One of the diseases that has contributed to high morbidity and mortality in the world is cancer, and excising the primary tumor is a major part of the curative treatment of most diseases. However, a growing body of evidence has suggested the perioperative period as an important aspect of oncological outcome in the long run. The physiological and immunological changes that transpire and take place during the surgery may inadvertently contribute to the tumor proliferation, fail to detect immunity, and increase the possibility of recurrence of cancer. It is the release of stress hormones, inflammatory mediators, as well as immunosuppressive cytokines, which is a response to surgical trauma in the form of an acute stress response. These fluctuations can undermine cell-mediated immune reaction, particularly natural killer (NK) cells reaction which are essential in the annihilation of tumours in circulation and micrometastatic disease. In this way, the means of reducing the state of perioperative immunosuppression has become a leading focus of clinical research (Bezu et al., 2025).

 

Regional anesthesia phenomenon has turned out to be an inviting and promising operation capable of influencing the functioning of immunity and prognosis of cancer in the long run. The neuroendocrine stress response involves less inhibition of afferent nociceptive pathways compared to general anesthesia when regional methods are employed, i.e., epidural, spinal, para-vertebral, and peripheral nerve blocks. Postoperative immune potential would be improved by lowering catecholamine and cortisol secretions through regional anesthesia. In addition, regional anesthesia allows avoiding the use of systemic opioids that are said to inhibit key immune functions, including NK-cell cytotoxicity, T- T-lymphocyte functioning, and macrophage responsiveness. So far, this opioid-sparing has provoked much interest because it can be indirectly employed to provide improved cancer follow-ups postoperatively (Kisdyanti et al., 2025).

 

These physiological benefits can be added to the recent laboratory results, which show that even the local anesthetics possess their own anti-tumor effects. It has been demonstrated that lidocaine and bupivacaine agents can exhibit the ability to reduce cell growth and viability, body movements, and induce apoptosis in cancer cells within various tumor systems. These kinds of outcomes have led to increased interest regarding the potential oncological use of the concept of regional anesthesia in the treatment of cancer during perioperative. In spite of the encouraging outcomes of the preclinical research, the clinical research on the topic has not provided a definite answer, and the results of randomized trials applied in different types of cancer are rather inconsistent. Nevertheless, the biological plausibility and the potential far-reaching shifts in the outcomes in the patients are one of the arguments that have to be promoted to make healthcare providers consider regional anesthesia as a technique of increasing the number of survival and recovery of cancer patients (Fagundes et al., 2025).

 

There is therefore a need to comprehend the perceptions and the knowledge of clinical personnel on immunological and oncological implications of the regional anesthesia. The application of anesthesia techniques and methodology is important and highly influenced by anesthetists, surgeons, and other professionals in the perioperative department, who are capable of influencing patient care pathways. These beliefs and preferences, and the knowledge of the available evidence, could have a direct implication on the clinical decision-making and the use of regional anesthesia in oncologic surgery. Such perceptions may be evaluated not only to illuminate the current trends of the practice level but also to provide the points where further training should be planned, or further development of research should be encouraged, or even the new policy should be developed and implemented (Khamdamov et al., 2025).

 

The study of the perceived impact of regional anesthesia on the immune system and the recurrence of cancer is a topical and interventional issue, given that the significance of maximizing perioperative care is increasingly gaining popularity in improving the outcome of cancer. The suggested study will presumably contribute to the existing literature by assessing the knowledge level of the professionals practicing healthcare, identifying the factors affecting it, and discussing the clinical implications of regional anesthesia in cancer surgery in general. Lastly, this study will be dedicated to maintaining evidence-based practices, which will foster patient, immune, and cancer control in the long term (Nguyen et al., 2025).

 

Literature Review

The association of approaches towards anesthesia and long-term cancer is one of the scientific subjects that has led to the increasing scientific interest over the past two decades. Even though surgery is regarded as a must in the elimination of the primary tumors, it might therefore be favoring the environment, which leads to recurrence of cancer and its proliferation. Other researchers have discovered as well that surgical trauma results in severe neuroendocrine stress that is characterized by catecholamine surges, cortisol surges, and inflammatory cytokines. These reactions play a significant role in compromising cell-mediated immunity, which is highly important in the process of detecting and destroying tumor cells in circulation (CTCs). Among them, a particular type of cell, the natural killer (NK) cells, is very sensitive to perioperative immunosuppression, and the impairment of the NK-cell functionality has been found to elevate the likelihood of metastatic growth. This has led scientists to investigate whether regional anesthesia (RA), with regard to its capability to suppress the physiological stress response, can be useful in saving the postoperative immune system and reducing the likelihood of new occurrences of cancer (Singh & Kumar, 2025).

