DOI: 10.4103/crst.crst_150_23 ISSN: 2590-3233

Prevalence of preoperative anxiety and depression in patients undergoing major oncologic surgeries: An analytical cross-sectional study

Sonali Opneja, Roopesh Sureshan, Jisha Abraham, Satheesan Balasubramanian, Riyas Malodan, Mayan John
  • Cancer Research
  • Oncology (nursing)
  • Drug Guides
  • Oncology


Depression and anxiety experienced before major cancer surgeries have been associated with postoperative morbidity and mortality.


This study aimed to estimate the prevalence of preoperative anxiety and depression in patients undergoing major oncosurgeries.

Materials and Methods:

This was a cross-sectional analytical study conducted between June 2021 and June 2022 at Malabar Cancer Center in Thalassery, Kerala, in South India. We enrolled patients aged 18–65 years undergoing major oncosurgeries with American Society of Anesthesiologists (ASA) Physical Status Grades I and II. Patients were administered a questionnaire (in the local language, Malayalam) by the anesthesiologist on their first preoperative visit after the preanesthetic checkup. The questionnaire was in two parts: part 1 consisted of the demographic data, and part 2 comprised the Patient Health Questionnaire-4 (PHQ-4) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). On the PHQ-4, a score of ≥3 for the first two questions was the cutoff for anxiety, and a score of ≥3 for the last two questions was the cutoff for depression. APAIS is a six-item questionnaire; a score of ≥11 on the anxiety scale was considered positive for anxiety, and a score of >5 was considered to indicate the need for more information.


We enrolled 200 patients; 136 (68%) were women, and the median age overall was 52 (interquartile range [IQR], 42–60). Patients enrolled were planned for surgeries for head-and-neck cancers (n = 55, 27.5%), laparotomies or therapeutic laparoscopies (n = 70, 35%), breast cancers (n = 67, 33.5%), and bone and soft tissue surgeries (n = 8, 4%). Anxiety was noted in 49 (24.5%) patients by PHQ-4 and 23 (11.5%) patients by APAIS; depression was detected in 31 (15.5%). The presence of depression significantly contributed to anxiety. Patients who screened positive for depression had 79.6 times higher odds of screening positive for anxiety, as compared to those who screened negative for depression.


Almost one in four patients undergoing major oncosurgeries experience preoperative anxiety, and one in six have depression. Patients have a substantial requirement for information concerning anesthesia and surgical procedures, which, if unmet, contributes to anxiety and/or depression. Preoperative counseling and providing more information to patients could reduce anxiety or depression. Other causative personal, familial, social, or economic factors should also be assessed and managed (Clinical Trials Registry of India number: CTRI/2021/07/034568).

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