Integrative psychosocial and nutritional intervention improves psychological recovery, sleep, and disease-free survival after abdominoperineal resection for rectal cancer: a prospective controlled study.

Abstract

Background: Patients undergoing abdominoperineal resection (APR) for low rectal cancer often experience colostomy, sexual dysfunction, sleep disturbance, and psychological distress. Evidence for integrative supportive strategies is scarce. This study aimed to evaluate whether a structured integrative psychosocial and nutritional intervention could improve psychological recovery, sleep quality, sexual function, quality of life, and survival outcomes in patients undergoing APR for rectal cancer.

Methods: In this prospective controlled study, 190 patients scheduled for APR (January 2021-2023) were assigned to an integrative intervention (n = 96) or control group (n = 94). The intervention combined six psychosocial sessions-cognitive behavioral therapy for insomnia, resilience training, and narrative therapy-with individualized ESPEN-guided nutrition including early enteral feeding, protein-energy supplementation, and ω-3 fatty acids. The psychosocial program was delivered in a structured format over a 2-3 month perioperative period, while nutritional support was continuously implemented from the preoperative week to 6 months postoperatively. Primary outcomes were depressive symptoms (BDI-II), sleep quality (PSQI), and sexual function (IIEF-5/FSFI). Secondary outcomes included quality of life (EORTC QLQ-C30), disease-free survival (DFS), and inflammatory markers (CRP, IL-6, TNF-α). Overall survival (OS) was assessed as a prespecified secondary survival endpoint with 24-month follow-up.

Results: At 3 months, the intervention improved BDI-II (adjusted mean difference -6.8, p < 0.001) and PSQI (-3.4, p < 0.001), exceeding minimal clinically important differences. Sexual function and quality of life improved significantly, with benefits in sexual function emerging from 3 months and sustained up to 12 months, while QoL improvements were most pronounced at 3-6 months. At 24 months, DFS was significantly improved in the intervention group (HR 0.62, 95% CI 0.45-0.85, p = 0.003), whereas OS showed a favorable but non-significant trend.

Conclusions: An integrative psychosocial and nutritional program significantly enhanced psychological well-being, sleep, and sexual function, while improving quality of life and DFS after APR. These findings suggest that structured multimodal supportive care may provide clinically meaningful benefits beyond standard perioperative management and may represent a feasible adjunct strategy within rectal cancer survivorship care pathways.