 

Other studies suggest that regional anesthesia has beneficial immunological responses due to blocking the transmission of afferent nociceptive fibres and therefore the sympathetic response. RA also inhibits the immunosuppressive responses to surgical stress through the inhibition of excess catecholamine secretion. Sessler et al. highlighted that with the aid of epidural or spinal anesthesia, there would be major capulet affirms of perioperative levels of stress hormones or hormones over general anesthesia, which results in the preservation of the NK-cell activity. Moreover, RA approaches also lead to less opioid systemic usage, which was discovered to suppress the NK-cell cytotoxicity, T- T-lymphocytes proliferation/development, and macrophages reactivity. The mentioned effect on opioid sparing has been placed in the vanguard supporting the use of the RA as a surgical modality in cancer, since they have been suggested to play four roles in promoting angiogenesis and intermediating tumor progression as a result of stimulating the µ-opioid receptor. By so doing, RA will tend to enhance an immune state which is desirable within the best perioperative period (Nunez-Rodriguez et al., 2025).

 

There is currently emerging evidence in addition to the role of immune regulation of the anti-cancer effect of local anesthetics per se. The inhibition of cancer cell migration, proliferation, and metastasis is evidenced in lab experiments when lidocaine, bupivacaine, and ropivacaine prevent cancerous migration, proliferation, and metastasis, inhibiting them through different mechanisms. An example of this would be with lidocaine, which was shown to be an interference with the Voltage-gated sodium channels involved in tumor cell invasion. Bupivacaine is the one that causes apoptosis via the mitochondrial pathways. Those discoveries have given rise to interest in the systematic application of lidocaine infusion in surgery for cancer. Several clinical studies have explored this possibility and have demonstrated that the inflammatory markers are minimized and postoperative immunophenotype enhanced in patients receiving lidocaine infusion. Although the consistency of the results is not as high as it could be, the prospect of the anti-tumor effect of local anesthetics is among the promising lines of its investigation (Ramly & Buggy, 2025).

 

The experimental results on how the usage of RA on the recurrence of cancer have produced varied findings. The initial retrospective studies had revealed that RA may help reduce postoperative recurrence of breast, prostate, and colorectal cancer. Accordingly, Exadaktylos et al. demonstrated that breast cancer recurrence was significantly reduced in patients who were treated with paravertebral block with GA compared to those who had been treated with GA. The identical trends were observed among the patients receiving an epidural anesthesia during the surgery for prostate cancer. Big randomized controlled trials (RCTs) have, instead, provided more contradictory findings, which ensued. Sessler et al. conducted one of the first large-scale RCTs to date, where paravertebral anesthesia with propofol rather than sevoflurane-opioid was compared in breast cancer surgery, and did not observe any difference in the rate of recurrence. These differences drive home the point that it is not so easy to distinguish the effects of anesthesia among other perioperative factors, e.g., tumor biology, comorbidities, and adjuvant therapies (Lin et al., 2025).

 

Even though RCTs have not been able to consistently demonstrate the reduction of recurrence, the vast majority of them have demonstrated quantifiable immunological advantages in RA. An analysis of the literature has identified that, despite the uncertainty about the long-term outcome in oncology, RA improves the early postoperative immune markers, including NK-cell activity. That is, there can be temporary immunoprotective activities of RA that are biologically plausible but not inextricably linked to overt effects of survival. In addition, variations in RA method, selection of the medicines, time, as well as the correlation and relationship with other pain medicines may contribute to discrepancies found in clinical trials (Deng et al., 2025).

 

The second parameter that has recently been analyzed according to the recent literature is the contribution of the effect of perioperative inflammation to tumor progression. Postoperative inflammation can also enhance tumor cell adhesion, angiogenesis, and create a microenvironment that would facilitate metastasis. RA was also proven to reduce the level of pro-inflammatory cytokines such as IL-6 and TNF-α, which are likely to harbor the conditions that favour the growth of tumours. It has also been discovered that enhanced incorporation of RA in the enhanced recovery after surgery (ERAS) routes contributes to its impact in reducing the postoperative complications, pain, and inflammation (Gottumukkala & Gan, 2025).

