Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000200004
Brazilian Journal of Anesthesiology
Artigo Científico

Impacto da avaliação pré-anestésica sobre a ansiedade e a depressão dos pacientes cirúrgicos com câncer

Impact of preanesthetic evaluation on anxiety and depression in cancer patients undergoing surgery

Lidiomar Lemos de Magalhães Filho; Arthur Segurado; José Alvaro Marques Marcolino; Lígia Andrade da Silva Telles Mathias

http://dx.doi.org/10.1590/S0034-70942006000200004 Braz J Anesthesiol, vol.56, n2, p.126-136, 2006
PDF Português
PDF English
Downloads: 1
Views: 1027

Resumo

JUSTIFICATIVA E OBJETIVOS: Na trajetória do câncer, a ansiedade (Ans) e a depressão (Dep) manifestam-se durante os diversos momentos do diagnóstico e continuam durante e após o tratamento. O tratamento cirúrgico pode ter graves conseqüências físicas e psicológicas para o paciente com câncer. Os estudos não discutem a situação emocional dos pacientes com câncer frente à proximidade da internação para o ato anestésico-cirúrgico. Não é analisada também a influência da avaliação pré-anestésica ambulatorial sobre a Ans e/ou Dep desses pacientes. Esta pesquisa prospectiva procurou verificar o impacto da avaliação pré-anestésica sobre os níveis e prevalência de ansiedade e de depressão dos pacientes cirúrgicos com câncer. MÉTODO: Após aprovação pelo Comitê de Ética do Hospital foram selecionados 63 pacientes adultos, com câncer a serem submetidos à intervenção cirúrgica relacionada à doença. Os pacientes foram distribuídos em dois grupos com a aplicação da escala antes (AAPA) ou no final (DAPA) da consulta pré-anestésica. Foram utilizadas as escalas de Ansiedade e Depressão Hospitalar (HAD). As variáveis analisadas foram idade, faixa etária, sexo, cor da pele, estado civil, grau de instrução e situação ocupacional atual, número e porcentagem de pacientes com Ans/com Dep (HAD > 8); escores das escalas HAD-Ans e HAD-Dep. Na análise estatística, foi considerado significativo p < 0,05. RESULTADOS: Os grupos foram homogêneos em relação aos dados sócio-demográficos. Comparando-se os dois grupos, observou-se diferença significativa dos níveis e prevalência de Ans entre os dois grupos e não se verificou diferença significativa dos níveis e prevalência de Dep (HAD-depressão). A mediana dos valores de AAPA e DAPA nos dois grupos, ficou abaixo do ponto de corte, mas houve redução significativa dos escores de Ans entre os grupos. Em relação à análise dos fatores de risco, houve diferença significativa apenas no item faixa etária (maior prevalência de Ans nos pacientes < 60 anos). CONCLUSÕES: A avaliação pré-anestésica reduziu a prevalência e os níveis de ansiedade dos pacientes deste estudo, mas não teve qualquer efeito sobre a prevalência e os níveis de depressão. A variável idade com valor menor ou igual a 60 anos foi identificada como fator de risco para a ansiedade.

Palavras-chave

AVALIAÇÃO PRÉ-ANESTÉSICA, CIRURGIA, Oncológica, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: In the course of a cancer disease, anxiety (ANX) and depression (DEPR) manifest during the several moments of diagnosis and continue during and after treatment. The surgical treatment may bring severe physical and psychological consequences to the cancer patient. However, the present studies do not discuss the cancer patients' emotional status when they are close to be hospitalized to undergo an anesthetic-surgical procedure. Also, there is no analysis of the impact of the ambulatory preanesthetic evaluation on these patients' anxiety and/or depression. The prospective study aimed at checking the impact of the preanesthetic evaluation on the anxiety and depression levels and prevalence of surgical cancer patients. METHODS: Upon approval by the Hospital Ethics Committee on Research, 63 adult patients bearing cancer and undergoing a disease-related surgery were selected and assigned to two groups, their end points being the before (AAPA) or after (DAPA) scale as regards the preanesthetic visit. For this purpose the Hospital Anxiety and Depression (HAD) scales were applied. The variables analyzed included age, age range, gender, skin color, marital status, education level and present working status, number and percentage of patients experiencing Anxiety / with Depression (HAD > 8) and the HAD-ANX and HAD-DEPR scales scores. In the statistical analysis, a p < 0.05 was regarded as a significant value. RESULTS: Both groups were homogeneous, as regards socio demographic data. When comparing these groups, a significant difference was noted in the Anxiety prevalence levels (HAD-ANX) between them, whereas the difference in the Depression (HAD-DEPR) levels and prevalence was not noted. The mean of the before and after preanesthetic analysis in both groups was under the cut point, however a significant reduction of the Anxiety scores was noted between the groups. As regards the risk factors analysis, there was a significant difference only in the age range variable (more prevalence of anxiety in patients aged < 60 years old). CONCLUSIONS: The preanesthetic evaluation reduced the patients' anxiety levels and prevalence in this study, but did not impact on the depression levels and its prevalence. The variable 60-year or below age was identified as a risk factor for anxiety.

