Cancer Patients and Anxiety in the Pre-Surgical Ambulatory Setting

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Introduction / Purpose: This primary research is aimed at identifying and scoring pre-procedural anxiety in cancer patients that undergo outpatient port placement. Identification of signs and symptoms of heightened levels of anxiety is common in the surgical setting. Determining a baseline level of anxiety in cancer patients can guide future studies and aid in determining proper protocols to plan for and treat anxiety in the outpatient setting. Hopefully, the future will consist of a routine anxiety score upon diagnosis and treatment options can be discussed early in the disease progress. Methods: Evaluation of anxiety levels will be assessed using the General Anxiety Disorder scale (GAD 7) as it is the most frequently used assessment tool for measuring anxiety levels in patients (Jordan, Shedden-Mora, & Löwe, 2017). The patients will be asked to self-score their anxiety levels upon arrival at the out-patient center on the morning of their port placement. The self_x0002_scoring assessment will provide useful data information to assist and guide the anesthesia clinician to properly evaluate and treat anxiety both pre-procedurally and intra-operatively. The anesthesia model selected for this evaluation will be limited to monitored anesthesia care (MAC)/ conscious sedation cases in the outpatient setting. Results: 5 Results after project completion revealed that 31.25% of participants scored ten or greater on the GAD 7 assessment tool used in pre-operative holding. Eleven males and twenty-one females participated in the study (N=32). A score of 10 or greater is considered significant and that anxiety is present (Jordan et al., 2017). The average age of the participants was 63 with a standard deviation of 11.9. The participants average weight in kilograms was 77.03. The anesthesia time in minutes from in the operating room until recovery hand-off in the post anesthesia care unit (PACU) averaged 57.19 minutes. Intravenous fentanyl average dose was 106.25 mcg and midazolam averaged 4.17 mg per participant. Of the participants that scored greater than 10 on the GAD 7 tool, 50% were males. Thusly, male cancer patients experienced heightened anxiety at a greater level of 45.4% whereas the female participants only reported heightened anxiety 23.8% of the time. The most prevalent cancer diagnosis in the convenience sample was lung cancer at a rate of 21.8%. Discussion: Surgery in an outpatient setting is quite common, it is also routine to be nervous or anxious on the day of the procedure. Generalized anxiety is a disorder that interferes with daily functioning and those that experience this phenomenon are overly concerned about routine matters such as health, finances, death, work related problems and inter-personal relationships. Symptoms can include excessive worry, intestinal issues, insomnia, irritability, exhaustion, trembling, muscle tension and aches, and can sometimes lead to more serious additional psychiatric issues (Mayo Clinic, 2018). 6 Based on the findings of the study this investigator recommends follow-up studies regarding anxiety recognition in patients diagnosed with cancer, and that early intervention and treatment options be discussed with patients and their caregivers. Future studies should aim at prevention of generalized anxiety disorders by treating anxiety with the initial diagnosis of cancer. Further studies should be aimed at prevention of anxiety in males that are facing cancer. This study finds that men experience anxiety at a much greater level than female patients and a larger study should be completed to confirm this finding. Additional studies should aim at treatment options and then after treatment do a repeat evaluation of anxiety levels with a proper scoring tool to evaluate and compare treatment modalities within this patient population . Expanding on existing studies should include males with anxiety when facing a cancer diagnosis, as well as statistical data on the quantitative data available for those that are being treated. Studies should be completed evaluating the use of anxiety evaluations for patients newly diagnosed with cancer and explore what treatment modalities provide the most appropriate relief for this patient population. Overall, further research should be done to expand on generalized anxiety disorders for cancer patients and anxiety evaluations should be considered as part of the full physical assessment for these patients. A gap in care exists between patient diagnosis of cancer and port placement for chemotherapy. Additional studies can be compiled to compare port placement surgery with tumor reduction or any surgery a cancer patient may face. Because cancer patients are diagnosed by routine findings on exam with their primary care physician, the referral process can be 7 overwhelming and rapid causing the diagnosis of anxiety to be of little importance. At times, this referral process to oncology, radiation, or surgery is rapid and necessary for proper treatment and best outcomes causes the patient to experience a myriad of emotional challenges. Anxiety is a commonly undiagnosed problem. Because nearly one-third of participants in this study reported significant anxiety, physicians should include an anxiety assessment as part of the clinical plan for cancer patients undergoing treatment. Proper recognition and consideration of anxiety issues will lead to better patient care and planning and provide a more wholistic plan of care for this patient population and the unique set of circumstances in which they find themselves.

Anxiety, peri-operative, cancer, port placement, Gad 7, MAC sedation