Psychiatric morbidity among patients with cancer of the esophagus or the gastro-esophageal junction: a prospective, longitudinal evaluation

Abstract

Cancer of the esophagus is often diagnosed at a late stage and is related to severe morbidity and a low 5-year survival rate. Previous studies have reported low health-related quality of life and high suicide rates for these patients. The occurrence of psychiatric morbidity and thus the potential need for psychological support may vary over time after diagnosis. This has not been adequately studied in patients with newly diagnosed cancer of the esophagus or gastro-esophageal junction. The present study therefore aimed to prospectively evaluate the prevalence of psychiatric morbidity in 94 consecutive patients (median age 66, range 45-88 years) with all stages of disease. Psychiatric morbidity was evaluated with the Hospital Anxiety and Depression Scale (HADS) questionnaire at inclusion and 1, 2, 3, 6 and 12 months later. At inclusion, 42% of the patients had HADS scores indicating possible or probable anxiety disorder and/or depression. At all follow-ups except at 3 months, proportions of patients with possible/probable anxiety disorder were significantly lower than at inclusion. Among patients with a duration of tumor-specific symptoms exceeding 6 months pre-diagnosis, larger proportions of patients with a possible/probable anxiety disorder were found at the 1- and 6-month follow ups. The prevalence of possible/probable depression was greater among patients treated with a palliative intent than among those with a curative intent at inclusion. Patients who died during the study period scored worse for depression compared to the survivors. Apart from this, the proportion of patients with possible/probable psychiatric morbidity (anxiety and/or depression) was relatively stable over time and was unrelated to patient characteristics or clinical background, including the treatment regime. In conclusion, psychiatric morbidity is common among esophageal cancer patients, both at inclusion and over time, regardless of the cancer therapy given. The findings stress the importance of monitoring the patients' mental health and of offering adequate psychological care when needed.

Perioperative Comprehensive Supportive Care Interventions for Chinese Patients with Esophageal Carcinoma: a Prospective Study

“…Prospective study showed that anxiety and depression were prevalent at diagnosis of cancer (Gil et al, 2012;Iwatani et al, 2013). Over 1/3 of patients newly diagnosed with esophageal cancer suffered from significant psychological symptoms, particularly anxiety (Bergguist et al, 2007;Dempster et al, 2012). Pain, fatigue, insomnia and mood disturbance are highly prevalent in patients, especially the elderly undergoing cancer therapy (Cheng et al, 2011;Stauder et al, 2013).…”

Discussions of Life Expectancy Moderate Relationships between Prognosis and Anxiety or Depression in Men with Advanced Cancer

“…These concerns seem reasonable given the prevalence of anxiety or depression in people with cancer [8][9][10] and the correlation with disease stage in some [11][12][13] but not all studies. [14][15] However, the majority of patients with advanced cancer express clear preferences for honest prognostic disclosure. 16 Furthermore, people with advanced cancer who discussed preferences for endof-life care with their oncologists were more likely to receive less aggressive medical care and have improved quality of life.…”

Depressão e comportamento suicida em pacientes oncológicos hospitalizados: prevalência e fatores associados

“…Ainda assim, a prevalência que encontramos foi superior aos 5% de alguns estudos que utilizaram critérios diagnósticos estritos, como por exemplo, episódio depressivo grave (major depression) 8,9 . É inferior, no entanto, a um trabalho recente no qual também se utilizou a HAD em 94 pacientes com câncer de esôfago, chegando-se a uma cifra de 42% para casos "prováveis e possíveis de depressão" 27 . Entretanto é difícil realizarmos uma comparação já que grande parte dos trabalhos avalia grupos específicos de pacientes oncológicos.…”