 

Overall, the literature will show the increase of the consensus that RA has immunological and physiological benefits that may help cancer patients achieve better results, although some conclusive evidence of such opinion in terms of RCTs remains inconclusive. The necessity to further investigate the use of RA as a significant component of multimodal analgesia in cancer surgery has also been raised by scholars. The potential interaction of the RA with the opioid-minimization, as well as the immune-preservation, is indicative of the relevance of the present study in the area. It has been implied that RA is a facilitating aspect with respect to optimization of perioperative factors in cancer patients, and future studies could facilitate the development of its importance over time in recurrence and survival (Cheng et al., 2025).

 

 

Data Analysis

 

 

Table 1: Normality Test (Shapiro–Wilk)

Normality Test

Table 1 shows the normality test of the data. The outcome of the Shapiro-Wilk test of normality showed that the values exhibited by the chosen variables had p-values that are above 0.05, and thus the data can be said to be normally distributed. This is a confirmation that the sample satisfied the basic assumption of the parametric statistical analysis. Advanced statistical measures like Pearson correlation, independent samples t-test, ANOVA, and regression analysis with the use of computational statistics can be utilized because of the normal distribution of variables like age and Likert scores. The test results indicated that the assumption of normality was met, and therefore, the data could be deemed as being statistically consistent towards the initiation of subsequent inferential studies, and the findings could be discussed (Ackerman et al., 2021).

 

Table 2: Reliability Test (Cronbach’s Alpha)

Reliability Test (Cronbach’s Alpha)

Table 2 shows the reliability analysis of the data. The alpha or Cronbach coefficient (0.873) was good, indicating that the chosen Likert-scale questions assessed the perceptions of the area of anesthesia, immune system, and cancer recurrence. A score of 0.70 is deemed acceptable, and over 0.80 is considered excellent reliability. Hence, a large alpha value indicates that the scale items had a high level of correlation and evaluated a unitary construct. This translates to the fact that the respondents went through and provided consistent responses to related questions, which adds credibility and reliability to the questionnaire as the research instrument (Sessler et al., 2019).

 

Table 3: Validity Test (KMO & Bartlett’s Test of Sphericity)

 

Validity Test (KMO & Bartlett’s Test)

Table 3 shows the validity test of the data. The fact that the data were applicable in conducting the factor analysis was justified by the fact that the KMO measure was 0.742, which is within the acceptable range of sampling adequacy. It means that there is sufficient common variance concerning the variables to warrant factor analysis. Besides, Bartlett Test of Sphericity was very significant and came with a p-value of less than 0.001, and proved that the correlation was not an identity matrix and the relationship between variables was indeed significant. These findings, in combination, indicate high construct validity and justification of the applicability of multivariate methods to investigate underlying dimensions of the dataset (Jin et al., 2019).

 

 

 

 

Table 4: Combined Statistical Tests

 

Independent Samples t-Test

Table 4 shows the Combined Statistical Tests of the data. The results of the independent samples t-test also pointed to the statistically significant difference between the participants of both male and female genders in the perception of the immune preserving with the usage of the regional anesthesia (p = 0.015). It means that the issue of gender plays an important role in defining the perception of the respondents concerning the immunological benefits of regional anesthesia. The agreement was more among the female respondents as compared to the male respondents. Research of this kind would imply the likelihood of the existence of a disparity in awareness and/or clinical exposure between gender groups that may influence their perception of the physiological implications of anesthesia (Oh et al., 2022).

One-way ANOVA

The ANOVA test was carried out in one-way; it was concluded that the perception of the professional groups regarding the perception of stress reduction using the method of regional anesthesia is significantly different (p = 0.003). The finding of this nature implies that these experts, as anesthesiologists, surgeons, oncologists, and medical trainees, do not perceive the usefulness of regional anesthesia in terms of its ability to alleviate surgical stress in an equal measure (Minhas et al., 2024). The most amiable anesthesiologists seemed to be the most amiable since they are conversant with the techniques of anesthesia, and they are directly involved. These findings suggest that professional background plays a significant role in the perception and decision-making of clinical science with respect to perioperative care (Xu et al., 2021).

 

Kruskal–Wallis Test

The Kruskal-Wallis test showed that significant differences existed in the perception insofar as the effect of regional anesthesia on the recurrence of cancer in the respondents with various clinical experiences (p = 0.009). It was identified that the more experienced clinicians were more convinced by the potential of the regional anesthesia in the benefits of oncology. This means that there is a strong influence of professional experience and experience on the effects that beliefs have on long-term cancer outcomes. This is because this test is non-parametric and will also serve to establish that there exist big differences regardless of the kind of distribution (Yap et al., 2019).

