Causes and alleviation of distress in patients with benign and malignant bone and soft-tissue tumors before and after orthopedic surgery: An observational study

Abstract

Introduction: Distress is common among cancer patients, especially in orthopedic oncology, but its perioperative course remains insufficiently explored

Objective: This study aimed, first, to describe the emotional distress experienced by patients with benign and malignant bone and soft-tissue tumors before orthopedic oncologic surgery and, second, to examine how the level of distress varied during hospitalization.

Methods: A retrospective observational study was performed, and patients admitted to the orthopedic oncology department were enrolled. Distress was recorded before and after surgery. A reduction of at least one point in the Distress Thermometer (DT) score was considered an improvement. Potential causes of distress were systematically documented. Data required for the study were extracted from patients’ medical records by a research nurse.

Results: During the study period, 319 patients were screened, of whom 119 were included in the analysis. The mean DT score was 5.2 at admission and 4.3 at discharge, with a statistically significant difference of 0.9 (95% confidence interval: 0.4–1.5; p <0.001). Pain was the main reported cause of distress at both admission and discharge. The presence of distress at admission, shorter duration of hospitalization, and receipt of psychological support were associated with a decrease in distress.

Conclusion: Perioperative distress in patients undergoing orthopedic oncologic surgery must be carefully monitored in clinical practice. Pre- to postoperative distress showed a favorable trajectory, with a significant reduction observed. Pain and emotional problems were identified as the main sources of distress, though with different trajectories: increasing for pain and decreasing for anxiety. Targeted pain management and psychological support pathways should be encouraged for these patients.

Keywords

Distress / Bone neoplasms / Sarcoma / Hospitalization / Orthopedic procedures

Acknowledgements

None.

Funding

This research was funded by the Italian Ministry of Health through the 5×Mille program 2021 (2020 income year) to the Rizzoli Orthopedics Institute (grant number: 5M-2021-23683816).

Conflict of interest

The authors declare that they have no competing interests

Author contributions

Conceptualization: Cristiana Forni, Felicia Iacovone, Daniela Di Nicolantonio

Formal analysis:Mattia Morri Funding: Mattia Morri, Cristiana Forni

Investigation: Felicia Iacovone, Grazia Lisciandrello, Francesca Corvino

Methodology: Mattia Morri, Cristiana Forni

Writing–original draft: Mattia Morri

Writing–review & editing: Davide Maria Donati, Daniela Di Nicolantonio

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Vast Area of Central Emilia (protocol no. 412/2024/Oss/IOR, 31/07/2024). Given the retrospective nature of the study, informed consent was not required.

Consent for publication

Given the retrospective nature of the study, informed consent was not required.

Availability of data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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