BACKGROUND: Perioperative psychological and behavioral vulnerabilities can impair recovery and 24-month outcomes in gastric cancer patients. Targeted behavioral interventions during this critical window may yield multidimensional benefits.
OBJECTIVE: To evaluate the effectiveness of a 12-week perioperative program integrating narrative therapy and sleep optimization in improving recovery and 2-year survival after curative gastrectomy.
METHODS: In this single-center randomized controlled trial, 310 patients undergoing gastrectomy for stage I-III gastric cancer were randomized 1:1 to receive standard care or standard care plus a structured behavioral intervention delivered by licensed psychologists and sleep specialists. The intervention comprised six biweekly face-to-face narrative therapy sessions and a CBT-I-based sleep program with remote follow-up. Outcomes were assessed at baseline, and at 1, 3, 6, 12, and 24 months postoperatively. Primary endpoints included emotional distress (Hospital Anxiety and Depression Scale, HADS), sleep quality, nutritional and inflammatory markers, and quality of life. Secondary endpoints were 12- and 24-month disease-free survival (DFS) and overall survival (OS). Mixed-effects models and Cox regression were used for statistical analyses.
RESULTS: The intervention group showed significantly greater improvements in HADS scores (p < 0.001), sleep quality (p < 0.001), BMI and albumin levels (p < 0.01), and lower CRP, IL-6, and TNF-α levels across follow-up. QoL scores were consistently higher postoperatively. At 24 months, DFS and OS rates were significantly higher in the intervention group (DFS: HR 0.59, 95% CI 0.40-0.87; OS: HR 0.54, 95% CI 0.35-0.84).
CONCLUSION: Integrating structured narrative therapy and sleep optimization into perioperative care improved biopsychosocial recovery and 2-year survival in gastric cancer patients. These findings support embedding behavioral strategies within surgical oncology pathways.
IMPLICATIONS FOR CANCER SURVIVORS: Integrating structured narrative therapy and sleep optimization into perioperative care offers a safe, low-cost, and scalable strategy to enhance recovery and long-term outcomes in gastric cancer survivors. By addressing psychological distress, sleep disruption, and inflammatory imbalance during the surgical period, this approach supports sustained emotional well-being, nutritional restoration, and survival. These findings highlight the importance of embedding behavioral interventions within survivorship care to promote holistic recovery and quality of life.