Chi-Square Test of Independence

The Chi-square test was significant and had a power value that was significant (p 0.001) in the two factors of association of reading scientific literature with beliefs that regional anesthesia is associated with cancer recurrence. This conclusion shows that individuals who can keep down with the contemporary literature are in a better position to achieve the conceivable results of the anesthesia procedure to the post-surgical cancer results. Such a close connection, in its turn, implies the significance of scientific literacy and lifelong medical education to the development of the clinical perception and evidence-based practice (Forget et al., 2019)

Table 5: Pearson Correlation Matrix

 

Pearson Correlation Matrix

Table 5 shows the correlation analysis of the data. The Pearson correlation table showed positive correlations between all the variables measured. The moderate to strong correlation values showed that perceptions on stress reduction, preserving immunity, affecting cancer recurrence, and supporting guidelines were strongly related. All the strongest correlations were related to the immune preservation and total perception score (r = 0.76), which prompted us to assume that the knowledge about the immunological benefits plays a key role in the formation of the overall perceptions. These results point to a consistent and mutually supportive order between the main variables of perception (Chang et al., 2021).

 

Table 6: Regression Analysis

Regression Analysis

Table 6 shows the regression analysis of the data. The regression analysis showed that the four predictor variables, which included stress reduction, immune reduction, anesthesia effect on recurrence, and guideline support, significantly and positively predicted the total perception score. The overall model fit was excellent since this model had an adjusted R 2 of 0.66. Immune preservation (0.34) was the strongest predictor; it indicates that this attribute plays a significant role in determining the general response of respondents towards regional anesthesia. These findings confirm the strength of predictability of the model and the key role of immunological knowledge in creating clinical perceptions (Cusack & Buggy, 2020).

Figure 1: Normality Test (Shapiro–Wilk p-Values)

Figure 1 shows the normality test of the data. The figure of the Normality Test gives a clear picture of the Shapiro-Wilk p-values five most important variables, namely, Age, Stress Reduction, Immune Preservation, Recurrence Influence, and Guideline Support. Each of the p-values that is charted is greater than the significance level of 0.05 shown by a red dashed line. It implies that there is no major variation of each variable from normality. The number supports the idea that the assumptions to be made in parametric testing are met. Accordingly, the given data is perfectly compatible with the use of the Pearson Correlation, Independent Samples t-Test, ANOVA, and Regression Analysis. This value contributes to good grounds to apply parametric statistical methods in the course of the study (Matzner et al., 2020).

Figure 2: Reliability Test (Cronbach’s Alpha)

Figure 2 shows the reliability analysis of the data. The Reliability Test figure shows the value of Cronbach's Alpha, and it is 0.873, demonstrating very high internal consistency of the items involved in the perception scale. The acceptable threshold of 0.70 is clearly depicted through the red dashed line, which indicates that the achieved figure of alpha is well above the normal standard criteria of reliability (Kanani & Sheikh, 2024). The high reliability of the items in the questionnaire is established by the fact that the height of the bar is large, which implies that the respondents are consistent in the way they answer all the items addressing related constructs. Such reliability contributes to the enhancement of the trust in the validity of the responses and facilitates the soundness of the scale to continue the statistical analysis (Montagna et al., 2021).

Figure 3: Validity Test Figure (KMO & Bartlett’s Test)

Figure 3 shows the validity test of the data. The above figure, the Validity Test, presents the results of the Kaiser-Meyer-Olkin (KMO) measure and the Bartlett test of Sphericity. The KMO of 0.742 indicates that the sample size employed is large enough to perform factor analysis, and it is within the range of an acceptable 0.6. The Bartlett 165.38 before the chi-square value is again used to confirm that the data is actually qualified to be used in the structure detection, since a high value of the chi-square of 165.38 means that the correlation between the variables is significant. The figure is a graphical analysis of the comparison of a low measure of KMO with a very high measure of Bartlett’s chi-square value, and it is clear that the combination of the tests can be employed to justify the factorability of data and its statistical validity. This is building up credibility to construct validity of the instrument itself (Makito et al., 2020).

