The practical value of psychological intervention based on stress response system theory in the perioperative period of thyroid cancer patients
Abstract
Objective: This study seeks to probe the practical value of psychological interventions based on stress response system theory in the perioperative care of thyroid cancer patients. Materials and methods: A total of 100 patients scheduled for thyroid cancer surgery at Tangshan Workers’ Hospital from October 2023 to March 2024 were selected as research subjects, all of whom were confirmed by pathological diagnosis. The 50 patients admitted from October 2023 to December 2023 were assigned to the control group; the 50 patients admitted from January to March 2024 were assigned to the experimental group. Both groups received standard thyroid cancer surgery-related health education, while the observation group was also subjected to psychological interventions based on stress response system theory. Comparisons were made in terms of negative emotions, sleep quality, quality of life, fatigue, self-efficacy, resilience, voice disorder, laryngopharyngeal reflux (LPR) symptoms, health behaviors at three months postoperatively, postoperative pain, and complications between the groups before and after the intervention. Results: Following the intervention, the observation group exhibited significantly lower scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Quality of Life Questionnaire-Core 30 (QLQ-C30), and Cancer Fatigue Scale (CFS) compared with the control group. Meanwhile, scores on the Chinese version of the Strategies Used by Patients to Promote Health (C-SUPPH), Connor-Davidson Resilience Scale (CD-RISC), and dimensions of health behaviors three months post-surgery were remarkably higher within the observation group. The observation group predominantly adopted coping strategies such as confrontation, while the control group leaned towards resignation and avoidance, with statistically significant differences (P < 0.05). Conclusion: Psychological interventions rooted in stress response system theory can significantly reduce negative emotions, boost sleep quality and overall quality of life, decrease fatigue, and strengthen resilience among thyroid cancer patients. By fostering healthier behaviors, these interventions support recovery, minimize complications, and improve prognoses.
Copyright (c) 2025 Jun e Liu, Yuwei Ma, Huijie Liang, Yaojie Hu, Wei Zheng, Hong Chen
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Chen DW, Lang BHH, McLeod DSA, et al. Thyroid cancer. Lancet. 2023; 401(10387): 1531–1544. doi: 10.1016/S0140-6736(23)00020-X
2. Boucai L, Zafereo M, Cabanillas ME. Thyroid Cancer: A Review. JAMA. 2024; 331(5): 425–435. doi: 10.1001/jama.2023.26348
3. Yang J, Barletta JA. Anaplastic thyroid carcinoma. Seminars in Diagnostic Pathology. 2020; 37(5): 248–256. doi: 10.1053/j.semdp.2020.06.005
4. Etan T, Amir E, Tibau A, et al. National comprehensive cancer network recommendations for drugs without US food and drug administration approval in metastatic breast cancer: A cross-sectional study. Cancer Treatment Reviews. 2020; 91: 102113. doi: 10.1016/j.ctrv.2020.102113
5. Han J, Liu J, Meng J, Zhang Y. Analysis of the degree of psychological distress and related causes in cancer patients (Chinese). Chinese Journal of Nursing. 2008; 43(6): 516–518.
6. Selye H. A syndrome produced by diverse nocuous agents. 1936. The Journal of Neuropsychiatry and Clinical Neurosciences. 1998; 10(2): 230–231. doi: 10.1176/jnp.10.2.230a
7. Slavova D, Ortiz V, Blaise M, Bairachnaya M, Giros B, Isingrini E. Role of the locus coeruleus-noradrenergic system in stress-related psychopathology and resilience: Clinical and pre-clinical evidences. Neurosci Biobehav Rev. 2024 Dec;167:105925.
