Palliative treatment and social support needs in patients with liver, gallbladder, and pancreatic tumors

Abstract

BACKGROUND

Malignant hepatobiliary and pancreatic (HBP) tumors occur in organs such as the liver, gallbladder, and pancreas. Their primary characteristics include invasive growth, high cellular atypia, and high rates of recurrence and metastasis. HBP tumors pose a serious threat to human health

AIM

To explore palliative treatment and social support for depression and anxiety in patients with end-stage HBP cancers.

METHODS

We retrospectively analyzed 100 patients with end-stage HBP tumors who were admitted to our hospital between January 2021 and January 2024. The control group (n = 47) received routine treatment and intervention, whereas the observation group (n = 53) received palliative treatment and social support. Anxiety and depression levels, social support, quality of life, cancer-related fatigue, and 1-year survival were compared between groups.

RESULTS

There were no significant differences in pre-intervention anxiety, depression, social support, or cancer-related fatigue scores between the two groups (P > 0.05). The post-intervention anxiety and depression scores of the observation group were 30.53 ± 4.15 and 42.04 ± 3.86 points, respectively. Both scores were significantly lower than those in the control group (P < 0.05). The post-intervention social support score of the observation group was 79.04 ± 5.74, which was significantly higher than that of the control group (67.82 ± 5.69; P < 0.05). All dimensions of post-intervention quality of life of the observation group were significantly better than those of the control group (P < 0.05). The post-intervention cancer-related fatigue score of the observation group was 2.63 ± 1.15, which was significantly lower than that of the control group (6.28 ± 1.04; P < 0.05). The 1-year survival rate of the observation group was significantly higher than that of the control group (P < 0.05).

CONCLUSION

Palliative treatment can relieve pain in patients with medical professional capabilities, and social support can prevent social vulnerability through humanistic care.

Key Words: End-stage hepatobiliary and pancreatic tumors; Depressive symptoms; Anxiety symptoms; Palliative treatment; Social support

Core Tip: This mixed-methods study pioneered the integration of palliative care with structured psychosocial support for patients with end-stage hepatobiliary and pancreatic (HBP) cancer, demonstrating synergistic efficacy in alleviating depression–anxiety comorbidity. By establishing a multidimensional symptom management protocol (targeting neuroendocrine dysregulation and inflammatory cascades) and an interdisciplinary social support network (addressing existential distress and familial burden), the intervention achieved significant survival benefits alongside enhanced quality of life, redefining holistic care paradigms for terminal HBP malignancies.

INTRODUCTION

Malignant hepatobiliary and pancreatic (HBP) tumors occur in organs such as the liver, gallbladder, and pancreas. Their primary characteristics include invasive growth, high cellular atypia, and high rates of recurrence and metastasis. HBP tumors pose a serious threat to human health[1-3]. As the disease progresses, patients with end-stage malignant tumors often experience strong negative emotions such as anxiety and depression. Some studies have noted that approximately 60%-70% of patients with tumors experience emotions such as anxiety and depression. The malignant disease itself and negative emotions such as anxiety and depression are a dynamic network of body and mind intertwined, rather than a one-way causal relationship. The negative emotions of patients affect the treatment effect and quality of life[4-6]. Palliative treatment is a treatment method for patients with end-stage tumors that focuses on relieving symptoms, reducing pain, and improving quality of life. Social support refers to providing practical help to patients through emotional interaction, resource coordination, and other means to help them cope with the social and psychological challenges brought about by malignant tumors[7-9]. Based on this, we selected 100 patients with stage IV HBP tumours who were admitted to our hospital within the last three years. The aim was to explore the impact of palliative treatment and social support interventions on patients with end-stage HBP tumours.

MATERIALS AND METHODS

Clinical data

A total of 100 patients with end-stage HBP tumors admitted between January 2021 and January 2024 were selected for the study. Based on admission sequence and odds, they were assigned to either a control group (n = 47) or an observation group (n = 53).

