Identification and correction of preoperative anxiety factors in breast cancer patients

Rudnitsky S.I.; Kirillov D.O.; Aleksina O.V.; Shvid E.S.; Klimov A.A.; Subbotin V.V.

doi:https://doi.org/10.17116/anaesthesiology202506151

Rudnitsky S.I.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0000-0001-7458-7893

Kirillov D.O.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0004-4563-2367

Aleksina O.V.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0000-4066-9719

Shvid E.S.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0004-0978-2122

Klimov A.A.

Loginov Moscow Clinical Scientific Center

ORCID: 0000-0001-7633-6852

Subbotin V.V.

Loginov Moscow Clinical Scientific Practical Center;
Federal Scientific Clinical Center of Resuscitation and Rehabilitation

ORCID: 0000-0002-0921-7199

Identification and correction of preoperative anxiety factors in breast cancer patients

Authors:

Rudnitsky S.I., Kirillov D.O., Aleksina O.V., Shvid E.S., Klimov A.A., Subbotin V.V.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2025;(6): 51‑57

DOI: 10.17116/anaesthesiology202506151

Read: 519 times

Contact the author

Table of contents

To cite this article:

Rudnitsky SI, Kirillov DO, Aleksina OV, Shvid ES, Klimov AA, Subbotin VV. Identification and correction of preoperative anxiety factors in breast cancer patients. Russian Journal of Anesthesiology and Reanimatology. 2025;(6):51‑57. (In Russ.)
https://doi.org/10.17116/anaesthesiology202506151

Использование инфографики авторами научных работ

Abstract:

Diagnosis of cancer undeniably triggers significant stress in patients. Constant thoughts about upcoming treatments and fear of death increase anxiety inevitably. Consequently, this stress, intended as an adaptive mechanism, becomes distress associated with pathological reactions depleting the body. Clinical manifestations of stress may occur in perioperative period and complicate primary disease. Assessment of preoperative anxiety is important worldwide. However, none available method for identifying preoperative anxiety covers all predisposing factors and fears affecting psychological state.

OBJECTIVE

To identify specific anxiety factors concerning patients with their subsequent correction.

MATERIAL AND METHODS

The study enrolled 50 female breast cancer patients scheduled for mastectomy or breast resection. In the main group, patients underwent preoperative examination by anesthesiologist two weeks before surgery. The purpose of examination was to identify the main factors of anxiety according to original questionnaire for subsequent correction. In the control group, patients did not receive correction of anxiety factors. We analyzed anxiety levels considering salivary free cortisol and visual analogue scale.

RESULTS

According to univariate analysis, the main group was characterized by significantly lower VAS score of anxiety after conversation with anesthesiologist (6.4 [4.9; 7.6] vs. 1.8 [1.4; 3.3], p<0.001). Salivary cortisol two weeks before surgery (125.1 [88.9; 200.3] vs. 80 [55.3; 97.8]), immediately before surgery (116.1 [93.9; 206.2] vs. 95.1 [80; 119.4]), and three hours after surgery (129.7 [88.2; 230.4] vs. 82.7 [59.6; 105]) was significantly lower (p=0.002, p=0.007, p=0.007, respectively) in the main group.

The questionnaire “Identification by anesthesiologist of the main preoperative anxiety factors” allows us to know the exact reasons of increased anxiety. Discussions addressing fears noted in the questionnaire reduce anxiety. This is confirmed by reduced number of fears upon re-surveying, VAS scores and free cortisol levels.

Keywords:

preoperative anxiety

anxiety prevention

free cortisol

breast cancer

anxiety during anesthesia and surgery

postoperative pain

Authors:

Rudnitsky S.I.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0000-0001-7458-7893

Kirillov D.O.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0004-4563-2367

Aleksina O.V.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0000-4066-9719

Shvid E.S.

Loginov Moscow Clinical Scientific Practical Center

ORCID: 0009-0004-0978-2122

Klimov A.A.

Loginov Moscow Clinical Scientific Center

ORCID: 0000-0001-7633-6852

Subbotin V.V.

