Effect of negative emotions on patients with advanced gastric cancer receiving systemic chemotherapy: a prospective study

BACKGROUND: Most patients with advanced gastric cancer (GC) are treated with systemic chemotherapy and many factors have remarkable impacts on their prognosis. However, the importance of psychological status in the prognosis of advanced GC patients is still unclear. This prospective study was performed to analyze the impact of negative emotions on GC patients treated with systemic chemotherapy. METHODS: Advanced GC patients admitted to our hospital between January 2017 and March 2019 were prospectively enrolled. Demographic and clinical data were collected, as were any adverse events (AEs) related to systemic chemotherapy. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess negative emotions. The primary outcome was progression-free survival (PFS) and overall survival (OS), and the secondary outcome was the quality of life which was assessed by The European Organization for Research and Treatment of Quality of Life Questionnaire-Core 30. Cox proportional hazards models were used to analyze the effects of negative emotions on prognosis, and logistic regression models were used to analyze the risk factors related to negative emotions. RESULTS: A total of 178 advanced GC patients were enrolled in this study. A total of 83 patients were divided into a negative emotion group and 95 patients were divided into normal emotion group. 72 patients experienced AEs during treatment. Many more patients experienced AEs in the negative emotion group than in the normal emotion group (62.7% vs. 21.1%, P<0.001). Enrolled patients were followed up for at least 3 years. It was found both PFS and OS were much lower in the negative emotion group than in the normal emotion group (P=0.0186 and 0.0387, respectively). Participants in negative emotion group had lower health status and more severe symptoms. Negative emotions, lower body mass index (BMI), and IV tumor stage were identified as risk factors. In addition, higher BMI and marital status were identified as protective factors of negative emotions. CONCLUSIONS: Negative emotions have a significant adverse effect on the prognosis of GC patients. The main risk factor of negative emotions is AEs during treatment. It is necessary to closely monitor the treatment process and improve the psychological status of patients.