Research progress on perioperative depression and anxiety and related interventions in lung cancer patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUAN Xinyu ¹ , XU Zijian ² , LIN Nengke ¹ , CHEN Zhiming ¹ , WANG Zhizhi ¹ , XU Jiansong ¹ , CHEN Jinyu ² , LI Shaobin ¹ , FENG Siyang ¹ ,  LU Di ¹ ,  CAI Kaican ¹

1. Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P. R. China;
2. Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P. R. China;

Corresponding author：

LU Di, Email: david_lu1989@163.com; CAI Kaican, Email: doc_cai@163.com

Keywords：

Lung cancer surgery; lung injury; depression; anxiety; protective measures; accelerated recovery; treatment; review

DOI：

10.7507/1007-4848.202501061

Video：

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[Abstract] Psychological problems are significant factors that contribute to the occurrence of postoperative complications, reduced quality of life, and prolonged hospital stays. Lung cancer patients who require surgery often experience high psychological stress related to both the disease and the treatment, making them more susceptible to depression and anxiety. Therefore, timely intervention to address these psychological issues is crucial for promoting postoperative recovery and improving patients' quality of life. This paper will review the current status, impact, and interventions for depression and anxiety-related psychological problems in lung cancer surgery patients.

1.	Park S, Kang CH, Hwang Y, et al. Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer. Eur J Cardiothorac Surg, 2016, 49(1): e16-e21.
2.	Paredes AZ, Hyer JM, Diaz A, et al. The impact of mental illness on postoperative outcomes among medicare beneficiaries: A missed opportunity to help surgical patients? Ann Surg, 2020, 272(3): 419-425.
3.	Krebber AMH, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psychooncology, 2014, 23(2): 121-130.
4.	Velasco-Durantez V, Cruz-Castellanos P, Hernandez R, et al. Prospective study of predictors for anxiety, depression, and somatization in a sample of 1807 cancer patients. Sci Rep, 2024, 14(1): 3188.
5.	Adzrago D, Williams DR, Williams F. Multiple chronic diseases and psychological distress among adults in the United States: The intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage. Soc Psychiatry Psychiatr Epidemiol, 2025, 60(1): 181-199.
6.	Naser AY, Hameed AN, Mustafa N, et al. Depression and anxiety in patients with cancer: A cross-sectional study. Front Psychol, 2021, 12: 585534.
7.	Henson KE, Brock R, Charnock J, et al. Risk of suicide after cancer diagnosis in England. JAMA Psychiatry, 2019, 76(1): 51-60.
8.	Guo C, Huang X. Hospital anxiety and depression scale exhibits good consistency but shorter assessment time than Zung self-rating anxiety/depression scale for evaluating anxiety/depression in non-small cell lung cancer. Medicine (Baltimore), 2021, 100(8): e24428.
9.	Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1(3): 385-401.
10.	Zung WW. A rating instrument for anxiety disorders. Psychosomatics, 1971, 12(6): 371-379.
11.	Jarvis CA, Bonney PA, Yuan E, et al. Comorbid depression in surgical cancer patients associated with non-routine discharge and readmission. Surg Oncol, 2021, 37: 101533.
12.	Lee Y, Hung CF, Chien CY, et al. Comparison of prevalence and associated factors of depressive disorder between patients with head and neck cancer and those with lung cancer at a tertiary hospital in Taiwan: A cross-sectional study. BMJ Open, 2020, 10(6): e037918.
