Identification and correction of preoperative anxiety factors in breast cancer patients

Diagnosis of cancer undeniably triggers significant stress in patients. Constant thoughts about upcoming treatments and fear of death increase anxiety inevitably. Consequently, this stress, intended as an adaptive mechanism, becomes distress associated with pathological reactions depleting the body. Clinical manifestations of stress may occur in perioperative period and complicate primary disease. Assessment of preoperative anxiety is important worldwide. However, none available method for identifying preoperative anxiety covers all predisposing factors and fears affecting psychological state. Objective. To identify specific anxiety factors concerning patients with their subsequent correction. Material and methods. The study enrolled 50 female breast cancer patients scheduled for mastectomy or breast resection. In the main group, patients underwent preoperative examination by anesthesiologist two weeks before surgery. The purpose of examination was to identify the main factors of anxiety according to original questionnaire for subsequent correction. In the control group, patients did not receive correction of anxiety factors. We analyzed anxiety levels considering salivary free cortisol and visual analogue scale. Results. According to univariate analysis, the main group was characterized by significantly lower VAS score of anxiety after conversation with anesthesiologist (6.4 [4.9; 7.6] vs. 1.8 [1.4; 3.3], p<0.001). Salivary cortisol two weeks before surgery (125.1 [88.9; 200.3] vs. 80 [55.3; 97.8]), immediately before surgery (116.1 [93.9; 206.2] vs. 95.1 [80; 119.4]), and three hours after surgery (129.7 [88.2; 230.4] vs. 82.7 [59.6; 105]) was significantly lower (p=0.002, p=0.007, p=0.007, respectively) in the main group. Conclusion. The questionnaire “Identification by anesthesiologist of the main preoperative anxiety factors” allows us to know the exact reasons of increased anxiety. Discussions addressing fears noted in the questionnaire reduce anxiety. This is confirmed by reduced number of fears upon re-surveying, VAS scores and free cortisol levels.