Clinical Report

Journal of International Medical Research

Prevalence rate and 2016, Vol. 44(2) 377–388

! The Author(s) 2016

influencing factors of
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DOI: 10.1177/0300060515616722
preoperative anxiety imr.sagepub.com

and depression in gastric

cancer patients in China:
Preliminary study
1,2 2 2
Le Xu , Qiong Pan * and Renqin Lin *

Abstract
Objectives: To investigate the prevalence rate and influencing factors of preoperative anxiety
and depression in patients with gastric cancer, in China.
Methods: Patients with gastric cancer who were diagnosed by gastroscopy and would accept
laparoscopic surgery were eligible for the study. Each participant completed self-administered
questionnaires, including the Hospital Anxiety and Depression Scale (HADS), Medical Coping
Modes Questionnaire (MCMQ), Social Support Rating Scale, and Type D personality scale before
surgery. Routine blood tests were undertaken within 7 days before surgery, to calculate the
neutrophil-to-lymphocyte ratio (NLR). Based on HADS, patients were divided into an anxiety/
depression group and a nonanxiety/depression group.
Results: Fifty-three patients with gastric cancer were included in the study. The prevalence of
preoperative anxiety and/or depression was 20.75% (11/53). Factors influencing preoperative
anxiety and depression were a resigned dimension of coping style, type D personality and NLR.
Logistic regression analysis showed that a higher score for the resigned dimension of coping style
on the MCMQ and a higher NLR were significantly associated with preoperative anxiety and
depression.
Conclusions: The prevalence of preoperative anxiety and depression in Chinese patients with
gastric cancer may be influenced by both the coping mode and NLR.

These data were presented at 10th Chinese Gastric

Cancer Congress, Beijing, China, 27–28 June 2015.
Abstract number: AB33.
*These authors are co-first authors.
Corresponding author:
1
Department of Nursing, Fujian Medical University Union Le Xu, Department of Nursing, Fujian Medical University
Hospital, Fuzhou, Fujian Province, China Union Hospital, No. 29 Xin Quan Road, Gulou District,
2
Fujian Medical University Union Clinical Medical Institute, Fuzhou, Fujian Province, 350001, China.
Fuzhou, Fujian Province, China Email: xl_8332@126.com

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122 Journal of International Medical Research 44(2)

Keywords
Gastric cancer, anxiety, depression, prevalence, influencing factors

Date received: 8 July 2015; accepted: 20 October 2015

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 Xu et 123
al.

treatment to researchers con- with gastric cancer

I achieve maximum sidered all or at throughout the
n control and reduce least some of the world has rarely
t the physiological symptoms of been reported.
8

r damage caused by anxiety to reflect This preliminary

6
cancer, patients depression. Thus, study aimed to
o
should be closely the combination of investi- gate
d monitored for the anxiety and preoperative
u potential depression has anxiety and
c psychological been deemed by depression in
t consequences of some scholars to be patients with
i cancer, to improve critical to the gastric cancer, with
their disease diagnosis and a view to providing
o resistance and treatment of
n scientific evidence
maintain a high cancer patients.
7
to support a
Cancer poses a health-related To date, theoretical basis
major threat to quality- of-life information about
2
for preventing
public health (HRQoL). pre- operative preopera- tive
worldwide; cancer A good anxiety and anxiety and
incidence rates have psychological state depression in depression,
increased in most plays as important patients improving
countries since a role in the postoperative
1
1990. diagnosis and treat-
Cancer caused over ment of cancer as a rehabilitation,
8.2 million deaths psychosomatic
3
worldwide in 2013 disease.
enhancing
and has moved Anxiety and
HRQoL, and
from the third depression have
increasing survival
leading cause of been reported to be
time.
death in 1990 to the two most
the second leading common
cause, behind psychological Pat
cardiovascular problems in cancer ien
4
disease, in 2013.
1
patients. Clinical ts
Cancer is currently research has shown and
recog- nized as a that comorbid me
controllable depres- sion and
anxiety are of
tho
chronic disease; its
diagnosis and major importance, ds
treatment conform resulting in more P
to the severe symptoms, a
biopsychosocial impair- ment,
subjective distress t
medical model
proposed by the and a long-term i
American scholar, course than either e
George L. Engel.
2 anxiety or n
5
In addition to depression alone. t
providing In 1997, British s

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 124 Journal of International Medical Research 44(2)