13.	Vijayvergia N, Shah PC, Denlinger CS. Survivorship in non-small cell lung cancer: Challenges faced and steps forward. J Natl Compr Canc Netw, 2015, 13(9): 1151-1161.
14.	王高祥, 章俊强, 吴明胜, 等. 肺部手术后慢性咳嗽诊疗中国专家共识. 中国胸心血管外科临床杂志, 2024, 31(1): 1-10.Wang GX, Zhang JQ, Wu MS, et al. Chinese expert consensus on the diagnosis and treatment of chronic cough after lung surgery. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(1): 1-10.
15.	Dicpinigaitis PV, Tso R, Banauch G. Prevalence of depressive symptoms among patients with chronic cough. Chest, 2006, 130(6): 1839-1843.
16.	Yan F, Yuan LH, He X, et al. Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients. World J Psychiatry, 2024, 14(6): 930-937.
17.	Ju X, Feng J, Yang J, et al. Factors influencing the preoperative anxiety in lung cancer patients undergoing video-assisted thoracoscopic surgery: The role of information needs, illness perception and patient trust. J Psychosom Res, 2023, 172: 111374.
18.	Rosenberger EM, DiMartini AF, DeVito Dabbs AJ, et al. Psychiatric predictors of long-term transplant-related outcomes in lung transplant recipients. Transplantation, 2016, 100(1): 239-247.
19.	Ran J, Wang J, Bi N, et al. Health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancer. Radiat Oncol, 2017, 12(1): 195.
20.	Myrdal G, Valtysdottir S, Lambe M, et al. Quality of life following lung cancer surgery. Thorax, 2003, 58(3): 194-197.
21.	Kim JY, Sun V, Raz DJ, et al. The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers. Lung Cancer, 2016, 101: 35-39.
22.	Chen M, Huang Y, Zhang J, et al. Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study. Eur J Surg Oncol, 2024, 50(10): 108605.
23.	Berggreen C, Schrøder JH, Christensen T, et al. To inform or not to inform about venous thromboembolisms: A qualitative study on communication between healthcare professionals and patients with lung cancer. Thromb Res, 2024, 243: 109132.
24.	Pinquart M, Duberstein PR. Depression and cancer mortality: A meta-analysis. Psychol Med, 2010, 40(11): 1797-1810.
25.	Lee S, Xue Y, Petricca J, et al. The impact of pre-operative depression on pain outcomes after major surgery: A systematic review and meta-analysis. Anaesthesia, 2024, 79(4): 423-434.
26.	Danielsen AV, Andreasen JJ, Dinesen B, et al. Pain trajectories and neuropathic pain symptoms following lung cancer surgery: A prospective cohort study. Eur J Pain, 2024, 28(8): 1343-1355.
27.	Feinstein MB, Krebs P, Coups EJ, et al. Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. J Thorac Oncol, 2010, 5(8): 1221-1226.
28.	Jeantieu M, Gaillat F, Antonini F, et al. Postoperative pain and subsequent PTSD-related symptoms in patients undergoing lung resection for suspected cancer. J Thorac Oncol, 2014, 9(3): 362-369.
29.	Merlo A, Carlson R, Espey J, et al. Postoperative symptom burden in patients undergoing lung cancer surgery. J Pain Symptom Manage, 2022, 64(3): 254-267.
30.	Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, et al. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer, 2022, 30(2): 1579-1586.
31.	Hou T, Peng W, Ho MH, et al. Factors associated with cancer-related cognitive impairment in patients with lung cancer: A systematic review. Eur J Oncol Nurs, 2024, 71: 102657.
32.	Andersen BL, Valentine TR, Lo SB, et al. Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms. Lung Cancer, 2020, 145: 195-204.
33.	Wu XN, Su D, Li HP, et al. Relationship between the depression status of patients with resectable non-small cell lung cancer and their family members in China. Eur J Oncol Nurs, 2013, 17(5): 668-672.
