Objective：The purpose of this study was to investigate changes in fatigue and related factors in patients with gastrointestinal cancer in the perioperative period.

Methods：The study included 46 patients with gastrointestinal cancer (25 men and 21 women aged 62.0±11.9 years). The Cancer Fatigue Scale (CFS) was used to measure fatigue. The Hospitality Anxiety Depression scale (HAD) was used to measure anxiety and depression. The isometric knee extension force (IKEF) and 6-minute walk distance (6MWD) were used to measure physical function. These examinations were performed at three stages：before surgery, after surgery, and after discharge.

Results：CFS scores were high before surgery, and then gradually decreased across the stages. CFS scores were positively correlated with anxiety and depression at all three stages. Moreover, CFS scores were negatively correlated with 6MWD and IKEF before surgery and after discharge.

Conclusion：Fatigue was related to anxiety and depression at all three stages. In addition, fatigue was negatively correlated with exercise tolerance and IKEF before surgery and after discharge. It is suggested that an intervention for improving physical function is important to decrease fatigue before surgery and after discharge in patients with gastrointestinal cancer in the perioperative period.

 Hot sprigs elements and balneological effects of Tokyo 23 wards, which is not recognized as hot spring region were considered. The density of the hot spring’s source in this region is high compared to other parts of the country. Moreover, a useful element and temperature for the balneological treatment was confirmed by the hot springs with deep digging in a lot of places.  The hot springs in Tokyo can be classified into the NaCl strong salt hot springs, NaHCO3, and the sodium metasilicates. The strong Na-Cl (salt) springs are recognized in hot springs found by deep digging, and exists everywhere in Tokyo. The hot springs of the NaHCO3 are localized in Ohta ward by moderate depth digging. The hot springs including with the rich sodium metasilicates in Ohta ward by shallow digging. If the hot springs in Tokyo are to be used the balneologically, the following effects are expected.  Thermal and warm keeping effects can be expected from the strong Na-Cl (salt) springs. Cleanness and smoothing effects of the skin can be expected of NaHCO3. Hyperkeratosis of the skin can be expected from rich sodium metasilicates.