This preliminary alcohol

cross-sectional dependence; (iv)
study enrolled con- comitant
consecutive inflammation.
patients In terms of
diagnosed with selecting the
gastric cancer by correct sample
gastroscopy and size, according to
admitted to the the multivariate
Gastric Surgery statistical method,
Ward of Fujian the sample size
Medical University should be 5 to
Union Hospital, 20 times as large
Fuzhou, Fujian as the independent
Province, China vari- ables that are
between September being measured.
2014 and Nine inde- pendent
January 2015. variables were
Inclusion criteria measured in the
were: (i) diagnosed present study:
with gastric cancer patients’ age; sex;
by gastroscopy and residence;
clinical pathology;
(ii) aged 18 years;
(iii) prepared to
accept
laparoscopic
surgery; (iv) fully
understood their
medical conditions
and agreed
to participate
in the
survey.
Exclusion criteria
were: (i)
concomitant
mental or
psychological
disease, or commu-
nication disorders;
(ii) took
antianxiety drugs,
antidepressants or
b-blockers within
3 days prior to
the start of the
study; (iii) drug or

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Xu et 125
al.

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126
insurance status; clinical staging; social
support; coping styles; type D personality;
neutrophil-to-lymphocyte ratio (NLR).
Ethical approval for the study was pro-
vided by the Ethics Committee of The
Union Hospital of Fujian Medical
University (reference no. 2015KY017). All
patients provided verbal informed consent.
Investigational methods
On obtaining verbal informed consent,
patients were asked to complete self-
administered questionnaires independently
on the day before surgery. If patients had
difficulties completing the questionnaire,
healthcare personnel were there to help
them, which guaranteed the consistency of
explanations regarding the questions being
asked.
Routine blood samples were collected
from all patients within 7 days prior to
surgery and the NLR was calculated.
A blood sample (3–5 ml) was taken from
the cubital vein using standard methods, and
added to 3.7–5.4 mmol/ml of ethylenediami-
netetra-acetic acid-K2. Blood samples were
stored at 18–22 C and tested within 2 h of
being drawn.
Anxiety and depression instruments
Patients completed a general information
form that included age, sex, place of resi-
dence and source of medical payments; they
also completed several mental health ques-
tionnaires. The Hospital Anxiety and
Depression Scale (HADS), which contains
14 items, was used to assess anxiety and
depression (seven anxiety items and seven
depression items); the cut-off score for
screening anxiety and depression is 11 and
the effectiveness of the Chinese version of
9 sion among patients with gastric cancer was
the HADS has been validated. Patient
coping was measured using the Medical
10
Coping Modes Questionnaire (MCMQ).
The MCMQ contains 20 items and three
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Journal of International Medical Research 44(2)
dimensions that correspond to three disease-
related cognitive and behavioural coping
modes: confrontive, avoidant and resigned.
Each item is scored on a four-point Likert
scale (from 1 to 4, with each score indicating
a different frequency of each coping mode’s
use (e.g. never, sometimes, often, always);
this scale has good reliability and validity.
11
Social support was measured using the
12
Social Support Rating Scale (SSRS),
which also has good reliability and valid-
13
ity. The SSRS contains 10 items, each of
which is also scored on a four-point Likert
scale (from 1 to 4, with a higher total score
indicating a higher level of total support).
The SSRS evaluates social support on three
dimensions: objective support, subjective
support and support utilization. The type
D scale-14 (DS-14) was used for psycho-
14
logical assessment; the Chinese version of
the DS-14 has demonstrated good reliability
15
and validity. The DS-14 includes two
subscales: negative affectivity (NA) and
social inhibition (SI); each subscale contains
seven items and each item is rated on a five-
point scale (ranging from 0, false to 4, true).
