Investigating distress levels in patients with metastatic spine disease undergoing surgical intervention

Abstract

Objective: Cancer patients often experience high levels of distress, which are particularly pronounced in the perioperative period. However, there is a dearth of research on distress rates in patients with metastatic spine disease (MSD). This study aims to assess pre- and postoperative distress levels in patients with MSD undergoing surgical intervention, as well as the association between distress and sociodemographic factors.

Methods: The authors retrospectively queried electronic medical records from a single institution for demographic and clinical data on patients with MSD who underwent surgical intervention between 2015 and 2023. Data included pre- (within 30 days of surgery) and postoperative (within 30 and 90 days of surgery) National Comprehensive Cancer Network's distress thermometer (NCCN-DT) scores. The proportion of patients with clinically significant distress (DT score ≥ 4) at each time point was examined, as well as changes between baseline distress and distress 30 days postoperatively. The association between clinically significant distress and sex, age, race/ethnicity, and marital status was assessed. A p value < 0.05 was considered significant.

Results: The study identified 265 patients with complete NCCN-DT questionnaires. Nearly half (47.5%) of the patients were female, with 66.0% identifying as Caucasian/White. The mean (± standard deviation) age at surgery was 61.4 ± 12.1 years. Preoperatively, the mean distress score was 3.6 ± 3.1 (range 0-10), with 89 (46.4%) of 192 patients reporting moderate to severe distress (DT ≥ 4). The mean distress score at 30 days postoperatively was 3.2 ± 3.0 (range 0-10), with 43.8% of patients reporting moderate to severe distress. At 90 days postoperatively, the mean distress score was 2.3 ± 2.5 (range 0-9) with 26.6% of patients reporting moderate to severe levels. Non-White patients had significantly higher preoperative distress than their White counterparts (p = 0.03).

Conclusions: Distress is a common experience among patients with MSD undergoing surgical intervention. Preoperatively, nearly half of these patients report moderate to severe distress, with distress levels remaining elevated through the 1st month after surgery. These findings highlight the critical need for timely psychosocial interventions to address distress at key stages of the surgical process. Race-based differences in distress rates emphasize the importance of developing targeted support strategies for more vulnerable groups.

Keywords: MSD; disparities; distress; metastatic spine disease; spine tumor.