34.	Zhao L, Ma L, Chen X, et al. Psychological nursing intervention improve the mental health status of young patients with lung cancer surgery during the perioperative period. Medicine (Baltimore), 2021, 100(31): e26736.
35.	Li S, Ding X, Zhao Y, et al. Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: A retrospective cohort study. BMC Anesthesiol, 2021, 21(1): 281.
36.	Wang M, Sun Y, Zhang M, et al. Effects of high-quality nursing care on quality of life, survival, and recurrence in patients with advanced non-small cell lung cancer. Medicine (Baltimore), 2022, 101(37): e30569.
37.	Mulick A, Walker J, Puntis S, et al. Does depression treatment improve the survival of depressed patients with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials. Lancet Psychiatry, 2018, 5(4): 321-326.
38.	Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): A multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol, 2014, 15(10): 1168-1176.
39.	Cetkin HE, Tuna A. How does health education given to lung cancer patients before thoracotomy affect pain, anxiety, and respiratory functions? J Cancer Educ, 2019, 34(5): 966-972.
40.	Lu HB, Wang YQ, Liu X, et al. Effects of preoperative high-intensity interval training combined with team empowerment education in lung cancer patients with surgery: A quasi-experimental trial. Cancer Nurs, 2023.
41.	Krebber AMH, Jansen F, Witte BI, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: A randomized, controlled trial. Ann Oncol, 2016, 27(9): 1754-1760.
42.	Zhu J, Chen SH, Guo JY, et al. Effect of digital storytelling intervention on resilience, self-efficacy and quality of life among patients with non-small cell lung cancer (NSCLC): A randomized controlled trial. Eur J Oncol Nurs, 2024, 69: 102535.
43.	Cox CE, Porter LS, Hough CL, et al. Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers. Intensive Care Med, 2012, 38(8): 1289-1297.
44.	Sui Y, Wang T, Wang X. The impact of WeChat app-based education and rehabilitation program on anxiety, depression, quality of life, loss of follow-up and survival in non-small cell lung cancer patients who underwent surgical resection. Eur J Oncol Nurs, 2020, 45: 101707.
45.	Zhou J, Chen H, Wu Y, et al. Evaluation of the application effect of WeChat platform-based communication mode in family members of patients after partial pulmonary resection in the anesthesia intensive care unit. Am J Health Behav, 2022, 46(6): 637-642.
46.	Wang F, Zhang S, Song B, et al. Anxiety, depression, and quality of life in postoperative non-small cell lung cancer patients under the intervention of cognitive-behavioral stress management. Front Psychol, 2023, 14: 1138070.
47.	Chen CY, Ding H, Wang SS. Effectiveness of Roy adaptation model-based cognitive stimulation therapy in elderly patients with non-small cell lung cancer undergoing curative resection. Tohoku J Exp Med, 2024, 263(1): 27-34.
48.	Yuan Z, Gao L, Zheng M, et al. Effect of multimodal health education combined with the feedback method in perioperative patients with lung cancer: A randomised controlled study. Patient Prefer Adherence, 2023, 17: 413-420.
49.	Lu HB, Ma RC, Yin YY, et al. Clinical indicators of effects of yoga breathing exercises on patients with lung cancer after surgical resection: A randomized controlled trial. Cancer Nurs, 2023. Epub ahead of print.
50.	Raz DJ, Sun V, Kim JY, et al. Long-term effect of an interdisciplinary supportive care intervention for lung cancer survivors after surgical procedures. Ann Thorac Surg, 2016, 101(2): 495-502.

