BACKGROUND: Patients undergoing abdominoperineal resection (APR) for low rectal cancer frequently experience profound psychosocial distress and impaired functional recovery due to permanent stoma formation. While ERAS protocols enhance physical rehabilitation, psychological dimensions remain under-addressed. This study evaluated the impact of a structured, integrative psychosocial intervention combining narrative therapy and cognitive behavioral therapy (CBT) on multidimensional recovery.
METHODS: In this single-center randomized controlled trial, 194 patients scheduled for curative APR were assigned to an intervention group (n = 97) receiving a 6-month narrative-CBT program in addition to standard ERAS care, or to a control group (n = 97) receiving ERAS care alone. Primary patient-reported outcomes included depressive symptoms (BDI-II), anxiety (BAI), stoma-related quality of life (Stoma-QOL), and sexual function (IIEF-5, FSFI). The key clinical endpoint was 2-year disease-free survival (DFS). Secondary outcomes included systemic inflammatory markers (CRP, IL-6, TNF-α), recovery metrics, and overall survival (OS). Analyses were conducted under the intention-to-treat principle.
RESULTS: Compared with controls, the intervention group demonstrated significantly greater reductions in depression and anxiety scores (p < 0.001), improved stoma-related quality of life and sexual function, and lower inflammatory marker levels on postoperative day 7 (p < 0.001). At 24 months, DFS was 86.8% vs. 72.2% (HR = 0.49, p = 0.021), and OS was 91.5% vs. 79.4% (HR = 0.43, p = 0.027).
CONCLUSIONS: An integrative narrative-CBT intervention was associated with improved psychosocial adaptation, reduced systemic inflammation, and better survival after APR. These exploratory findings suggest associative-not causal-links between psychosocial intervention and oncologic outcomes, warranting prospective mechanistic confirmation within integrated perioperative oncology frameworks.