Figure 4: Combined Statistical Tests (t-Test, ANOVA, Kruskal–Wallis, Chi-Square)

Figure 4 shows the Combined Statistical Tests (t-Test, ANOVA, Kruskal–Wallis, Chi-Square) of the data. The bar chart contains the value of the test statistic in a visual comparative form of the four most important inferential statistics, which are the Independent Samples t-test, One-Way ANOVA, Kruskal-Wallis test, and Chi-Square test. The number is a clear indication that the Chi-Square statistic test realized the best value of test statistics (18.74) and therefore the most evidence of a relationship between the variables tested. Another test Kruskal-Wallis test, also obtained a relatively high value (11.52), which proves that significant differences among groups exist in terms of perceptions on the issue of cancer recurrence after undergoing anesthesia. There was a moderate effect (4.82) of the ANOVA bar, thus vindicating that professional groups differed significantly in their perceptions of stress reduction with the use of regional anesthesia. The t-test, with a value is 2.47, means that there is a statistically significant difference between the two gender-based groups regarding immune preservation beliefs. In general, the composite value will help to note the different levels of each statistical test and will allow one to visually prove that all tests provided statistically significant results (Ricon et al., 2019).

Figure 5: Correlation

Figure 5 shows the correlation matrix of the data. The correlation measure shows that there exist positive correlation coefficients between the important pairs of variables, including Stress-Immune, Stress-Recurrence, Immune-Recurrence, and guideline-total perception. There were moderately strong to strong correlations in all bars, with the highest value being depicted between the Guideline Support and Total Perception Score. This graphical illustration corroborates the fact that the more the perception an individual has, the more the associated perceptions. The general direction of positive relationships confirms the consistency of the conceptual framework, which means that everything in the perception of regional anesthesia has connections and supports each other (Guerrero Orriach et al., 2020).

Figure 6: Regression Analysis

Figure 6 shows the regression analysis of the data. The regression figure shows the coefficients of the tetrachannel beta of the four predictor variables that have been factored into the regression model, namely Stress Reduction, Immune Preservation, Recurrence Influence, and Guideline Support. The value of all betas is positive, which proves that all predictors have a positive contribution to the Total Perception Score. Immune Preservation has the strongest predictor (the highest beta = 0.34), which means that although the other variables are also significant predictors. The figure gives one a clear visual perception of the relative contribution of each variable to the general perceptions. This justifies the finding that the contributions of beliefs regarding attainment of immunological benefits have the most significant roles in

 

 

Data Analysis

 

 

Table 1: Normality Test (Shapiro–Wilk)

Normality Test

Table 1 shows the normality test of the data. The outcome of the Shapiro-Wilk test of normality showed that the values exhibited by the chosen variables had p-values that are above 0.05, and thus the data can be said to be normally distributed. This is a confirmation that the sample satisfied the basic assumption of the parametric statistical analysis. Advanced statistical measures like Pearson correlation, independent samples t-test, ANOVA, and regression analysis with the use of computational statistics can be utilized because of the normal distribution of variables like age and Likert scores. The test results indicated that the assumption of normality was met, and therefore, the data could be deemed as being statistically consistent towards the initiation of subsequent inferential studies, and the findings could be discussed (Ackerman et al., 2021).

 

Table 2: Reliability Test (Cronbach’s Alpha)

Reliability Test (Cronbach’s Alpha)

Table 2 shows the reliability analysis of the data. The alpha or Cronbach coefficient (0.873) was good, indicating that the chosen Likert-scale questions assessed the perceptions of the area of anesthesia, immune system, and cancer recurrence. A score of 0.70 is deemed acceptable, and over 0.80 is considered excellent reliability. Hence, a large alpha value indicates that the scale items had a high level of correlation and evaluated a unitary construct. This translates to the fact that the respondents went through and provided consistent responses to related questions, which adds credibility and reliability to the questionnaire as the research instrument (Sessler et al., 2019).

 

Table 3: Validity Test (KMO & Bartlett’s Test of Sphericity)

 

Validity Test (KMO & Bartlett’s Test)

Table 3 shows the validity test of the data. The fact that the data were applicable in conducting the factor analysis was justified by the fact that the KMO measure was 0.742, which is within the acceptable range of sampling adequacy. It means that there is sufficient common variance concerning the variables to warrant factor analysis. Besides, Bartlett Test of Sphericity was very significant and came with a p-value of less than 0.001, and proved that the correlation was not an identity matrix and the relationship between variables was indeed significant. These findings, in combination, indicate high construct validity and justification of the applicability of multivariate methods to investigate underlying dimensions of the dataset (Jin et al., 2019).