A type D personality is defined as NA 10
and SI 10.
Based on the findings from HADS,
9
patients were stratified into two groups:
those with anxiety and/or depression were
included in the anxiety/depression group;
those with no symptoms of anxiety and/or
depression were included in the nonanxiety/
depression group.
Statistical analyses
All statistical analyses were performed using
the SPSS statistical package, version 19.0
(SPSS Inc., Chicago, IL, USA) for
Windows . The level of anxiety and depres-
represented as n (%) of patients. Student’s
t-test was used to compare the means of the
2
two groups for continuous data; -test and
Fisher’s exact test were used to compare
categorical data. Logistic regression analysis Table 1. Demographic and clinical characteristics
was used to examine the independent effects of patients with gastric cancer (n ¼ 53), included in
of a resigned coping style, type D personal- a study to investigate the extent of preoperative
ity and NLR. A P-value < 0.05 was con- anxiety and depression.
sidered statistically significant. Anxiety/ Nonanxiety/
depression depression
group group
Results n ¼ 11 n ¼ 42
Characteristic
Fifty-three participants diagnosed with gas-
tric cancer were included in the study; prior Age, years 59.0 10.4 58.1 10.9
to surgery, each participant’s levels of anx- Age range, years 42–78 29–77
iety and depression were measured using Age categories, years
<60 6 (54.5) 22 (52.4)
HADS. According to the results, two
60 5 (45.5) 20 (47.6)
patients had preoperative anxiety symp-
toms, four had preoperative depression Sex
Male 6 (54.5) 29 (69.0)
symptoms, and five had both anxiety and
Female 5 (45.5) 13 (31.0)
depression symptoms. Consequently, these
11 patients formed the anxiety/depression Residence
Rural 7 (63.6) 22 (52.4)
group and the remaining 42 patients without
Urban 4 (36.4) 20 (47.6)
symptoms of anxiety and/or depression
formed the nonanxiety/depression group. Medical insurance
The prevalence of preoperative anxiety No 1 (9.1) 7 (16.7)
Yes 10 (90.9) 35 (83.3)
and depression in gastric cancer patients was
therefore 20.75% (11/53). The demographic Cancer staging
and clinical characteristics of the two groups I 4 (36.4) 9 (21.4)
II 3 (27.3) 8 (19.0)
are presented in Table 1; there were no
III 3 (27.3) 21 (50.0)
significant differences between the two IV 1 (9.1) 4 (9.5)
groups.
The results of the MCMQ showed no Data presented as mean SD or n (%) of patients. Cancer
significant differences between the two staging was undertaken in accordance with the tumour,
node, metastasis staging system of the American Joint
groups on the confrontive and avoidant 58
Committee on Cancer.
dimensions, but the anxiety/depression
group had a significantly higher score on
the resigned dimension (P < 0.05) (Table 2). than the Chinese population norm (34.56
Furthermore, confrontive dimension scores 3.73; P < 0.05).17
in the two groups were significantly lower The results of the DS-14 instrument
than the Chinese population norm showed that the proportion of type D per-
(19.48 3.81; P < 0.05), whereas avoidant sonality in the anxiety/depression group was
dimension scores in the two groups were significantly higher than in the nonanxiety/
similar to the Chinese population norm depression group (P ¼ 0.0497) (Table 4).
16
(14.44 2.97). Blood studies showed that the NLR was
The results of the SSRS showed no significantly higher in the anxiety/depres-
significant differences between the two sion group compared with the nonanxiety/
groups for objective support, subjective depression group (P < 0.05) (Table 5).
support and support utilization (Table 3). Logistic regression analysis showed that,
Furthermore, total scores for social support at a ¼ 0.05 significance level, influencing
in the two groups were significantly higher factors of preoperative anxiety and
Table 2. Comparison of coping modes between Table 4. Comparison of the prevalence of type D
patients with gastric cancer (n ¼ 53), categorized personality in patients with gastric cancer (n ¼ 53)
according to presence or absence of preoperative categorized according to presence or absence of
anxiety and depression. preoperative anxiety and depression.

