Family Squabbles Can Derail Recovery From Cancer Surgery

Study finds infection, other complications more likely for patients with difficult lives

Thursday, September 18, 2014

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THURSDAY, Sept. 18, 2014 (HealthDay News) -- Cancer patients burdened by stress and family conflicts before surgery may face a higher risk for complications following their operation, a new study suggests.

Investigators found that patients with a so-called quality-of-life "deficit" appeared to have a nearly three times greater risk for complications compared to those with a normal or good quality of life.

"We've long known that patient quality of life is a complex and important construction," said study lead author Dr. Juliane Bingener, a professor of surgery at the Mayo Clinic in Rochester, Minn. "It involves spiritual health, mental health, social support and family support. And we know that for cancers such as colon, pancreatic and lung cancer, it can predict overall survival. But what we didn't know is if it also correlates with complication risk following surgery."

What the researchers found, Bingener said, "is that if a patient has a deficit in their quality of life before surgery, then their risk for having a serious complication within the first two weeks following surgery is much higher than it is for patients with a good quality of life."

Post-surgical complications included fever, bleeding and infections, some of which were fatal.

The findings, published in a recent issue of the Journal of Gastrointestinal Surgery, were based on 431 colon cancer patients who underwent surgery in 1993. The study only found an association between quality of life and surgical outcomes; it did not prove cause and effect.

Patient surveys ranked quality of life on the basis of a wide range of physical, social and psychological measures, including pain, fatigue and nausea, as well as "distress" related to daily routines, the work environment, and interactions with family and friends.

The research team found that nearly one in five patients experienced some type of complication, including death in two cases, before hospital discharge.

Thirteen percent of patients were determined to have a relatively poor quality of life before surgery. That translated into a 16 percent risk for developing a serious complication while still in the hospital, the researchers said.

By comparison, those with better quality-of-life scores faced a complication risk of 6 percent.

"The situation is very individual for each patient. And other factors can play a major role in complication risk, such as a patient's age or the presence of other diseases," said Bingener. "But all things being equal, there was a very clear correlation between a poor quality of life and a higher risk for problems following surgery."

The role played by family members, caregivers and close friends can be important, Bingener suggested.

"Support can have a big influence on quality of life," she noted. While there's no cookie cutter recipe that everyone who wants to help can follow before surgery, she said simply being there and having a conversation to find out what the patient's needs are can help reduce worry and offer reassurance. "That in itself may ultimately boost quality of life," Bingener said.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, said the findings strike him as "reasonable," given the burden patients face while recovering from surgery.

"It's important to note that patients emerging from any type of surgery tend to do a lot better when they cooperate with the rehabilitation regimen set forth for them," he said. "But patients who feel stressed or depressed tend not to participate fully. If you're scared or in shock, you either don't do the exercises or you don't do them as vigorously as one should."

That can boost your odds for complications, Brawley said. For example, failing to do recommended breathing exercises can result in pneumonia, and refusing to walk or follow prescribed leg movements can lead to serious blood clots, he added.

"So, yes, the way people in a patient's circle handle the situation leading up to surgery can make a difference," Brawley said, adding it's important not to panic.

"The most helpful thing you can do," Brawley said, "is to try to have a positive attitude, and to choose to deal with what comes next as constructively as possible."

SOURCES: Juliane Bingener, M.D., professor, surgery, department of surgery, Mayo Clinic, Rochester, Minn.; Otis Brawley, M.D., chief medical officer, American Cancer Society, and professor, oncology and epidemiology, Emory University, Atlanta, Ga.; August 2014, Journal of Gastrointestinal Surgery

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