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Meta-Analysis
. 2025 Mar;14(6):e70456.
doi: 10.1002/cam4.70456.

Perioperative Trends in Distress Among Cancer Patients: A Systematic Review and Meta-Analysis

Dana G Rowe  1 , Ellen O'Callaghan  1 , Seeley Yoo  1 , Juliet C Dalton  1 , Joshua Woo  1 , Edwin Owolo  1 , Tara Dalton  2 , Margaret O Johnson  2 , Andrea N Goodwin  3 , Kerri-Anne Crowell  4 , Samantha Kaplan  5 , Melissa M Erickson  6 , C Rory Goodwin  2
Affiliations
Meta-Analysis

Perioperative Trends in Distress Among Cancer Patients: A Systematic Review and Meta-Analysis

Dana G Rowe et al. Cancer Med. 2025 Mar.

Abstract

Introduction: Distress is common among cancer patients, especially those undergoing surgery. However, no study has systematically analyzed distress trends in this population. The purpose of this study was to systematically review perioperative rates of distress, as well as differences across cancer types, in cancer patients undergoing surgical intervention.

Methods: A systematic review was conducted using PubMed, EMBASE, Scopus, and APA PsycINFO (searched until July 17, 2023). Included studies were clinical studies of cancer patients undergoing surgery reporting distress measured by the National Comprehensive Cancer Network (NCCN) distress thermometer (DT). Data on study and patient characteristics, and preoperative and postoperative distress rates were extracted. Results were pooled, and overall distress rates were calculated as weighted means. Subanalysis by cancer type was performed. Three meta-analyses were conducted: (1) preoperative distress, (2) postoperative distress, and (3) change in distress.

Results: Fifty-seven studies including 13,410 cancer patients were reviewed. Most patients were female (67.4%), White (77.8%), and married/partnered (72.2%), with an average age of 59.2 years. The most common cancers were breast (14 studies), brain (8), and colorectal (7). Weighted mean pre- and postoperative distress scores were 5.1 and 4.5, respectively. Distress remained high through 30 days postoperatively, then declined thereafter. Brain cancer patients reported the highest postoperative distress (5.1), followed by breast cancer patients (4.9).

Conclusion: The perioperative phase is a critical period of elevated distress in cancer patients. Preoperatively, patients experience moderate to severe levels of distress, which persist throughout the early postoperative phase, gradually declining from the 1-month postoperative mark onwards.

Keywords: HRQOL; cancer; distress; oncology surgery; perioperative; quality of life.

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Conflict of interest statement

Dana Rowe: Received grants from Duke Bass Connections, a Pfizer Foundation grant and the Duke Clinical Translational Science Institute (CTSI). C. Rory Goodwin: Received grants from the Robert Wood Johnson Harold Amos Medical Faculty Development Program, the Federal Food and Drug Administration, Duke Bass Connections, and the NIH 1R01DE031053‐01A1. Consultant for Stryker and Medtronic. Deputy Editor for Spine. Patent Application/invention disclosures outside of the current work. Melissa M. Erickson: Received grants from Duke Bass Connections. Consultant for Medtronic, Restor3D, Depuy Synthes, and Globus. Received fellowship funding from Globus/Nuvasive and Medtronic.

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(a) Forest plot of preoperative distress. (b) Forest plot of postoperative distress. (c) Forest plot of change in distress from preoperative to postoperative period.
FIGURE 2
FIGURE 2
Distress scores by perioperative time point.
FIGURE 3
FIGURE 3
Distress scores by perioperative time point.
FIGURE 4
FIGURE 4
Perioperative problem list concerns.
See this image and copyright information in PMC

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