Anxiety/ Nonanxiety/ Type D personality

depression depression
group group Group Yes No
Coping mode n ¼ 11 n ¼ 42
Anxiety/ 8 (72.7)* 3 (27.3)
Confrontive 15.27 5.39 16.43 4.46 depression n ¼ 11
Avoidant 14.45 1.51 14.57 2.63 Nonanxiety/ 16 (38.1) 26 (61.9)
Resigned 12.18 3.55 8.86 2.01* depression n ¼ 42

Data presented as mean SD. Data presented as n (%) of patients.

*P < 0.05 compared with anxiety/depression group; *P < 0.05 compared with the nonanxiety/depression
Student’s t-test. group; Fisher’s exact test.

Table 3. Comparison of the levels of the
different types of social support experienced by
patients with gastric cancer (n ¼ 53) categorized
according to presence or absence of preoperative
anxiety and depression.
Table 5. Comparison of the neutrophil- to-
lymphocyte ratio (NLR) in patients with gastric
cancer (n ¼ 53) categorized according to the
presence or absence of preoperative anxiety and
depression.

Anxiety/ Nonanxiety/ Anxiety/ Nonanxiety/

depression depression depression depression
group group group group
Type of support n ¼ 11 n ¼ 42 Parameter n ¼ 11 n ¼ 42

Objective 9.18 2.48 8.98 2.28 NLR 2.65 8.57 2.08 7.67*
Subjective 24.36 3.61 24.00 3.85
Utilization 7.64 2.36 7.02 2.17 Data presented as mean SD.
*P < 0.05 compared with anxiety/depression group;
Total score 41.18 5.89 40.00 5.71
Student’s t-test.
Data presented as mean SD.
20
considerable research. Gastric cancer is

depression were a resigned dimension of

coping style (P < 0.05) and NLR (P <
0.05).

Discussion
In people with cancer, psychological factors
play vital roles in not only tumourigenesis,
but also in tumour therapy, subsequent
rehabilitation and improvements in
18,19
HRQoL. Therefore, exploring the psy-
chological state of patients and its influence
on cancer patients has become the focus of
one of the most frequent cancers in the
world, with almost two-thirds of gastric
cancer cases and deaths occurring in less-
1,21
developed global regions.
Comprehensive therapy encompassing
surgery, chemotherapy and radiotherapy
has become the major treatment modality
22
for gastric cancer. Studies on anxiety and
depression in patients with gastric cancer
have mainly examined the diagnosis and
treatment of anxiety and depression follow-
20,23,24
ing chemotherapy or surgery. A study
in the Republic of Korea reported that,
before chemotherapy, the proportion of
anxiety-depressive disorders was as high as
63% in 43 patients demonstrated a provide edu- cation identify such
with advanced prevalence rate of on the prevention patients in a
gastric cancer.
23 preoperative and treatment of timely manner and
Another study anxiety and/ or tumours (such as perform effective
undertaken in the depression of gastric cancer), interventions, to
Republic of Korea 20.75% in 53 patients affected by con- trol their
reported that the patients with the disease (and psychological
preva- lence of gastric cancer, their family symptoms and
postoperative which was lower members) can fully improve outcomes.
depression was than that found in understand gastric When Japanese
44% in 391 the aforementioned cancer; thus we researchers
patients with studies. believer that they investigated the
gastric cancer.
24 These current, develop a more factors related to
In China, the preliminary, results positive attitude to depression in 1334
prevalence rates for dem- onstrate a low the disease. patients with lung
anxiety and prevalence rate of In this present cancer, depression
depression were preopera- tive study, 11 patients was not only
30.24% and anxiety and with gastric cancer correlated with
63.42%, depression in presented obvious biological factors
respectively, in 205 patients with preopera- tive such as cancer
patients with gastric cancer in symptoms of classification,
gastric cancer China, probably anxiety and stage and patient
among a total of owing to the depression. As the sex and age, but
1217 cancer following reasons. major purveyors was also signifi-
20
patients surveyed. First, China’s of cancer cantly correlated
Although economic prevention and with psychological
prevalence rates for development has treatment, factors (such as
preoperative brought an enor- healthcare coping mode and
anxiety and mous government personnel should neurotic person-
27
depression in investment in all ality). Coping
patients with fields of medical refers to one’s
gastric cancer insurance, which ability to change
have rarely been ensures the med- cognitive and
reported, such ical reimbursement behavioural efforts
rates were 44.7% of patients with constantly, to
and gastric cancer. manage specific
17.1%, respectively, Secondly, the external or internal
for patients with continuous rise in demands that are
25
lung cancer. In the level of appraised as
patients with breast medical care in taxing or exceeding
cancer, the China has made the resources of the
prevalence rates of comprehensive person; this
preoperative therapy accessible concept
anxiety and to most patients originated
depression reached with gastric cancer. from
70% and 37%, Finally, when theories of self-
26 28
respect- ively. healthcare defence. Anna
This present study personnel actively Freud pro- posed
the idea of the health. A positive
self-defence coping mode in
mechan- ism, cancer patients is
based on Sigmund correlated with
Freud’s theory of good psychological
defence adjust- ment,
29
mechanisms. whereas a negative
Self-defence is a coping mode is
method in which, correlated with
to adjust the psychological
33
relationship disorder.
between internal Moreover, a
conflict and negative coping
external real- ity, mode can, to some
the individual gets extent, result in
rid of anxiety and anxiety and
controls the depression in
emotional and cancer patients.
34

