Association between chronological depressive changes and physical symptoms in postoperative pancreatic cancer patients

Background: Pancreatic cancer (PC) has poorer prognosis and higher surgical invasiveness than many other cancers, with associated psychiatric symptoms including depression and anxiety. Perioperative depression has not been investigated in PC patients regarding surgical stress and relevant interventions. Methods: We evaluated chronological depressive changes and subjective physical symptoms in surgically treated PC patients preoperatively and at 3 and 6months postoperatively. Enrolled patients undergoing pancreatic tumor surgery completed questionnaires based on the Self-Rating Depression Scale (SDS) and Functional Assessment of Cancer Therapy for Patients with Hepatobiliary Cancer (FACT-Hep) preoperatively, and at 3 and 6months postoperatively. Responses were analyzed with JMP® Pro using one-way and two-way ANOVA, Spearman's rank correlation coefficient, and multiple regression analysis. Results: Malignancy was diagnosed in 73 of 101 patients postoperatively; SDS score was significantly higher in these patients than in those with benign tumors at all timepoints: malignant/benign, 41.8/37.9 preoperatively (p=0.004); 43.5/37.8 3months postoperatively (p=0.006); and 42.9/37.7 6months postoperatively (p=0.020). SDS scores were significantly higher in patients <65years old with malignancy at 3months than at 6months postoperatively (44.6/42.5, p=0.046) and in patients with malignancy who underwent pancreaticoduodenectomy at 3months postoperatively than preoperatively (43.4/41.1; p=0.028). SDS scores moderately correlated with 8 physical symptom-related FACT-Hep items 3months postoperatively (p<0.05), showing low-to-moderate correlation with 16 physical symptom-related FACT-Hep items at 6months postoperatively (p<0.05). Multiple regression analysis of FACT-Hep symptoms significantly correlated with SDS scores revealed the following significant variables: "lack of energy" (p<0.000) and "pain" (p=0.018) preoperatively (R²=0.43); "able to perform usual activities" (p=0.031) and "lack of energy" (p<0.000) at 3months postoperatively (R²=0.51); and "stomach swelling or cramps" (p=0.034) and "bowel control" (p=0.049) at 6months postoperatively (R²=0.52). Conclusions: PC patients experience persistently high levels of depression preoperatively through 6months postoperatively, with associated subjective symptoms including pain and gastrointestinal symptoms.