Hellstadius Ylva, Lagergren Jesper, Zylstra Janine, Gossage James, Davies Andrew, Hultman Christina M, Lagergren Pernilla, Wikman Anna
a Department of Molecular Medicine and Surgery, Surgical Care Science , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
b Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery , Karolinska Institutet , Stockholm , Sweden.
Acta Oncol. 2017 May;56(5):746-752. doi: 10.1080/0284186X.2017.1287945. Epub 2017 Feb 17.
Psychological distress is common among patients with oesophageal cancer. However, little is known about the course and predictors of psychological distress among patients treated with curative intent. Therefore, the aim of this study was to explore the prevalence, course and predictors of anxiety and depression in patients operated for oesophageal cancer, from prior to surgery to 12 months post-operatively.
A prospective cohort of patients with oesophageal cancer (n = 218) were recruited from one high-volume specialist oesophago-gastric treatment centre (St Thomas' Hospital, London, UK). Anxiety and depression were assessed prior to surgery, 6 and 12 months post-operatively. Mixed-effects modelling was performed to investigate changes over time and to estimate the association between clinical and socio-demographic predictor variables and anxiety and depression symptoms.
The proportion of patients with anxiety was 33% prior to surgery, 28% at 6 months, and 37% at 12 months. Prior to surgery, 20% reported depression, 27% at 6 months, and 32% at 12-month follow-up. Anxiety symptoms remained stable over time whereas depression symptoms appeared to increase from pre-surgery to 6 months, levelling off between 6 and 12 months. Younger age, female sex, living alone and more severe self-reported dysphagia (i.e., difficulty swallowing) predicted higher anxiety symptoms. In-hospital complications, greater limitations in activity status and more severe self-reported dysphagia were predictive of higher depression.
Many patients report psychological distress during the first year following oesophageal cancer surgery. Whether improving the experience of swallowing difficulties may also reduce distress among these patients warrants further study.
心理困扰在食管癌患者中很常见。然而，对于接受根治性治疗的患者心理困扰的病程及预测因素知之甚少。因此，本研究旨在探讨食管癌手术患者术前至术后12个月焦虑和抑郁的患病率、病程及预测因素。
从一个高容量的专科食管胃治疗中心（英国伦敦圣托马斯医院）招募了218例食管癌患者的前瞻性队列。在术前、术后6个月和12个月评估焦虑和抑郁情况。采用混合效应模型研究随时间的变化，并估计临床和社会人口学预测变量与焦虑和抑郁症状之间的关联。
术前焦虑患者比例为33%，6个月时为28%，12个月时为37%。术前有20%的患者报告有抑郁，6个月时为27%，12个月随访时为32%。焦虑症状随时间保持稳定，而抑郁症状似乎从术前到6个月有所增加，在6至12个月之间趋于平稳。年龄较小、女性、独居以及自我报告的吞咽困难更严重（即吞咽困难）预示着焦虑症状更高。住院并发症、活动状态受限更大以及自我报告的吞咽困难更严重是抑郁程度更高的预测因素。
许多患者在食管癌手术后的第一年报告有心理困扰。改善吞咽困难的体验是否也能减轻这些患者的困扰值得进一步研究。
