and whether their needs are being met.
Researchers studied 431 colon cancer surgery patients and found that before surgery, 13 percent had a quality of life deficit, defined as an overall quality of life score of less than 50 on a 100-point scale.
Nearly three times as many patients who entered surgery with a quality of life deficit experienced serious post-surgery complications as those with a normal or good quality of life score. Patients with a postoperative complication spent 3.5 days longer in the hospital on average than those who didn't.
"The question I'm exploring is whether, if we understand before surgery that someone is in the red zone for quality of life, can we do something to help them cope with the new stress that's going to come, so they're better equipped to go through surgery?" Dr. Bingener says.
Preventing complications by intervening with behavioral therapy or other assistance would likely cost much less than an ICU stay for an infection after major surgery, Dr. Bingener notes.
Stress can weaken patients' immune response, putting them at higher risk of infection. A patient's outlook on life can also influence how active they are in working to recover.
"You have a surgery, you're lying there in pain, now you wonder, 'Why should I even get up and walk around? Why do I have to do these deep-breathing exercises? I don't feel like it.' You might get pneumonia much faster than somebody who says, 'Oh, I have to get up. There's something worth living for, my quality of life is good and I need to get back to that,'" Dr. Bingener says.
The study is part of ongoing work by Mayo to identify and address factors that can influence patients' recovery from cancer surgery, to help improve their outcomes. Years ago, physicians were just concerned with whether patients survived cancer, because survival was so hard to achieve, Dr. Bingener says. Now, there is growing awareness of the mind's influence on the body's health.
"We're understanding much better now that patients are not just a body with a disease: There's a whole person with that, and everything plays together," Dr. Bingener says. "Now that survival is possible, we want to achieve it in a way that preserves normal life for patients as much as possible. And we think that's probably also the most economical way to go."
- Juliane Bingener, Jeff A. Sloan, Paul J. Novotny, Barbara A. Pockaj, Heidi Nelson. Perioperative Patient-Reported Outcomes Predict Serious Postoperative Complications: a Secondary Analysis of the COST Trial. Journal of Gastrointestinal Surgery, 2014; DOI: 10.1007/s11605-014-2613-2
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