Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated

Abstract

Depression and anxiety are emotional disorders that commonly affect patients with esophageal cancer. As a result of its high morbidity, mortality, and complication rates, this population is at particularly high risk for developing or exacerbating affective disorders; even when compared to patients with other forms of cancer. Many of the medical conditions and social behaviors that predispose patients to this disease are also independently associated with affective disorders, and likely compound their effects. Unfortunately, in the existing literature, there is wide variability in study design and diagnostic criteria. There is no standard method of evaluation, many studies are limited to written surveys, and widespread mental health screening is not included as a part of routine care. As a result, the prevalence of these illnesses remains elusive.Additionally, psychiatric and psychosocial illness can affect compliance with surveillance and treatment, and gaps in knowledge may ultimately influence patient outcomes and survival. This review will discuss the existing literature on depression and anxiety in patients with esophageal cancer. It will highlight current methods of psychological evaluation, the prevalence of affective disorders in this population, and their effects on treatment, compliance, and outcomes. It will also discuss possible screening tools, treatments and interventions for these comorbid illnesses that may improve oncologic outcomes as well as quality of life.

Feasibility of OptiMaL, a Self-Management Programme for Oesophageal Cancer Survivors

“…12 This is concerning given that anxiety and/ or depression are linked to poorer health outcomes. 13,42 However, the findings from the current study may yield some promising results for the impact of self-management interventions with regards to mood and well-being of oesophageal cancer survivors.…”

“…8 However, Liu and colleagues reported clinically significant symptoms of anxiety or depression in up to 23.3% of their participants in their study of psychological distress and Health-Related Quality of Life (HRQoL) 2 years post-surgery. 16 Psychological distress and decreased energy levels have a significant impact on the health and well-being of oesophageal cancer survivors, and have been cited as predictors of poorer survival 13,16,17 following treatment. Qualitative studies lend support to these findings, describing the impact of psychological distress in the recovery period from oesophageal cancer, with many participants identifying the impact of fear of cancer recurrence and pain during post-operative period.…”

“…11,12 Anxiety and/or depression appear to be common amongst oesophageal cancer survivors, particularly within 1 year of diagnosis and treatment. 13 The incidence of anxiety and depression appears to peak shortly after completion of surgery, with studies reporting between 40% and 63.3% of participants meeting the criteria for probable anxiety or depression. 14,15 Schandl et al reported that 11% of their participants reported clinically significant symptoms of anxiety, and 12% of participants reported clinically significant symptoms of depression in the year following surgery.…”

Effects of preoperative albumin-to-globulin ratio on overall survival and quality of life in esophageal cell squamous carcinoma patients: a prospective cohort study

“…In addition, several studies also proved that lower preoperative AGR has a negative correlation to prognosis in gastric cancer [30], bladder cancer [31], and colorectal cancer [32], which consistent with our results. High morbidity, mortality, and complication rates predispose patients with esophageal cancer to emotional distress and psychiatric disorders [33]. Meanwhile, a nationwide population-based longitudinal study showed that the number of EC patients incident psychological distress after surgery increased year by year [34].…”

Developing & integrating a mobile application tool into a survivorship clinic for esophageal cancer patients

“…Furthermore, in local care settings, communication between surgical teams, primary care providers, patients, and caregivers is often disorganized and results in significant miscommunication and unnecessary suffering ( 9 ). The financial, emotional, and physical impact of this breakdown in communication and burden results in extraordinarily high suicide ( 10 ) and depression rates ( 11 ) among EC patients. Patients continue to struggle even 15 years from surgery, often with severe symptoms ( 12 ).…”