Uncovering the psychological impact: tailoring preoperative care for colorectal cancer patients

Background: Colorectal cancer surgery preparation can lead to significant psychological distress, with patients often experiencing heightened anxiety and depression. Psychological prehabilitation, a growing focus in gastrointestinal care, aims to improve psychological wellbeing and aid recovery, but existing literature has primarily focused on general anxiety reduction. However, there is limited consensus on the specific targets of prehabilitation, and evidence of its effectiveness in improving psychological well-being remains scarce. Aims: To enhance the understanding of colorectal cancer patients' psychological needs before surgery and inform the development of psychologically supportive care strategies tailored to this patient group. Methods: This exploratory study included two parts: (1) 69 consecutive colorectal cancer patients, including 26 who received psychological prehabilitation, completed the Hospital Anxiety and Depression Scale 3-4 weeks before surgery and again three months postoperatively; (2) semi-structured interviews were conducted with 13 patients who had undergone colorectal cancer surgery in the past six months, 2 relatives, and 8 multidisciplinary health professionals, exploring the psychological impact of preparing for colorectal surgery. Findings: Before surgery, 46% of patients reported clinically significant anxiety, and 48% reported clinically significant depression. Post-surgery, anxiety levels generally decreased, particularly in those who received psychological prehabilitation, which resulted in a clinically significant reduction. However, depression scores remained unchanged. Thematic analysis of interviews revealed that many patients experienced anticipatory anxiety, especially related to the formation of a stoma. Patients emphasised the need for personalised, tailored information to aid in their adjustment during this period, highlighting a crucial role for care providers in providing psychological support. Conclusion: The study highlights the complex psychological concerns of colorectal cancer patients before surgery, suggesting that psychological prehabilitation should be individualized for those with elevated distress. Care teams should be equipped with the skills to deliver psychologically supportive care, with a focus on providing tailored information, especially regarding stoma formation. This research underscores the critical role of gastrointestinal care providers in managing both the physical and psychological well-being of patients undergoing colorectal surgery.