The male/female ratio of the control group was 29: 18, the age range was 50-75 years old, and the average age was 64.28 ± 5.71 years old. Eight patients had only primary school education, 10 had secondary school education, and 29 people had junior college education or higher. One person was unmarried, 36 were married, six were divorced, and four were widowed. The primary tumor was in the liver in 22 patients, the gallbladder in 20, and the pancreas in five.

The male/female ratio of the observation group was 31:22, the age range was 48-75 years old, and the average age was 63.92 ± 6.04 years old. Ten patients had only primary school education, 12 had secondary school education, and 31 had junior college education or higher. One person was unmarried, 42 were married, seven were divorced, and three were widowed. The primary tumor site was the liver in 24 patients, the gallbladder in 23, and the pancreas in six. There were no significant differences in sex, age, primary tumor site, marital status, or educational background between the two groups. Patients and their families were informed about the study and signed an informed consent form. Although convenient, this grouping method was not based on random number tables or computerized randomization, which may have introduced a potential selection bias.

Inclusion and exclusion criteria

Inclusion criteria: Both groups of research subjects were patients with end-stage (stage IV) malignant HBP tumors clearly diagnosed by pathology. Patients had no major medical events in the previous two weeks, no mental diseases, and no auditory or visual impairments.

Exclusion criteria: Patients who were unwilling to participate in this survey, those with combined mental cognitive impairment, and those who could not complete the self-assessment of the questionnaire under the guidance of professionals were excluded.

Methods

The control group received standard care, whereas the observation group was provided with palliative treatment combined with social support.

Control group: The patients in the control group were given routine chemotherapy (75 mg/m² docetaxel + 75 mg/m² cisplatin) repeated once every 3 weeks, as one cycle, for a total of four cycles. At the same time, they were given routine clinical nursing and psychological intervention, which consisted of creating a comfortable living environment for the patients, giving them routine psychological counseling and intervention, and giving them guidance and suggestions on diet and exercise.

Observation group: Palliative treatment in the observation group was carried out as follows. Morphine/nerve block and other treatments were administered to reduce pain perception. Individualized intervention plans were made for patients with dyspnea, including low-dose opioid drugs combined with oxygen inhalation or non-invasive ventilation. Antiemetic drugs such as ondansetron/dexamethasone were administered for those experiencing nausea and vomiting. For the malnutrition symptoms caused by long-term nausea and vomiting, diet supplementation and oral nutritional agents could be given[10]. Regarding social support, personalized intervention plans were formulated after assessing the patient’s psychological state. The social support system comprises the patients' family members, friends, and medical staff. At the same time, enterprises and social organizations are involved in the patients' social support system to carry out fundraising and volunteer services, covering the directions of psychological counseling, psychological counseling, etc., to reduce the economic burden on patients and help them better cope with psychological problems in treatment and rehabilitation[11,12]. Owing to the nature of the intervention, it was not feasible to blind the patients; however, the outcome assessors and data analysts were blinded to the group assignment to minimize bias. The intervention was implemented continuously until patient discharge, death, or completion of the one-year follow-up period.

Self-rating anxiety scale: A total of 20 items, using a four-level scoring method, were divided into 15 positive-scoring questions and five negative-scoring questions. Scores of 50-59 are considered mild, 60-69 is moderate, and > 70 is severe. The degree of anxiety was proportional to the total score.

Self-rating depression scale: A total of 20 items using a four-point scoring method. A score < 50 was considered normal, 50-59 was mild, 60-69 was moderate, and > 70 was severe. The degree of depression is proportional to the score.

Perceived social support scale: The perceived social support scale (PSSS) measures three dimensions of social support: Family, friends, and other sources. Scores range from 12 to 84, with 12-36 indicating low support, 37-60 moderate support, and 61-84 high support. Higher scores reflect greater perceived social support.

Quality of life: The 36-item short form (SF-36) was used to assess quality of life, which includes four dimensions of physical, cognitive, role, and social function. Higher scores indicate a higher quality of life.

Cancer-related fatigue: The piper fatigue scale (PFS) was used to score cancer-related fatigue. Higher scores indicate greater fatigue.

