BACKGROUND: Psychological distress and malnutrition are common among gastric cancer patients and are associated with poor postoperative recovery and long-term prognosis. However, these modifiable factors are rarely addressed in an integrated manner. This study was designed to evaluate whether a combined intervention of psychological resilience training and nutritional support improves postoperative recovery, systemic inflammation, sleep quality, nutritional status, and survival in gastric cancer patients undergoing curative surgery.
METHODS: In this randomized controlled trial, 260 patients undergoing curative gastrectomy were randomly assigned to receive either standard care or an integrated intervention combining cognitive-behavioral resilience training and individualized nutritional support. Primary outcomes included changes in psychological resilience (Connor-Davidson Resilience Scale), sleep quality (Pittsburgh Sleep Quality Index), emotional distress (Hospital Anxiety and Depression Scale), and nutritional indices (albumin, prealbumin, body mass index). Secondary outcomes included inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha), postoperative complications, hospital stay, and 2-year disease-free survival and overall survival.
RESULTS: Compared with controls, the intervention group showed significantly greater improvements in resilience, sleep quality, emotional well-being, and nutrition (all p < 0.001). Inflammatory markers were reduced, and complication rates were lower (16% vs. 28%, p = 0.015). Hospital stay was shorter (8.9 vs. 10.4 days, p < 0.001). Two-year DFS and OS were significantly higher (disease-free survival: 79.3% vs. 64.2%; overall survival: 84.6% vs. 69.2%), with multivariable Cox models confirming the intervention as an independent prognostic factor.
CONCLUSION: Integrated psychological and nutritional interventions enhance recovery and survival in gastric cancer, offering a promising adjunct to standard perioperative care.
