Perioperative risk factors of psychological distress in patients undergoing treatment for esophageal cancer

Abstract

Background Esophageal cancer patients often feel depressed and are fearful of metastasis and death. The objective of this study was to clarify the characteristics of patients with psychological distress at all 5 time points compared with patients with no psychological distress especially from standpoints of personal coping styles and QOL. Methods In total, 102 of 152 consecutive patients who attended the outpatient clinic at Toranomon Hospital between April 2017 and April 2019 met eligibility criteria for inclusion in this study. Questionnaires designed to identify psychological distress (HADS-scores) and assess QOL (EORTC QLQ C-30/OES18) were administered at 5 time points from the time of the first outpatient consultation to 3 months after esophagectomy. The questionnaire of coping strategies (MAC-scales) was administered at only time 1 point. Results Based on the trends of HADS-scores, we defined two groups: “persistent high-HAD scores” and “persistent low-HADS scores.” There are strong relationships between psychological distress and coping strategy, and psychological distress and QOL. The possibility that there are relationships between stress coping strategies and some QOL status depending on some point of treatment. Conclusions The psychological distress during the treatment course of esophageal cancer is significantly associated with the coping strategies and QOL influenced by esophagectomy. This study can provide baseline information for identifying patients in need of psychological management and paves the way for larger clinical studies in the future.

Pre-surgery supportive and goal-oriented strategies are associated with lower post-surgery perceived distress in women diagnosed with breast cancer

“…As coping embraces both cognitive and behavioral responses that could be labeled as approach or avoidant strategies towards stressful experiences, the second research aim has been achieved through factor extraction and rotation, and further predictive analyses through the Backward Elimination Regression. In line with a recent study that has shed light on the relationships that may link cancer-related distress, coping, and quality of life [ 35 ], the present study has detected specific factors that might have contributed to the significant distress reduction emerging over the brief timespan of in-patient surgery. As a result, half of the factors extracted have been shown to be positively associated with approach coping strategies.…”

“…Patients who perceived being supported and committed to functional activities before undergoing surgery had greater chances to show mild to moderate distress as well as lower chances to experience severe distress following surgery. This result could be explained in view of the key role played by such proactive behaviors in enhancing well-being and resilience among cancer patients undergoing surgery [ 35 ]. Firstly, seeking and obtaining comfort, understanding, information and/or advice may act as adaptive strategies, resulting in a more effective and tangible way to rapidly relieve distressed patients, compared with cognitive approach coping implying the reappraisal of breast cancer diagnosis and treatment [ 59 ].…”

“…Another weakness is represented by the administered self-report questionnaires. Indeed, albeit time-effective and recommended to screen for patients’ situational responses [ 26 , 35 , 41 ], the DT and Brief-COPE may be threatened by measurement errors such as respondent biases (e.g., social desirability, poor introspective ability, misreporting risks while asking ‘sensitive’ questions). Consistently, it has been shown that the DT instrument measures non-specific psychological distress compared to psycho-oncology gold standards that allow for the discrimination between surgically driven and general distress in breast cancer patients [ 66 , 67 ].…”

“…In order to detect the types of coping strategies suitable for factor analysis as well as for predictive analysis, pre-surgery coping strategies assessed through the Brief-COPE were interpreted based on Roth’s [ 24 ] and Carver’s [ 46 ] bidimensional model, as previously reported in literature [ 26 , 35 ]. Consistently, the scores concerning patients’ strategies to deal with pre-surgery distress were categorized as approach or avoidant coping strategies.…”

“…Similar to distress [ 32 , 33 ], coping strategies seem to evolve over time [ 13 , 22 ] as they reflect patients’ psychological status [ 34 , 35 ]. Indeed, a recently proposed view shows that, while survival fosters positive cognitive restructuring as a lifetime adaptive strategy [ 13 ], adverse effects of surgery may have a negative impact on health-related quality of life [ 36 ], representing challenging stress factors to cope with.…”