Causes and alleviation of distress in patients with benign and malignant bone and soft-tissue tumors before and after orthopedic surgery: An observational study

Introduction: Distress is common among cancer patients, especially in orthopedic oncology, but its perioperative course remains insufficiently explored. Objective: This study aimed, first, to describe the emotional distress experienced by patients with benign and malignant bone and soft-tissue tumors before orthopedic oncologic surgery and, second, to examine how the level of distress varied during hospitalization. Methods: A retrospective observational study was performed, and patients admitted to the orthopedic oncology department were enrolled. Distress was recorded before and after surgery. A reduction of at least one point in the Distress Thermometer (DT) score was considered an improvement. Potential causes of distress were systematically documented. Data required for the study were extracted from patients’ medical records by a research nurse. Results: During the study period, 319 patients were screened, of whom 119 were included in the analysis. The mean DT score was 5.2 at admission and 4.3 at discharge, with a statistically significant difference of 0.9 (95% confidence interval: 0.4–1.5; p<0.001). Pain was the main reported cause of distress at both admission and discharge. The presence of distress at admission, shorter duration of hospitalization, and receipt of psychological support were associated with a decrease in distress. Conclusion: Perioperative distress in patients undergoing orthopedic oncologic surgery must be carefully monitored in clinical practice. Pre-to postoperative distress showed a favorable trajectory, with a significant reduction observed. Pain and emotional problems were identified as the main sources of distress, though with different trajectories: increasing for pain and decreasing for anxiety. Targeted pain management and psychological support pathways should be encouraged for these patients.