 

 

 

 

Table 4: Combined Statistical Tests

 

Independent Samples t-Test

Table 4 shows the Combined Statistical Tests of the data. The results of the independent samples t-test also pointed to the statistically significant difference between the participants of both male and female genders in the perception of the immune preserving with the usage of the regional anesthesia (p = 0.015). It means that the issue of gender plays an important role in defining the perception of the respondents concerning the immunological benefits of regional anesthesia. The agreement was more among the female respondents as compared to the male respondents. Research of this kind would imply the likelihood of the existence of a disparity in awareness and/or clinical exposure between gender groups that may influence their perception of the physiological implications of anesthesia (Oh et al., 2022).

One-way ANOVA

The ANOVA test was carried out in one-way; it was concluded that the perception of the professional groups regarding the perception of stress reduction using the method of regional anesthesia is significantly different (p = 0.003). The finding of this nature implies that these experts, as anesthesiologists, surgeons, oncologists, and medical trainees, do not perceive the usefulness of regional anesthesia in terms of its ability to alleviate surgical stress in an equal measure (Minhas et al., 2024). The most amiable anesthesiologists seemed to be the most amiable since they are conversant with the techniques of anesthesia, and they are directly involved. These findings suggest that professional background plays a significant role in the perception and decision-making of clinical science with respect to perioperative care (Xu et al., 2021).

 

Kruskal–Wallis Test

The Kruskal-Wallis test showed that significant differences existed in the perception insofar as the effect of regional anesthesia on the recurrence of cancer in the respondents with various clinical experiences (p = 0.009). It was identified that the more experienced clinicians were more convinced by the potential of the regional anesthesia in the benefits of oncology. This means that there is a strong influence of professional experience and experience on the effects that beliefs have on long-term cancer outcomes. This is because this test is non-parametric and will also serve to establish that there exist big differences regardless of the kind of distribution (Yap et al., 2019).

Chi-Square Test of Independence

The Chi-square test was significant and had a power value that was significant (p 0.001) in the two factors of association of reading scientific literature with beliefs that regional anesthesia is associated with cancer recurrence. This conclusion shows that individuals who can keep down with the contemporary literature are in a better position to achieve the conceivable results of the anesthesia procedure to the post-surgical cancer results. Such a close connection, in its turn, implies the significance of scientific literacy and lifelong medical education to the development of the clinical perception and evidence-based practice (Forget et al., 2019)

Table 5: Pearson Correlation Matrix

 

Pearson Correlation Matrix

Table 5 shows the correlation analysis of the data. The Pearson correlation table showed positive correlations between all the variables measured. The moderate to strong correlation values showed that perceptions on stress reduction, preserving immunity, affecting cancer recurrence, and supporting guidelines were strongly related. All the strongest correlations were related to the immune preservation and total perception score (r = 0.76), which prompted us to assume that the knowledge about the immunological benefits plays a key role in the formation of the overall perceptions. These results point to a consistent and mutually supportive order between the main variables of perception (Chang et al., 2021).

 

Table 6: Regression Analysis

Regression Analysis

Table 6 shows the regression analysis of the data. The regression analysis showed that the four predictor variables, which included stress reduction, immune reduction, anesthesia effect on recurrence, and guideline support, significantly and positively predicted the total perception score. The overall model fit was excellent since this model had an adjusted R 2 of 0.66. Immune preservation (0.34) was the strongest predictor; it indicates that this attribute plays a significant role in determining the general response of respondents towards regional anesthesia. These findings confirm the strength of predictability of the model and the key role of immunological knowledge in creating clinical perceptions (Cusack & Buggy, 2020).

Figure 1: Normality Test (Shapiro–Wilk p-Values)

Figure 1 shows the normality test of the data. The figure of the Normality Test gives a clear picture of the Shapiro-Wilk p-values five most important variables, namely, Age, Stress Reduction, Immune Preservation, Recurrence Influence, and Guideline Support. Each of the p-values that is charted is greater than the significance level of 0.05 shown by a red dashed line. It implies that there is no major variation of each variable from normality. The number supports the idea that the assumptions to be made in parametric testing are met. Accordingly, the given data is perfectly compatible with the use of the Pearson Correlation, Independent Samples t-Test, ANOVA, and Regression Analysis. This value contributes to good grounds to apply parametric statistical methods in the course of the study (Matzner et al., 2020).

