Tumor rehabilitation and psychosocial support in GI cancer patients

Article ID: 4590

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Keywords: advanced gastrointestinal tumors; humanistic care; nutritional support; quality of life

Abstract

Background: The disease progression of advanced gastrointestinal tumors is rapid, and traditional treatments often focus on tumor control while easily ignoring psychological needs and nutritional imbalances. Previous studies have shown that nutritional intervention and psychological support have potential value in improving the quality of life of patients in advanced stages, but there is still a lack of systematic evidence-based research in primary hospitals with relatively limited resources. Objective: To investigate, in hospitalized patients aged 18–80 years with stage IIIb/IV advanced gastrointestinal tumors (expected survival ≥3 months), using a randomized exploratory design, the difference between a control group receiving routine care and nutritional support and an intervention group receiving routine care plus standardized nutritional support, structured rehabilitation exercises, and patient‐centered psychosocial care, on the primary outcome of EORTC QLQ-C30 global health status (items 29 and 30, 0–100 scale), and on secondary outcomes including psychological status (assessed by SAS and SDS), nutritional indicators, and cancer‐related fatigue (assessed by RPFS-CV), with Bonferroni correction applied for multiple testing. Methods: A prospective randomized controlled design was used in this study, and a total of 100 patients with advanced gastrointestinal tumors who met the inclusion and exclusion criteria were enrolled. They were randomly divided into an intervention group and a control group, with 50 patients in each group. The intervention group received humanistic care in addition to routine care and nutritional support. After 2 months, changes in EORTC QLQ-C30, SAS, SDS, nutritional indicators, and cancer-related fatigue were compared between the two groups. Independent sample t-test, paired t-test, multiple regression, and Logistic regression were used to analyze the primary and secondary outcome measures, and the χ² test was used to evaluate adverse events. A two-sided test with P < 0.05 was considered statistically significant. Results: After 2 months of intervention, the EORTC QLQ-C30 functional dimensions in the intervention group were significantly higher than those in the control group (all P < 0.05), and the scores for fatigue, nausea and vomiting, and pain were significantly reduced (all P < 0.05), with a significant difference observed before and after the intervention in the intervention group (all P < 0.001). Multiple linear regression showed that the intervention had an independent positive effect on the overall health status score (P = 0.002), with an increase of 4.75 points in the intervention group compared to the control group after adjusting for covariates. The SAS and SDS in the intervention group improved significantly compared to the control group (both P < 0.05). Among the nutritional indicators of the intervention group, serum albumin and NRS 2002 scores were significantly higher than those of the control group (P = 0.009, 0.002), and the RPFS-CV total fatigue score was also significantly reduced (all P < 0.05). There was no statistically significant difference in adverse events between the groups (all P > 0.05). Conclusion: Humanistic care combined with nutritional support can safely and effectively improve the quality of life, psychological state, and certain nutritional indicators of patients with advanced gastrointestinal tumors in primary hospitals. It is worthy of further promotion and the conduct of longer-term, multi-center studies.