Loginov Moscow Clinical Scientific Practical Center;
Federal Scientific Clinical Center of Resuscitation and Rehabilitation

ORCID: 0000-0002-0921-7199

Received:

03.02.2025

Accepted:

03.06.2025

Close metadata

References:

Sotelo JL, Musselman D, Nemeroff C. The biology of depression in cancer and the relationship between depression and cancer progression. International Review of Psychiatry. 2014;26(1):16-30. https://doi.org/10.3109/09540261.2013.875891
Goldstein DS, Kopin IJ. Evolution of concepts of stress. Stress. 2007;10(2): 109-120. https://doi.org/10.1080/10253890701288935
Lu S, Wei F, Li G. The evolution of the concept of stress and the framework of the stress system. Cell Stress. 2021;5(6):76-85. https://doi.org/10.15698/cst2021.06.250
Facco E, Stellini E, Bacci C, Manani G, Pavan C, Cavallin F, Zanette G. Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiologica. 2013;79(12):1389-1395.
Baagil H, Baagil H, Gerbershagen MU. Preoperative Anxiety Impact on Anesthetic and Analgesic Use. Medicina. 2023;59(12):2069. https://doi.org/10.3390/medicina59122069
Shin KJ, Lee YJ, Yang YR, Park S, Suh P-G, Follo MY, Cocco L, Ryu SH. Molecular Mechanisms Underlying Psychological Stress and Cancer. Current Pharmaceutical Design. 2016;22(16):2389-2402. https://doi.org/10.2174/1381612822666160226144025
Musa A, Movahedi R, Wang JC, Safani D, Cooke C, Hussain SF, Tajran J, Hamid S, Gucev G. Assessing and reducing preoperative anxiety in adult patients: A cross-sectional study of 3661 members of the American Society of Anesthesiologists. Journal of Clinical Anesthesia. 2020;65:109903. https://doi.org/10.1016/j.jclinane.2020.109903
Bragin DB, Astakhov AA, Turchaninov AYu, Lebedeva YuV. Express test of situational anxiety in choosing premedication. Russian Journal of Anesthesiology and Reanimatology. 2023;2:65-70. (In Russ.). https://doi.org/10.17116/anaesthesiology202302165
Volkan B, Bayrak NA, Ucar C, Kara D, Yıldız S. Preparatory information reduces gastroscopy-related stress in children as confirmed by salivary cortisol. Saudi Journal of Gastroenterology. 2019;25(4):262-267. https://doi.org/10.4103/sjg.SJG_493_18
Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Euteneuer F, Rüsch D. Preoperative anxiety in adults — a cross-sectional study on specific fears and risk factors. BMC Psychiatry. 2020;20(1):140. https://doi.org/10.1186/s12888-020-02552-w
Berth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) — the first trial of a German version. Psycho-Social Medicine. 2007;4:Doc01.
Tolksdorf W. [Preoperative stress. Research approach and methods of treatment]. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32(3 Suppl): S318-S324. https://doi.org/10.1055/s-2007-995183
Pereira L, Figueiredo-Braga M, Carvalho IP. Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Patient Education and Counseling. 2016;99(5):733-738. https://doi.org/10.1016/j.pec.2015.11.016
Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Euteneuer F, Rüsch D. Preoperative anxiety in adults — a cross-sectional study on specific fears and risk factors. BMC Psychiatry. 2020;20(1):140. https://doi.org/10.1186/s12888-020-02552-w
Kharod U, Panchal NN, Varma J, Sutaria K. Effect of pre-operative communication using anaesthesia information sheet on pre-operative anxiety of patients undergoing elective surgery — A randomised controlled study. Indian Journal of Anaesthesia. 2022;66(8):559-572. https://doi.org/10.4103/ija.ija_32_22
Baghele A, Dave N, Dias R, Shah H. Effect of preoperative education on anxiety in children undergoing day-care surgery. Indian Journal of Anaesthesia. 2019;63(7):565-570. https://doi.org/10.4103/ija.IJA_37_19
Salzmann S, Euteneuer F, Kampmann S, Rienmüller S, Rüsch D. Preoperative anxiety and need for support — A qualitative analysis in 1000 patients. Patient Education and Counseling. 2023;115:107864. https://doi.org/10.1016/j.pec.2023.107864
Lavedán Santamaría A, Masot O, Canet Velez O, Botigué T, Cemeli Sánchez T, Roca J. Diagnostic Concordance between the Visual Analogue Anxiety Scale (VAS-A) and the State-Trait Anxiety Inventory (STAI) in Nursing Students during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2022;19(12):7053. https://doi.org/10.3390/ijerph19127053