Figure 2: Reliability Test (Cronbach’s Alpha)

Figure 2 shows the reliability analysis of the data. The Reliability Test figure shows the value of Cronbach's Alpha, and it is 0.873, demonstrating very high internal consistency of the items involved in the perception scale. The acceptable threshold of 0.70 is clearly depicted through the red dashed line, which indicates that the achieved figure of alpha is well above the normal standard criteria of reliability (Kanani & Sheikh, 2024). The high reliability of the items in the questionnaire is established by the fact that the height of the bar is large, which implies that the respondents are consistent in the way they answer all the items addressing related constructs. Such reliability contributes to the enhancement of the trust in the validity of the responses and facilitates the soundness of the scale to continue the statistical analysis (Montagna et al., 2021).

Figure 3: Validity Test Figure (KMO & Bartlett’s Test)

Figure 3 shows the validity test of the data. The above figure, the Validity Test, presents the results of the Kaiser-Meyer-Olkin (KMO) measure and the Bartlett test of Sphericity. The KMO of 0.742 indicates that the sample size employed is large enough to perform factor analysis, and it is within the range of an acceptable 0.6. The Bartlett 165.38 before the chi-square value is again used to confirm that the data is actually qualified to be used in the structure detection, since a high value of the chi-square of 165.38 means that the correlation between the variables is significant. The figure is a graphical analysis of the comparison of a low measure of KMO with a very high measure of Bartlett’s chi-square value, and it is clear that the combination of the tests can be employed to justify the factorability of data and its statistical validity. This is building up credibility to construct validity of the instrument itself (Makito et al., 2020).

Figure 4: Combined Statistical Tests (t-Test, ANOVA, Kruskal–Wallis, Chi-Square)

Figure 4 shows the Combined Statistical Tests (t-Test, ANOVA, Kruskal–Wallis, Chi-Square) of the data. The bar chart contains the value of the test statistic in a visual comparative form of the four most important inferential statistics, which are the Independent Samples t-test, One-Way ANOVA, Kruskal-Wallis test, and Chi-Square test. The number is a clear indication that the Chi-Square statistic test realized the best value of test statistics (18.74) and therefore the most evidence of a relationship between the variables tested. Another test Kruskal-Wallis test, also obtained a relatively high value (11.52), which proves that significant differences among groups exist in terms of perceptions on the issue of cancer recurrence after undergoing anesthesia. There was a moderate effect (4.82) of the ANOVA bar, thus vindicating that professional groups differed significantly in their perceptions of stress reduction with the use of regional anesthesia. The t-test, with a value is 2.47, means that there is a statistically significant difference between the two gender-based groups regarding immune preservation beliefs. In general, the composite value will help to note the different levels of each statistical test and will allow one to visually prove that all tests provided statistically significant results (Ricon et al., 2019).

Figure 5: Correlation

Figure 5 shows the correlation matrix of the data. The correlation measure shows that there exist positive correlation coefficients between the important pairs of variables, including Stress-Immune, Stress-Recurrence, Immune-Recurrence, and guideline-total perception. There were moderately strong to strong correlations in all bars, with the highest value being depicted between the Guideline Support and Total Perception Score. This graphical illustration corroborates the fact that the more the perception an individual has, the more the associated perceptions. The general direction of positive relationships confirms the consistency of the conceptual framework, which means that everything in the perception of regional anesthesia has connections and supports each other (Guerrero Orriach et al., 2020).

Figure 6: Regression Analysis

Figure 6 shows the regression analysis of the data. The regression figure shows the coefficients of the tetrachannel beta of the four predictor variables that have been factored into the regression model, namely Stress Reduction, Immune Preservation, Recurrence Influence, and Guideline Support. The value of all betas is positive, which proves that all predictors have a positive contribution to the Total Perception Score. Immune Preservation has the strongest predictor (the highest beta = 0.34), which means that although the other variables are also significant predictors. The figure gives one a clear visual perception of the relative contribution of each variable to the general perceptions. This justifies the finding that the contributions of beliefs regarding attainment of immunological benefits have the most significant roles in influencing the overall perception of respondents regarding regional anesthesia (Zhu et al., 2020).