instinct desires that In this current

would cause study, there were
excessive impulse no
29
behav- iours. In significant
different periods, differences
the term ego has between the
taken on specific anxiety/depression
meanings, group and
depending on the
characteristics of
the actual context
and how the context
correlates with the
subjective
30
structure.
In 1985,
Folkman and
31,32
Lazarus pro-
posed that a coping
mode was a crucial
intermediate factor
that affected the
out- come of a
stressful event, and
that different
coping modes
resulted in different
emotional states
that influenced
psychosomatic
the that they had a support was support, as well as
nonanxiety/depress ‘deadly disease’. proposed as a support utilization.
ion group in con- However, the scientific concept In this present
frontive or avoidant anxiety/ in the study, there were no
35,36
dimensions of the depression group 1970s, after significant
MCMQ, but the which many differences in any
groups’ results tended to scholars started dimension of social
were sig- nificantly choose to study social sup- port between
different in the ‘resigned’ as a support. Social the
resigned dimen- negative coping support is described anxiety/depression
sion. However, mode, which may as the psychological group and the
both groups had be related to and material help nonanxiety/depress
scores on the personality. This offered to an ion group; total
confrontive type of negative individual by all scores in both
dimension of the coping is likely to types of social groups were higher
MCMQ that were induce or worsen sources, including than the norm for
lower than the the anxious and family members, the Chinese
Chinese population depressive psycho- friends, colleagues population. This
norm, indicating logical symptoms and medical indi- cates that
that patients with of personnel, which material,
gastric cancer anxious/depressed reflect how closely psychological,
failed to adopt a patients, leading to an individual is diagnos- tic and
positive and a vicious cycle of integrated into therapeutic support
37
mature symp- toms. Thus, society. (provided by the
‘confrontive’ healthcare Social support government,
coping mode after personnel should can be divided into patient’s relatives
being told of the provide relevant object- ive and friends, and
diagnosis, no matter psychological support and healthcare
whether they counselling for subjective personnel) were
presented with patients with gastric (perceived) basically satisfying
anxious or cancer who have the demands of
depressive emo- preoperative patients with
tions. In both anxiety and gastric cancer in
groups, avoidant depression, to help medical settings in
mode scores for the them develop more China. The findings
MCMQ were optimistic attitudes of this current
similar to the towards cancer. study are rela-
Chinese population In 1960, tively consistent
norm, probably psychologists with other research
due to the rela- began to from China,
tively insignificant investi- possibly because of
effects of avoidance gate the effects of the powerful
on patients’ social support as traditional role that
psychological part of research on the family plays in
and the role of life facilitating the
stress in physical acquisition of a
emotional states: and psychological great many
most patients felt health. Social types of
social pessimism,
support for becoming anxious
38
patients. easily and,
However, invariably, nervous
another point of behaviours.
view should be International
considered: the studies have
suggestion that the demonstrated a
social network link between type D
formed in an personality and
organization may cardio- vascular
not always be disease, and found
positive; it can correlations
have a negative between type D
effect on individual personality and
support, which can anxiety and
be a stressor that depression.
41,42
A
affects other kinds study that investi-
39
of support. gated the
In addition, social relationship
support should be between type D per-
per- ceived and sonality and
accepted by an psychological
individual rather health in 3080
than only being cancer survivors
offered by some demonstrated that
39
person or entity. the 572 survivors
Therefore, (19%) who had
utilization or type D personality
acceptance of
support by patients
should also be con-
sidered when social
support is provided
to patients with
gastric cancer.
In 1996, Denollet
40
et al. proposed a
more
integral personality
trait called the
type D personality.
This unique
personality subtype
includes NA and
SI; it is
characterized by
introversion,
were more likely to preoperative tumour progression, tumour
feel anxious (51% psychological and inflammatory environment for
versus interventions for cells in tumour cancer progression
14% in nontype D patients with type microenvironments by secreting
personality, P < D personality to are critical pre- cytokines: this
0.0001) and counter- act the cursors for the leads to a
depressed (44% adverse emotional genesis and decrease in the
versus 13% in effects (which are development of lymphocyte count
nontype D relatively tumours; a series of as well as
personality, P < transient), in inflammatory lymphocyte
0.0001).
14
In the order to prevent mediators released dysfunction.
49
An
present study, anxiety and by tumour cells elevation of the
significantly more change the tumour NLR indicates a
depression
patients with gas- microenvironment relative increase in
effectively.
tric cancer had type and facilitate neutrophils and
Contemporary
proliferation and a relative
D personality in the oncobiology 46
anxiety/depression research has metastasis. The decrease
group (eight of found that peripheral in lymphocytes.
11; tumour neutrophil level can The occurrence of
72.7%) than in the genesis and reflect the systemic such an imbalance
nonanxiety/depress development are inflammatory state (that is, the
47
ion group (16/42; related to multiple in humans. The development of the
38.1%). This fac- tors.
43
Other lymphocyte, which inflammatory
suggests that that evidence indicates is an immune- response for
type D personality a close link effector cell, is a tumour promo-
is predictive of between the major component of tion and the
anxiety and inflammatory the tumour-specific relative reduction
depression in immune response immune of lympho- cytes)
48
patients with and response. predicts a poor
gastric cancer, and tumourigenesis After being prognosis.
50

that those with and stimulated by a Research has

44
type D personality development. tumour, systemic revealed that the
are more likely to Research in inflammatory cells elevation of proin-
present with psychosocial provide a flammatory
anxiety and oncology and favourable cytokines in the
depression prior to psychoneuroimmun peripheral blood of
surgery, compared ology has found an cancer patients is
with other interaction between closely correlated
personality inflammatory with the
subtypes. Since immune response development of
type D personality and anxiety and
51
is stable and it is a depression.
long and difficult psychosocial Anxiety and
process to change depression can
45
person- ality, factors. impair human
healthcare Inflammation is an immunity
personnel should important through the
intensify component of excessive release of
hormones, such as factors such as
55
catecholamines, by tumour therapy,
the hypothalamic– cardiovascular
56
pituit- ary–adrenal inter- vention
52
axis. Meanwhile, and
this would decrease
the number and the Alzheimer’s
percentage of
lymphocytes, and disease.
57
increase the Nevertheless, no
number and the reports have
percentage of answered whether
neutrophils preoperative NLR
52
significantly. has specific effects
Furthermore, on anxiety and
psychological depression in
stress has been patients with
linked with immune gastric cancer. This
function, and good present study found
psychological care a significantly
can, to some extent, higher preoperative
alleviate immune NLR in the
injury and anxiety/depression
improve HRQoL group than in the
in cancer nonanxiety/depress
53
patients. A ion group,
controlled study of suggesting that
22 patients with NLR was not
ovarian cancer on only related to
chemotherapy the prognosis of
demonstrated a gastric cancer as
significantly higher shown
peripheral
lymphocyte count
in the
‘clinical
psychological
relaxation training
group’ compared
with the control
54
group.
In addition to
being an
inflammatory
immune index,
NLR can be used
as a prognostic
biological index for
previously,
50
but psychological care In conclusion, cancer prior to
was also closely for those at high this study surgery; this is in
correlated with the risk, actively demonstrated that keeping with their
occurrence of control the the prevalence of personality and
preoperative inflammatory preoperative coping mode. In
anxiety and response and anxiety and addition, NLR
depression in decreased depression in should be actively
patients with immunity patients with monitored so that
gastric cancer. induced gastric cancer in the inflammatory
Besides being a by tumours, China appears to response can be
biological index and reduce the be relatively low controlled, and
that reflects prevalence of anx- compared with the
preoperative iety and other studies of
inflammation, NLR depression. patients with immune
can, relatively This study had gastric cancer; the
accurately, indicate a number of rate was affected
function boosted,
the inflammatory limitations. First, by the coping
in order to help
response and the study mode and NLR.
prevent and treat
immune func- tion methodology was These pre- liminary
preoperative
of patients with relatively simple. It findings suggest
anxiety and
gastric cancer, would be more that healthcare
depression in
and is simple and valuable for clin- personnel should
patients with gastric
economic to ical prevention and provide appropriate
cancer. A variety of
measure. As the treatment if gene psy- chological and
psychological care
NLR might play expres- sion and medical therapy,
activities could be
an important role polymorphisms and provide
offered in order to
in the diagnosis were considered in cognitive guidance,
prevent and treat
and treatment of the exploration of to patients with
preoperative
preoperative the pathogenesis of gastric
anxiety and
anxiety and pre- operative depression in
depression in anxiety and patients with
patients with depression in gastric cancer.
gastric cancer it is patients with
worthy of further gastric cancer.
study. In addition to Secondly, this was
A
providing a single-centre
c
humanistic and study with a k
psychological care, relatively small n
healthcare sample size and o
personnel should potential bias may w
study the exist. The present l
psychological states results suggest the e
of patients with need for a high- d
gastric cancer at quality, multicentre g
the biomole- cular trial with a large e
level, provide sample size to be m
appropriate conducted in the e
preopera- tive future. n
t r
s e
We would like to n
thank to Professor
c
e
Changming Huang,
s
Department of
Gastric Surgery, and 1. Global Burden of
Associate Professor Disease Cancer
Sheng Yang, Collaboration,
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