Keywords

COMPLICATIONS, PREANESTHETIC EVALUATION, SURGERY, Oncologic

Referências

Shepherd M, Davis B, Culpan RH. Psychiatric illness in a general hospital. Acta Psychiatr Scand. 1960;35:518-525.

Maguire P, Faulkner A, Regnard C. Managing the anxious patient with advancing disease: a flow diagram. Palliat Med. 1993;7:239-244.

Moffic HS, Paykel ES. Depression in medical in-patients. Br J Psychiatry. 1975;126:346-353.

Akiskal HS. Mood Disorders: Clinical Features. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 2005:1611-1652.

Schwab JJ, Clemmons RS, Bialow M. A study of the somatic symptomatology of depression in medical inpatients. Psychosomatics. 1965;6:273-276.

Cavanaugh S, Clark DC, Gibbons RD. Diagnosing depression in the hospitalized medically ill. Psychosomatics. 1983;24:809-815.

Botega NJ, Ponde MP, Medeiros P. Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epilépticos ambulatoriais. J Bras Psiq. 1998;47:285-289.

Mayou R, Hawton K. Psychiatric disorder in general hospital. Br J Psychiatry. 1986;149:172-190.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.

Andrade L, Gorenstein C. Escalas de Avaliação Clínica em Psiquiatria e Psicofarmacologia. 2000:110-129.

Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1:29-31.

Marcolino JAM, Suzuki FM, Alli LAC. Escala hospitalar de ansiedade e depressão: estudo de validade com pacientes no pré-operatório. Rev Bras Anestesiol. 2004;54:298.

Jenkins PL, May VE, Hughes LE. Psychological morbidity associated with local recurrence of breast cancer. Int J Psychiatry Med. 1991;21:149-155.

Carroll BT, Kathol RG, Noyes R Jr. Screening for depression and anxiety in cancer patients using the hospital anxiety and depression scale. Gen Hosp Psychiatry. 1993;15:69-74.

Friedman LC, Lehane D, Webb JA. Anxiety in medical situations and chemotherapy-related problems among cancer patients. J Cancer Educ. 1994;9:37-41.

Breitbart W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer. 1995;3:45-60.

McDaniel JS, Musselman DL, Porter M. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry. 1995;52:89-99.

Ballone GJ. Ansiedade no paciente com câncer. 2001.

Winell J, Roth AJ. Depression in cancer patients. Oncology. 2004;18:1554-1560.

Bailey RK, Geyen DJ, Scott-Gurnell K. Understanding and treating depression among cancer patients. Int J Gynecol Cancer. 2005;15:203-208.

Bottomley A. Psychosocial problems in cancer care: a brief review of common problems. J Psychiatr Mental Health Nurs. 1997;4:323-331.

Braz DS, Ribas MM, Dedivitis RA. Quality of life and depression in patients undergoing total and partial laryngectomy. Clinics. 2005;60:135-142.

Kathol RG, Mutgi A, Williams J. Diagnosis of major depression in cancer patients according to four sets of criteria. Am J Psychiatry. 1990;147:1021-1024.

Razavi D, Delvaux N, Farvacques C. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry. 1990;156:79-83.

Ibbotson T, Maguire P, Selby P. Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer. 1994;30:37-40.

Ramirez AJ, Richards MA, Jarrett SR. Can mood disorder in women with breast cancer be identified preoperatively?. Br J Cancer. 1995;72:1509-1512.

Grassi L, Travado L, Moncayo FL. Psychosocial morbidity and its correlates in cancer patients of the Mediterranean area: findings from the Southern European Psycho-Oncology Study. J Affect Disord. 2004;83:243-248.

Mystakidou K, Tsilika E, Parpa E. The hospital anxiety and depression scale in Greek cancer patients: psychometric analyses and applicability. Support Care Cancer. 2004;12:821-825.

Gil F, Grassi L, Travado L. Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Support Care Cancer. 2005;13:600-606.

Mohamed IE, Skeel Williams K, Tamburrino M. Understanding locally advanced breast cancer: what influences a woman's decision to delay treatment?. Prev Med. ;2005:399-405.

Morris T, Greer HS, White P. Psychological and social adjustment to mastectomy: a two year follow up study. Cancer. 1977;40:2381-2387.

Maguire P, Lee EG, Bevington DJ. Psychiatric problems in the first year after mastectomy. Br Med J. 1978;1(6118):963-965.

Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89:1346-1351.

Caumo W, Schmidt AP, Schneider CN. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45:298-307.

Yan H, Sellick K. Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer. Cancer Nurs. 2004;27:389-399.

Burgess C, Cornelius V, Love S. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330:702-710.

Carlsen K, Jensen AB, Jacobsen E. Psychosocial aspects of lung cancer. Lung Cancer. 2005;47:293-300.

Ell K, Sanchez K, Vourlekis B. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol. 2005;23:3052-3060.

Malyszczak K, Tomasz W, Mazur G. Anxiety and depressive symptoms in patients treated due to haematologic malignancies. Psychiatr Pol. 2005;39:33-40.

O'Mahony S, Goulet J, Kornblith A. Desire for hastened health, cancer pain and depression: report of a longitudinal observational study. J Pain Symptom Manage. 2005;29:446-457.

Sarna L, Brown JK, Cooley ME. Quality of life and meaning of illness of women with lung cancer. Oncol Nurs Forum. 2005;32:E9-E19.

Zhou FL, Zhang WG, Wei YC. Impact of comorbid anxiety and depression on quality of life and cellular immunity changes in patients with digestive tract cancers. World J Gastroenterol. 2005;211:2313-2318.

Bondy LR, Sims N, Schroeder DR. The effect of anesthetic patient education on preoperative patient anxiety. Reg Anesth Pain Med. 1999;24:158-164.

Macuco MV, Macuco OC, Bedin A. Efeito de um consultório de anestesiologia sobre as preocupações, percepções e preferências relacionadas à anestesia: Comparação entre o sexo masculino e feminino. Rev Bras Anestesiol. 1999;49:179-189.

Castiglia YMM. Avaliação Pré-Anestésica. Temas de Anestesiologia. 2000:15-19.

Roizen MF. More preoperative assessment by physicians and less by laboratory tests. N Engl J Med. 2000;342:204-205.

Mackenzie JW. Daycase anaesthesia and anxiety: A study of anxiety profiles amongst patients attending a day bed unit. Anaesthesia. 1989;44:437-440.

Kiyohara LY, Kayano LK, Oliveira LM. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:51-56.

Shuldham C. A review of the impact of pre-operative education on recovery from surgery. Int J Nurs Stud. 1999;36:171-177.

Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry. 1990;51:12-17.

Hipkins J, Whitworth M, Tarrier N. Social support, anxiety and depression after chemotherapy for ovarian cancer: a prospective study. Br J Health Psychol. 2004;9:569-581.

Hwang SS, Chang VT, Cogswell J. Study of unmet needs in symptomatic veterans with advanced cancer: incidence, independent predictors and unmet needs outcome model. J Pain Symptom Manage. 2004;28:421-432.

Rihmer Z, Angst L. Mood Disorders: Epidemiology. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 2005:1575-1582.

Westbrook MT, Viney LL. Age and sex differences in patients' reactions to illness. J Health Soc Behav. 1983;24:313-324.

Smith AB, Selby PJ, Velikova G. Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother. 2002;75:165-176.

Dean C. Psychiatric morbidity following mastectomy: preoperative predictors and types of illness. J Psychosom. 1987;31:385-392.

Metzger LF, Rogers BF, Bauman LJ. Effects of age and marital statues on emotional distress after mastectomy. J Psychos Oncol. 1983;1:17-33.

Ohara-Hirano Y, Kaku T, Hirakawa T. Uterine cervical cancer: a holistic approach to mental health and its socio-psychological implications. Fukuoka Igaku Zasshi. 2004;95:183-194.

Stommel M, Kurtz ME, Kurtz JC. A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate. Health Psychol. 2004;23:564-573.

Iqbal A. Common types of mental disorders in adult cancer patients seen at Shaukat Khanum Memorial Cancer Hospital and Research Centre. J Ayub Med Coll Abbottabad. 2004;16:65-69.

Kash KM, Mago R, Kunkel EJ. Psychosocial oncology: supportive care for the cancer patient. Semin Oncol. 2005;32:211-218.

Mainio A, Hakko H, Timonen M. Depression in relation to survival among neurosurgical patients with a primary brain tumor: a 5-year follow-up study. Neurosurgery. 2005;56:1234-1241.

Ryan H, Schofield P, Cockburn J. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care. 2005;14:7-15.

Rispoli A, Pavone I, Bongini A. Genitourinary cancer: psychological assessment and gender differences. Urol Int. 2005;74:246-249.

Moerman N, Van Dam FS, Muller MJ. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996;82:445-451.

Gilbody SM, House AO, Sheldon TA. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ. 2001;322:406-409.

5dd433c70e8825d146c63493 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections