AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025310331
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ORIGINAL RESEARCH ARTICLE

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

Mattia Morri1* ,  Felicia Iacovone2 ,  Cristiana Forni1 ,  Grazia Lisciandrello2 ,  Francesca Corvino2 ,  Davide Maria Donati2 ,  Daniela Di Nicolantonio1
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1 Nursing, Technical, and Rehabilitation Service, IRCCS Rizzoli Orthopedic Institute, Bologna, Emilia-Romagna, Italy
2 3rd Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Rizzoli Orthopedic Institute, Bologna, Emilia-Romagna, Italy
EJMO, 025310331 https://doi.org/10.36922/EJMO025310331
Received: 30 July 2025 | Revised: 11 November 2025 | Accepted: 19 November 2025 | Published online: 6 January 2026
(This article belongs to the Special Issue Nursing Care in Cancer)
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

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.

Keywords
Distress
Bone neoplasms
Sarcoma
Hospitalization
Orthopedic procedures
Funding
This research was funded by the Italian Ministry of Health through the 5×Mille program 2021 (2020 income year) to the Rizzoli Orthopedics Institute (grant number: 5M-2021- 23683816).
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Bultz BD, Carlson LE. Emotional distress: The sixth vital sign--future directions in cancer care. Psychooncology. 2006;15(2):93-95. doi: 10.1002/pon.1022

 

  1. Cimino T, Said K, Safier L, Harris H, Kinderman A. Psychosocial distress among oncology patients in the safety net. Psychooncology. 2020;29(11):1927-1935. doi: 10.1002/pon.5525

 

  1. Fehrenbach MK, Wilhelmy F, Wende T, Güresir E, Kasper J. Perioperative psychological distress in patients with intracranial tumors; a single center study. J Neurooncol. 2024;168(1):151-157. doi: 10.1007/s11060-024-04657-8

 

  1. McDonough J, Eliott J, Neuhaus S, Reid J, Butow P. Health-related quality of life, psychosocial functioning, and unmet health needs in patients with sarcoma: A systematic review. Psychooncology. 2019;28(4):653-664. doi: 10.1002/pon.5007

 

  1. Riba MB, Donovan KA, Ahmed K, et al. NCCN Guidelines® insights: Distress management, version 2.2023. J Natl Compr Canc Netw. 2023;21(5):450-457. doi: 10.6004/jnccn.2023.0026

 

  1. Ross Majumdar J, Goodman P, Barton-Burke M, Gilliland J, Jairath N. Distress, pain, and nausea on postoperative days 1 and 14 in women recovering from breast-conserving surgery: A repeated-measures study. Oncol Nurs Forum. 2024;51(4):381-390. doi: 10.1188/24.ONF.381-390

 

  1. Batterham PJ, Sunderland M, Slade T, Calear AL, Carragher N. Assessing distress in the community: Psychometric properties and crosswalk comparison of eight measures of psychological distress. Psychol Med. 2018;48(8):1316-1324. doi: 10.1017/S0033291717002835

 

  1. Hahn C, Joo SH, Chae JH, Lee CU, Kim TS. Feasibility of psychosocial distress screening and management program for hospitalized cancer patients. Psychiatry Investig. 2017;14(6):734-745. doi: 10.4306/pi.2017.14.6.734

 

  1. McElroy JA, Waindim F, Weston K, Wilson G. A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non-English speaking countries. Psychooncology. 2022;31(8):1267-1274. doi: 10.1002/pon.5989

 

  1. Sun H, Lv H, Zeng H, Niu L, Yan M. Distress thermometer in breast cancer: Systematic review and meta-analysis. BMJ Support Palliat Care. 2022;12(3):245-252. doi: 10.1136/bmjspcare-2021-002960

 

  1. Tonsing KN, Vungkhanching M. Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center. Soc Work Health Care. 2018;57(2):126-136. doi: 10.1080/00981389.2017.1402844

 

  1. Ise M, Nakata E, Katayama Y, et al. Prevalence of psychological distress and its risk factors in patients with primary bone and soft tissue tumors. Healthcare (Basel). 2021;9(5):566. doi: 10.3390/healthcare9050566

 

  1. Marie Uhlenbruch F, Schopow N, Roschke E, et al. The validity of the distress thermometer in patients with musculoskeletal tumors. J Bone Oncol. 2024;44:100479. doi: 10.1016/j.jbo.2023.100479

 

  1. Lenze F, Kirchhoff C, Pohlig F, et al. Standardized screening and psycho-oncological treatment of orthopedic cancer patients. In Vivo. 2018;32(5):1161-1167. doi: 10.21873/invivo.11359

 

  1. Benedetti MG, Erfe Delayon S, Colangeli M, et al. Rehabilitation needs in oncological patients: The On-rehab project results on patients operated for musculoskeletal tumors. Eur J Phys Rehabil Med. 2017;53(1):81-90. doi: 10.23736/S1973-9087.16.04192-7

 

  1. Bergerot CD, Bergerot PG, Philip EJ, et al. Assessment of distress and quality of life in rare cancers. Psychooncology. 2018;27(12):2740-2746. doi: 10.1002/pon.4873

 

  1. Lopes-Júnior LC, Bomfim EO, Nascimento LC, Nunes MDR, Pereira-da-Silva G, Lima RG. Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: An integrative review. Eur J Cancer Care (Engl). 2016;25(6):921-935. doi: 10.1111/ecc.12381

 

  1. Ownby KK. Use of the distress thermometer in clinical practice. J Adv Pract Oncol. 2019;10(2):175-179.

 

  1. Park H, Kim KE, Moon E, Kang T. Psychometric properties of assessment tools for depression, anxiety, distress, and psychological problems in breast cancer patients: A systematic review. Psychiatry Investig. 2023; 20(5):395-407. doi: 10.30773/pi.2022.0316

 

  1. Guan B, Wang K, Shao Y, et al. The use of distress thermometer in advanced cancer inpatients with pain. Psychooncology. 2019;28(5):1004-1010. doi: 10.1002/pon.5032

 

  1. Iskandarsyah A, Klerk C, Suardi DR, Soemitro MP, Sadarjoen SS, Passchier J. The distress thermometer and its validity: A first psychometric study in Indonesian women with breast cancer. PLoS One. 2013;8(2):e56353. doi: 10.1371/journal.pone.0056353

 

  1. Lim HA, Mahendran R, Chua J, Peh CX, Lim SE, Kua EH. The distress thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore. Compr Psychiatry. 2014;55(4):1055-1062. doi: 10.1016/j.comppsych.2014.01.008

 

  1. Ohnhäuser S, Wüller J, Foldenauer AC, Pastrana T. Changes in distress measured by the distress thermometer as reported by patients in home palliative care in Germany. J Palliat Care. 2018;33(1):39-46. doi: 10.1177/0825859717751932

 

  1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Med Care. 2003;41(5):582-592. doi: 10.1097/01.MLR.0000062554.74615.4C

 

  1. Mouelhi Y, Jouve E, Castelli C, Gentile S. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020;18(1):136. doi: 10.1186/s12955-020-01344-w

 

  1. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18(3):205-207. doi: 10.1136/emj.18.3.205

 

  1. Santos MSD, Thomaz FM, Jomar RT, Abreu AMM, Taets GGDCC. Music in the relief of stress and distress in cancer patients. Rev Bras Enferm. 2021;74(2):e20190838. doi: 10.1590/0034-7167-2019-0838

 

  1. Siebenhüner AR, Mikolasek M, Witt CM, Barth J. Improvements in health might contradict adherence to mobile health interventions: Findings from a self-care cancer app study. J Alternat Complement Med. 2021;27(S1):S115-S123. doi: 10.1089/acm.2020.0111

 

  1. Lewis F, Merckaert I, Liénard A, et al. Anxiety and its time courses during radiotherapy for non-metastatic breast cancer: A longitudinal study. Radiother Oncol. 2014;111(2):276-280. doi: 10.1016/j.radonc.2014.03.016

 

  1. StataCorp. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC. Published; 2023.

 

  1. Paredes T, Canavarro MC, Simões MR. Anxiety and depression in sarcoma patients: Emotional adjustment and its determinants in the different phases of disease. Eur J Oncol Nurs. 2011;15(1):73-79. doi: 10.1016/j.ejon.2010.06.004

 

  1. Santiago L, Anzuatégui PR, Ribeiro JPA, Filon MC, Mello GJP, Rigolino AVB. Assessing psychosocial distress in bone metastases treated with endoprosthesis. Acta Ortop Bras. 2019;27(5):257-260. doi: 10.1590/1413-785220192705220293

 

  1. Zaza C, Baine N. Cancer pain and psychosocial factors: A critical review of the literature. J Pain Symptom Manage. 2002;24(5):526-542. doi: 10.1016/s0885-3924(02)00497-9

 

  1. Tang MH, Castle DJ, Choong PFM. Identifying the prevalence, trajectory, and determinants of psychological distress in extremity sarcoma. Sarcoma. 2015;2015:745163. doi: 10.1155/2015/745163
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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