Integrated psychological resilience and nutritional support improves sleep, emotional wellbeing, inflammation, and clinical recovery in colon cancer: a randomized controlled trial

Psychological vulnerability, sleep disturbance, emotional distress, and malnutrition are common in colon cancer and impair recovery and survival. Integrated perioperative strategies remain underexplored. To evaluate whether combining psychological resilience training with individualized nutritional support improves co-primary outcomes and to explore effects on recovery, inflammation, and survival after colon cancer surgery. In this randomized trial, 310 patients with stage I - III colon cancer were assigned to standard care or a 12-week integrated program. Co-primary outcomes were resilience (CD-RISC), sleep quality (PSQI), emotional distress (HADS), and nutritional status (albumin, prealbumin, BMI), assessed up to 24 months. Secondary outcomes included hospital stay, major complications (Clavien - Dindo ≥ III), systemic inflammation (CRP, IL-6, TNF-α), and 24-month disease-free survival (DFS) and overall survival (OS). Linear mixed-effects models were applied for longitudinal endpoints and Cox regression for survival. All co-primary outcomes improved significantly in the intervention group (group×time, all <i>p</i> < 0.001). Effect sizes at 24 months were large for CD-RISC (d = 1.13) and PSQI (d = 1.07), and moderate for HADS (d ≈ 0.70). Nutritional recovery was faster, with normalization in 86.3% vs. 64.4% at 12 months (<i>p</i> = 0.002). Hospital stay was shorter (8.6 ± 1.7 vs. 10.1 ± 2.3 days; <i>p</i> < 0.001), and major complications reduced (7.7% vs. 15.5%; <i>p</i> = 0.050). Inflammatory markers were lower (all <i>p</i> < 0.001). As exploratory outcomes, 24-month DFS (82.3% vs. 67.4%; <i>p</i> = 0.004) and OS (87.1% vs. 72.6%; <i>p</i> = 0.003) were higher in the intervention group. An integrated perioperative program of resilience training and nutritional support produced sustained improvements in psychobehavioral and nutritional outcomes, with favorable biological and exploratory survival effects.