1. Park S, Kang CH, Hwang Y, et al. Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer. Eur J Cardiothorac Surg, 2016, 49(1): e16-e21.
2. Paredes AZ, Hyer JM, Diaz A, et al. The impact of mental illness on postoperative outcomes among medicare beneficiaries: A missed opportunity to help surgical patients? Ann Surg, 2020, 272(3): 419-425.
3. Krebber AMH, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psychooncology, 2014, 23(2): 121-130.
4. Velasco-Durantez V, Cruz-Castellanos P, Hernandez R, et al. Prospective study of predictors for anxiety, depression, and somatization in a sample of 1807 cancer patients. Sci Rep, 2024, 14(1): 3188.
5. Adzrago D, Williams DR, Williams F. Multiple chronic diseases and psychological distress among adults in the United States: The intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage. Soc Psychiatry Psychiatr Epidemiol, 2025, 60(1): 181-199.
6. Naser AY, Hameed AN, Mustafa N, et al. Depression and anxiety in patients with cancer: A cross-sectional study. Front Psychol, 2021, 12: 585534.
7. Henson KE, Brock R, Charnock J, et al. Risk of suicide after cancer diagnosis in England. JAMA Psychiatry, 2019, 76(1): 51-60.
8. Guo C, Huang X. Hospital anxiety and depression scale exhibits good consistency but shorter assessment time than Zung self-rating anxiety/depression scale for evaluating anxiety/depression in non-small cell lung cancer. Medicine (Baltimore), 2021, 100(8): e24428.
9. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1977, 1(3): 385-401.
10. Zung WW. A rating instrument for anxiety disorders. Psychosomatics, 1971, 12(6): 371-379.
11. Jarvis CA, Bonney PA, Yuan E, et al. Comorbid depression in surgical cancer patients associated with non-routine discharge and readmission. Surg Oncol, 2021, 37: 101533.
12. Lee Y, Hung CF, Chien CY, et al. Comparison of prevalence and associated factors of depressive disorder between patients with head and neck cancer and those with lung cancer at a tertiary hospital in Taiwan: A cross-sectional study. BMJ Open, 2020, 10(6): e037918.
13. Vijayvergia N, Shah PC, Denlinger CS. Survivorship in non-small cell lung cancer: Challenges faced and steps forward. J Natl Compr Canc Netw, 2015, 13(9): 1151-1161.
14. 王高祥, 章俊强, 吴明胜, 等. 肺部手术后慢性咳嗽诊疗中国专家共识. 中国胸心血管外科临床杂志, 2024, 31(1): 1-10.Wang GX, Zhang JQ, Wu MS, et al. Chinese expert consensus on the diagnosis and treatment of chronic cough after lung surgery. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(1): 1-10.
15. Dicpinigaitis PV, Tso R, Banauch G. Prevalence of depressive symptoms among patients with chronic cough. Chest, 2006, 130(6): 1839-1843.
16. Yan F, Yuan LH, He X, et al. Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients. World J Psychiatry, 2024, 14(6): 930-937.
17. Ju X, Feng J, Yang J, et al. Factors influencing the preoperative anxiety in lung cancer patients undergoing video-assisted thoracoscopic surgery: The role of information needs, illness perception and patient trust. J Psychosom Res, 2023, 172: 111374.
18. Rosenberger EM, DiMartini AF, DeVito Dabbs AJ, et al. Psychiatric predictors of long-term transplant-related outcomes in lung transplant recipients. Transplantation, 2016, 100(1): 239-247.
19. Ran J, Wang J, Bi N, et al. Health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancer. Radiat Oncol, 2017, 12(1): 195.
20. Myrdal G, Valtysdottir S, Lambe M, et al. Quality of life following lung cancer surgery. Thorax, 2003, 58(3): 194-197.
21. Kim JY, Sun V, Raz DJ, et al. The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers. Lung Cancer, 2016, 101: 35-39.
22. Chen M, Huang Y, Zhang J, et al. Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study. Eur J Surg Oncol, 2024, 50(10): 108605.
23. Berggreen C, Schrøder JH, Christensen T, et al. To inform or not to inform about venous thromboembolisms: A qualitative study on communication between healthcare professionals and patients with lung cancer. Thromb Res, 2024, 243: 109132.
24. Pinquart M, Duberstein PR. Depression and cancer mortality: A meta-analysis. Psychol Med, 2010, 40(11): 1797-1810.
25. Lee S, Xue Y, Petricca J, et al. The impact of pre-operative depression on pain outcomes after major surgery: A systematic review and meta-analysis. Anaesthesia, 2024, 79(4): 423-434.
26. Danielsen AV, Andreasen JJ, Dinesen B, et al. Pain trajectories and neuropathic pain symptoms following lung cancer surgery: A prospective cohort study. Eur J Pain, 2024, 28(8): 1343-1355.
27. Feinstein MB, Krebs P, Coups EJ, et al. Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. J Thorac Oncol, 2010, 5(8): 1221-1226.