8. Gosain R, Gage-Bouchard E, Ambrosone C, et al. Stress reduction strategies in breast cancer: Review of pharmacologic and non-pharmacologic based strategies. Seminars Immunopathology. 2020; 42(6): 719–734. doi: 10.1007/s00281-020-00815-y
9. Yuan X, Xu B, Cai B, et al. Implementing nursing interventions based on stress system theory alongside painting therapy for pediatric post-traumatic stress disorder following accidental injury. BMC Nursing. 2024; 23(1): 489. doi: 10.1186/s12912-024-02159-6
10. Pitt SC, Saucke MC, Roman BR, et al. The Influence of Emotions on Treatment Decisions about Low-Risk Thyroid Cancer: A Qualitative Study. Thyroid. 2021; 31(12): 1800–1807. doi: 10.1089/thy.2021.0323
11. Gusakova EA, Gorodetskaya IV. The role of the mediator and hormonal links of the sympathetic-adrenal system in the anxiolytic effect of close to physiological doses of L-thyroxine under stress (Russian). Zh Nevrol Psikhiatr Im S S Korsakova. 2023; 123(6): 106–112. doi: 10.17116/jnevro2023123061106
12. Mao W, Feng X, Wang Y, et al. County-based demographics, patterns of treatment seeking, and disease burden for malignant tumor patients in China. Annals of Palliative Medicine. 2021; 10(10): 10383–10390. doi: 10.21037/apm-21-2075
13. Cai M, Gou J. Symptoms and negative emotions in patients with advanced thyroid cancer: A prospective cross-sectional study. BMC Cancer. 2024; 24(1): 1418. doi: 10.1186/s12885-024-13169-7
14. Wasserman MD, Wing B, Bickford N, et al. Stress Responses across the Scales of Life: Toward a Universal Theory of Biological Stress. Integrative and Comparative Biology. 2022; 61(6): 2109–2118. doi: 10.1093/icb/icab113
15. Badcock PB, Davey CG, Whittle S, et al. The Depressed Brain: An Evolutionary Systems Theory. Trends in Cognitive Sciences. 2017; 21(3): 182–194. doi: 10.1016/j.tics.2017.01.005
16. Roth AJ, Kornblith AB, Batel-Copel L, et al. Rapid screening for psychologic distress in men with prostate carcinoma: A pilot study. Cancer. 1998; 82(10): 1904–1908.
17. Holland JC, Andersen B, Breitbart WS, et al. Distress management. Journal of the National Comprehensive Cancer Network. 2013; 11(2): 190–209. doi: 10.6004/jnccn.2013.0027
18. Gessler S, Low J, Daniells E, et al. Screening for distress in cancer patients: is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psychooncology. 2008; 17(6): 538–547.
19. Dunstan DA, Scott N. Norms for Zung’s Self-rating Anxiety Scale. BMC Psychiatry. 2020; 20(1): 90. doi: 10.1186/s12888-019-2427-6
20. Luz JK, Martini J, Clever K, et al. Psychometric Properties of the Fear of Progression Questionnaire for Children (FoP-Q-SF/C). Klinische Padiatrie. 2020; 232(3): 136–142. doi: 10.1055/a-1128-0471
21. Zitser J, Allen IE, Falgàs N, et al. Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults. PLoS One. 2022; 17(6): e0270095. doi: 10.1371/journal.pone.0270095
22. Suarez-Almazor M, Pinnix C, Bhoo-Pathy N, et al. Quality of life in cancer care. Med. 2021; 2(8): 885–888. doi: 10.1016/j.medj.2021.07.005
23. Ruiz-Casado A, Álvarez-Bustos A, de Pedro CG, et al. Cancer-related Fatigue in Breast Cancer Survivors: A Review. Clin Breast Cancer. 2021; 21(1): 10–25. doi: 10.1016/j.clbc.2020.07.011
24. Chen TJ, Dong B, Dong Y, et al. Matching actions to needs: Shifting policy responses to the changing health needs of Chinese children and adolescents. Lancet. 2024; 403(10438): 1808–1820.
25. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003; 18(2): 76–82. doi: 10.1002/da.10113
26. Zeng Q, Cao H, Ma Q, et al. Appetite loss, death anxiety and medical coping modes in COVID-19 patients: A cross-sectional study. Nursing Open. 2021; 8(6): 3242–3250. doi: 10.1002/nop2.1037
27. Krause AJ, Walsh EH, Weissbrod PA, et al. An update on current treatment strategies for laryngopharyngeal reflux symptoms. Annals of the New York Academy of Sciences. 2022; 1510(1): 5–17. doi: 10.1111/nyas.14728
28. Chouhan S, Das S, Niwariya Y, et al. Health Promoting Lifestyle Profile Assessment among Medical and Nursing Students of Central India. Mymensingh Medical Journal. 2022; 31(2): 531–538.
29. Nabhan F, Dedhia PH, Ringel MD. Thyroid cancer, recent advances in diagnosis and therapy. International Journal of Cancer. 2021; 149(5): 984–992. doi: 10.1002/ijc.33690
30. Grimm D. Recent Advances in Thyroid Cancer Research. International Journal of Molecular Sciences. 2022; 23(9): 4631. doi: 10.3390/ijms23094631
31. Haymart MR. Progress and Challenges in Thyroid Cancer Management. Endocrine Practice. 2021; 27(12): 1260–1263. doi: 10.1016/j.eprac.2021.09.006
32. Jimenez-Labaig P, Aymerich C, Braña I, et al. A comprehensive examination of mental health in patients with head and neck cancer: Systematic review and meta-analysis. JNCI Cancer Spectrum. 2024; 8(3).
33. Crum AJ, Jamieson JP, Akinola M. Optimizing stress: An integrated intervention for regulating stress responses. Emotion. 2020; 20(1): 120–125. doi: 10.1037/emo0000670
34. Daks JS, Peltz JS, Rogge RD. Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens. Journal of Contextual Behavioral Science. 2020; 18: 16–27. doi: 10.1016/j.jcbs.2020.08.003
35. Krebber AMH, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014; 23(2): 121–130.
36. Banihashem S, Arabzadeh M, Jafarian Bahri RS, Qutbi M. Psychological Status and Quality of Life Associated with Radioactive Iodine Treatment of Patients with Differentiated Thyroid Cancer: Results of Hospital Anxiety and Depression Scale and Short-Form (36) Health Survey. Indian Journal of Nuclear Medicine. 2020; 35(3): 216–221.
37. Lin C, Wan X, Zhang R, et al. Quality of life and its influencing factors in patients with schizophrenia (Chinese). Journal of Central South University (Medical Science). 2023; 48(3): 472–480. doi: 10.11817/j.issn.1672-7347.2023.220438
38. Kalemikerakis I, Evaggelakou A, Kavga A, et al. Diagnosis, treatment and quality of life in patients with cancer-related lymphedema. Official Journal of The Balkan Union of Oncology. 2021; 26(5): 1735–1741.
39. Sun M, Wang L, Wang X, et al. Interaction between sleep quality and dietary inflammation on frailty: NHANES 2005–2008. Food & Function. 2023; 14(2): 1003–1010. doi: 10.1039/d2fo01832b
40. Ma Y, He B, Jiang M, et al. Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis. International Journal of Nursing Studies. 2020; 111: 103707. doi: 10.1016/j.ijnurstu.2020.103707
41. Silva S, Bártolo A, Santos IM, et al. Validation of the Portuguese Version of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) in Portuguese Cancer Survivors. Healthcare. 2022; 10(12): 2466. doi: 10.3390/healthcare10122466
42. Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress. 2007; 20(6): 1019–1028. doi: 10.1002/jts.20271
43. Abdelaziz EM, Elsharkawy NB, Mohamed SM. Health Promoting Lifestyle Behaviors and Sleep Quality Among Saudi Postmenopausal Women. Frontiers in Public Health. 2022; 10. doi: 10.3389/fpubh.2022.859819
44. Chu-Ko F, Chong ML, Chung CJ, et al. Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status. BMC Public Health. 2021; 21(1): 2196. doi: 10.1186/s12889-021-12239-w