The findings of the present study can be applicable in the disclosure of the perceived impacts of regional anesthesia on immune response and cancer recurrence amongst health practitioners. The results indicated that a positive perception of the immunology and oncology superiority of the regional anesthesia existed in the respondents (Samin et al., 2025). This is in accordance with the existing bodies of clinical evidence that suggest that regional anesthesia can alleviate post-operative stress responses, reduce the use of opioids, and retain natural killer (NK) cell activity, which are arguably some of the determining factors of postoperative cancer outcomes. The perfection of Cronbach's Alpha and the acceptability of KMO and Bartlett's Test also go a long way in justifying the credibility of such findings and show that the measurement scale was competent in capturing the perceptions of the participants (Chen et al., 2019).

 

Inferential analyses of the study revealed that significant differentiation and association of the groups existed. The independent t-test had shown that significant influence on the perceptions concerning the preservation of immunity was made by the gender, and female respondents were more likely to agree. This may be a sign of clinical exposure anomaly, reading, and risk perception among the genders. The one-way ANOVA has also indicated that there was a significant difference in professions with regard to beliefs in reducing stress. Having the expertise and being more familiar with regional anesthesia, it is natural to note the highest levels of agreement amongst anesthesiologists. Quite to the contrary, surgeons and oncologists were considerably moderate in their perception, which perhaps may be associated with diverse education levels, or with divergent experience in planning anesthesia (Albrecht & Chin, 2020).

 

The other interesting finding was that the influences of clinical experience on the decrease of cancer were significant, as it was found by the Kruskal-Wallis test. The elders appeared to be much more conscious of the potential benefits in the long term, which might be predicated on the long-term patient outcomes. The other important relationship that was observed to be significant by the Chi-Square test was the relationship between the reading of scientific literature and belief in the oncological properties of regional anesthesia. This indicates the need to have lifelong learning and evidence-based practice to help enrich the opinion of clinicians (Thota et al., 2019).

The correlation analysis conducted increased these results by the fact that there are strong positive correlations among all the variables of perception. It means that the individuals who believed in the stress-reducing quality of regional anesthesia were also likely to see its immune-saving quality and its potential to be used for cancer recurrence prevention. The interrelatedness was upheld by the regression analysis, according to which all the primary variables of perception were significantly associated with the total perception scores. The conviction of the immunity remaining was the strongest predictor that provided an impression of the immunological knowledge taking the centre stage in the development of larger regional anesthesia views (Rao et al., 2020).

 

Overall, the outcomes of the research can be named in the list of studies which suggest the development of the practice of regional anesthesia as the perceived way of reducing pain, but also as a modality that could present limited benefits to the system and cancer. Even though the research involved perceptions and not clinical outcomes, the results indicated that there were significant gaps, in terms of knowledge, that had to be addressed, and that more scientific studies should be introduced to the health care providers. Perhaps an awareness innovation daily through training, seminars, and new guidelines can serve to enhance the interdisciplinary collaboration and progress in consent of the anesthetic decisions towards taking action more informed during the cancer surgery (Sen et al., 2019).

The present study can be mentioned as possessing profound knowledge about the perceptions of medical practitioners on the efficacy of regional anesthesia on the immune system and recurrence of cancer. The findings indicate that the respondents are more likely to give a positive impression of the possible advantages of regional anesthesia, particularly in alleviating surgical stress and ability to maintaining postoperative immunity. Such perceptions were substantiated by very good statistical support on such perceptions in terms of reliability in measuring instruments, construct, and significance of findings in different tests of inference. A difference in gender and profession, and the clinical experience, can also serve to emphasize the different factors that affect to shape of the knowledge of clinicians with regard to the overall effects of the anesthesia techniques.

 

The second role of scientific literacy is relevant to the study as well, since the participants who said that they read research literature demonstrated a significantly higher level of conviction regarding the oncological benefit of regional anesthesia. The outcome of the regression model and positive relation confirms, and further, the character of the relationship between the perceptions, dealing with the preservation of immunity, stress reduction, and recurrence of cancer. These results put together suggest that the perceived value of regional anesthesia is strongly linked to the consequences of analgesia, but the prospect of systemic and longitudinal effects of the technique is just gaining reasonable approval.

 

Generally, the study concludes that regional anesthesia can be discussed as a helpful practice in cancer surgery that has great implications in terms of immune functioning and possible cancer recurrence. Although they are data of the perception, yet not outcome, these data should be highlighted with respect to the importance of further research, professional studies, and multidisciplinary awareness. Increasing awareness of the providers involved in the healthcare sector might lead to more clinical decisions being taken and assist in engaging appropriate perioperative care plans for cancer patients.

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