28. Jeantieu M, Gaillat F, Antonini F, et al. Postoperative pain and subsequent PTSD-related symptoms in patients undergoing lung resection for suspected cancer. J Thorac Oncol, 2014, 9(3): 362-369.
29. Merlo A, Carlson R, Espey J, et al. Postoperative symptom burden in patients undergoing lung cancer surgery. J Pain Symptom Manage, 2022, 64(3): 254-267.
30. Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, et al. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer, 2022, 30(2): 1579-1586.
31. Hou T, Peng W, Ho MH, et al. Factors associated with cancer-related cognitive impairment in patients with lung cancer: A systematic review. Eur J Oncol Nurs, 2024, 71: 102657.
32. Andersen BL, Valentine TR, Lo SB, et al. Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms. Lung Cancer, 2020, 145: 195-204.
33. Wu XN, Su D, Li HP, et al. Relationship between the depression status of patients with resectable non-small cell lung cancer and their family members in China. Eur J Oncol Nurs, 2013, 17(5): 668-672.
34. Zhao L, Ma L, Chen X, et al. Psychological nursing intervention improve the mental health status of young patients with lung cancer surgery during the perioperative period. Medicine (Baltimore), 2021, 100(31): e26736.
35. Li S, Ding X, Zhao Y, et al. Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: A retrospective cohort study. BMC Anesthesiol, 2021, 21(1): 281.
36. Wang M, Sun Y, Zhang M, et al. Effects of high-quality nursing care on quality of life, survival, and recurrence in patients with advanced non-small cell lung cancer. Medicine (Baltimore), 2022, 101(37): e30569.
37. Mulick A, Walker J, Puntis S, et al. Does depression treatment improve the survival of depressed patients with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials. Lancet Psychiatry, 2018, 5(4): 321-326.
38. Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): A multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol, 2014, 15(10): 1168-1176.
39. Cetkin HE, Tuna A. How does health education given to lung cancer patients before thoracotomy affect pain, anxiety, and respiratory functions? J Cancer Educ, 2019, 34(5): 966-972.
40. Lu HB, Wang YQ, Liu X, et al. Effects of preoperative high-intensity interval training combined with team empowerment education in lung cancer patients with surgery: A quasi-experimental trial. Cancer Nurs, 2023.
41. Krebber AMH, Jansen F, Witte BI, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: A randomized, controlled trial. Ann Oncol, 2016, 27(9): 1754-1760.
42. Zhu J, Chen SH, Guo JY, et al. Effect of digital storytelling intervention on resilience, self-efficacy and quality of life among patients with non-small cell lung cancer (NSCLC): A randomized controlled trial. Eur J Oncol Nurs, 2024, 69: 102535.
43. Cox CE, Porter LS, Hough CL, et al. Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers. Intensive Care Med, 2012, 38(8): 1289-1297.
44. Sui Y, Wang T, Wang X. The impact of WeChat app-based education and rehabilitation program on anxiety, depression, quality of life, loss of follow-up and survival in non-small cell lung cancer patients who underwent surgical resection. Eur J Oncol Nurs, 2020, 45: 101707.
45. Zhou J, Chen H, Wu Y, et al. Evaluation of the application effect of WeChat platform-based communication mode in family members of patients after partial pulmonary resection in the anesthesia intensive care unit. Am J Health Behav, 2022, 46(6): 637-642.
46. Wang F, Zhang S, Song B, et al. Anxiety, depression, and quality of life in postoperative non-small cell lung cancer patients under the intervention of cognitive-behavioral stress management. Front Psychol, 2023, 14: 1138070.
47. Chen CY, Ding H, Wang SS. Effectiveness of Roy adaptation model-based cognitive stimulation therapy in elderly patients with non-small cell lung cancer undergoing curative resection. Tohoku J Exp Med, 2024, 263(1): 27-34.
48. Yuan Z, Gao L, Zheng M, et al. Effect of multimodal health education combined with the feedback method in perioperative patients with lung cancer: A randomised controlled study. Patient Prefer Adherence, 2023, 17: 413-420.
49. Lu HB, Ma RC, Yin YY, et al. Clinical indicators of effects of yoga breathing exercises on patients with lung cancer after surgical resection: A randomized controlled trial. Cancer Nurs, 2023. Epub ahead of print.
50. Raz DJ, Sun V, Kim JY, et al. Long-term effect of an interdisciplinary supportive care intervention for lung cancer survivors after surgical procedures. Ann Thorac Surg, 2016, 101(2): 495-502.

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