Data processing

Data were entered into Excel (Microsoft, Redmond, WA, United States) and analyzed using SPSS 24.0 (IBM, Armonk, NY, United States). Scores for anxiety, depression, quality of life, social support, and cancer-related fatigue were expressed as mean ± SD. Between-group comparisons were conducted using the t-test, with statistical significance set at P < 0.05.

RESULTS

Comparison of self-rating anxiety scale and self-rating depression scale scores before and after intervention between groups

There was no significant difference in the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores before intervention between groups (P > 0.05); However, after the intervention, the SAS and SDS scores of patients in the observation group were significantly lower than those of the control group (P < 0.05; Table 1).

Table 1 Comparison of self-rating anxiety scale and self-rating depression scale scores before and after intervention between groups.

Group	Case	SAS		SDS
		Before	After	Before	After
Control	47	59.24 ± 3.17	38.58 ± 5.25	57.94 ± 6.36	51.28 ± 3.13
Observation	53	59.33 ± 3.06	30.53 ± 4.15a	57.88 ± 6.44	42.04 ± 3.86a
t value		0.4563	7.5824	4.2136	11.0645
P value		> 0.05	< 0.05	> 0.05	< 0.05

^aP < 0.05 compared with the control group.

SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Comparison of PSSS scores between groups

Before the intervention, there was no significant difference in social support scores between the two groups (P > 0.05). However, following the intervention, patients in the observation group reported significantly higher social support scores compared to the control group (P < 0.05; Table 2).

Table 2 Comparison of social support scores between groups.

Group	Case	Before	After
Control	47	44.36 ± 3.82	67.82 ± 5.69
Observation	53	44.61 ± 3.62	79.04 ± 5.74a
t value		0.526	10.192
P value		> 0.05	< 0.05

^aP < 0.05 compared with the control group.

Comparison of quality-of-life scores between groups

Following the intervention, scores across all SF-36 dimensions in the observation group were significantly higher than those in the control group (P < 0.05; Table 3).

Table 3 Comparison of quality-of-life scores between groups.

Group	Case	Somatic function	Cognitive function	Character function	Social function
Control	47	71.35 ± 4.38	74.37 ± 4.21	71.48 ± 5.17	74.35 ± 6.06
Observation	53	82.06 ± 3.22a	80.55 ± 6.24a	81.49 ± 6.81a	81.28 ± 6.02a
t value		9.173	5.282	8.495	4.336
P value		< 0.05	< 0.05	< 0.05	< 0.05

^aP < 0.05 compared with the control group.

Comparison of PFS scores between groups

Prior to the intervention, there was no significant difference in PFS scores between the two groups (P > 0.05). However, after the intervention, the observation group showed significantly lower PFS scores compared to the control group (P < 0.05; Table 4).

Table 4 Comparison of cancer-related fatigue scores between groups.

Group	Case	Before	After
Control	47	8.14 ± 0.76	6.28 ± 1.04a
Observation	53	8.22 ± 0.58	2.63 ± 1.15a
t value		0.492	9.306
P value		> 0.05	< 0.05

^aP < 0.05 compared with the control group.

Comparison of 1-year mortality rates between groups

After the intervention, the 1-year survival rate of patients in the observation group was significantly higher than that in the control group (P < 0.05; Table 5).

Table 5 Comparison of 1-year mortality rate within 1 year between groups, n (%).

Group	Total mortality	3 months	6 months	12 months
Control	25 (53.19)	15 (31.91)	7 (14.89)	3 (6.38)
Observation	23 (43.39)	10 (18.87)	6 (11.32)	7 (13.20)
χ2				9.374
P value				< 0.05

DISCUSSION

Tumors and their effects on mental health have become the most common disease threatening people's health. Patients with end-stage tumors experience organ dysfunction as the disease progresses, and their immunity decreases accordingly. At the same time, tumor treatment leads to changes in the patient’s appearance (such as hair loss, scars, etc.), and patients may show behaviors of refusing social interaction, which can be accompanied by anxiety and depression. Family support is the main form of support provided to patients with tumors during treatment. However, the course of treatment for tumors is relatively long and often places a large economic burden on families. Long-term care provided by family members can lead to them becoming physically and mentally exhausted[13-15]. Studies have shown that social support can indirectly maintain patients’ quality of care. Intervention by community volunteers can further assist the family to intervene more effectively for patients and avoid family conflicts[16]. Simultaneously, social support interventions can also reduce the economic burden on patients and avoid treatment dropout due to cost issues. The World Health Organization has also included "social support" as a dimension for evaluating the quality of life of patients with tumors. At the same time, patients with end-stage malignant tumors often face multi-dimensional physical symptoms (such as pain, dyspnea, nausea, and vomiting) and experience great physical and psychological pain. Palliative treatment is the core link in the care of patients with end-stage disease. It can not only provide targeted intervention for physical pain but also maintain the dignity of patients. Simultaneously, social medical resources could be allocated[17,18]. In this study, patients in the observation group received social support and palliative treatment to explore the impact of this intervention method on patients' psychology, social support, survival rate, and quality of life to provide a reference for clinical interventions for comorbid anxiety and depression in patients with end-stage malignant tumors.

The results of this study showed that the SAS and SDS scores of the observation group were significantly lower than those of the control group (P < 0.05). This finding is consistent with the results reported by Bradley et al[19]. This indicates that social support and palliative treatment can relieve depressive and anxious emotions in patients with end-stage HBP tumors. The reason may be that patients can relieve symptoms and reduce pain as much as possible according to their own wishes through palliative treatment and social support, thus showing more positive emotions and self-efficacy. At the same time, with the help of the community, the economic burden can be reduced, and more accurate information support (such as clinical trials) can be obtained. Members of social support systems also help patients release their emotions and reduce their psychological stress levels through emotional companionship, listening, and empathy, thus relieving anxiety and depression. Some studies have noted that the occurrence of anxiety and depressive emotions in patients with end-stage HBP tumors during the treatment process significantly affects their quality of life and the treatment effect[20]. The results of this study showed that after the intervention, the social support, quality of life, and 1-year survival rate of the patients in the observation group were all better than those in the control group, and the cancer-related fatigue score was significantly lower than that in the control group (P < 0.05). This indicates that social support and palliative treatment can relieve the degree of fatigue in patients with comorbid anxiety and depression in end-stage HBP diseases and improve their quality of life and social support. This may be because patients can more effectively relieve psychological trauma through social support, and their stress resistance can also be improved. Additionally, fatigue reduction may indirectly prolong survival by reducing inflammatory responses and improving treatment compliance. Social support can reduce the occurrence of patients interrupting treatment due to loneliness, helplessness, or economic burden and avoid self-marginalization of patients. Psychological counseling can help patients re-establish social connections, help them retain some social functions, and indirectly maintain the quality of care for patients through third-party intervention and promote family communication.

Patient participation in medical decision-making can be improved through palliative treatment. By targeting the physical symptoms of end-stage patients, their quality of life and degree of fatigue can be improved, their survival time can be prolonged, and unnecessary invasive operations can be avoided, allowing them to live with dignity and increasing their sense of meaning in existence. However, this was a single-center retrospective analysis, and the generalizability of the findings may be limited. Multicenter prospective studies are needed to verify the results and enhance external validity. Additionally, although the intervention model integrates enterprise-based fundraising support, which may help reduce individual medical expenses, this study did not evaluate the cost-effectiveness of the overall approach. Further health economic analyses are required to assess their clinical value.

CONCLUSION

In conclusion, the treatment of comorbid anxiety and depression in patients with end-stage HBP malignant tumors is both a medical and social problem. Through social support interventions, psychological and emotional interventions and available resources are integrated to enhance the will to survive and help patients obtain more social and emotional support. Through palliative treatment, patients can achieve better symptom control, optimize resource utilization, and reduce economic pressure. Palliative treatment can relieve pain in patients, and social support can prevent social vulnerability. The combination of these two forms of treatment can help patients with end-stage HBP tumors minimize pain and maximize dignity. Social support and palliative treatment can effectively relieve negative emotions such as anxiety and depression in patients, increase their social support, prolong the survival period of patients, improve their quality of life, and reduce the degree of fatigue in patients with end-stage tumors, which is worthy of clinical promotion and application.