Psychological distress following oesophageal cancer treatment : is there a need for psychological support?

Oesophageal cancer is associated with a poor prognosis, an extensive treatment pathway and a difficult recovery process. Previous studies have shown that oesophageal cancer patients suffer from great physical impact of the disease and treatment from the early rehabilitation process up to ten years following curatively intended treatment. Thus, affecting all aspects of their life situation. In addition, major adjustments in food intake and eating habits are required, negatively affecting the patients’ wellbeing. Even though evidence regarding poor recovery and deterioration in Health related quality of life, have been established during the past years. The psychological distress experienced by oesophageal cancer patients has not yet been thoroughly investigated. Therefore, the overarching aim of this thesis was to describe the psychological distress experienced by patients undergoing curatively intended treatment for oesophageal cancer in an attempt to evaluate if psychological support is needed? Study I was a cross-sectional study using data from a prospective cohort study carried out at St Thomas’ Hospital in London, England. Using data from the data collection at St Thomas’ Hospital, Study II was longitudinal in design. Study III used data from a prospective cohort study based on Swedish data. Study IV was a qualitative interview study carried out in Sweden. Studies I-III used self-report questionnaires aiming to assess anxiety and depression (using the The Hospital Anxiety and Depression scale) and aspects of emotional functioning (i.e., four items; tension, worry, irritation and depressed mood) from the EORTC QLQ-C30. In Study I anxiety and depression were assessed pre-surgery, in Study II the same outcomes were measures at pre-surgery and then at six and 12 months post-surgery. In Study III aspects of emotional functioning were assessed at six months and five years following the operation. In Study IV in-depth interviews were completed at six months post-surgery. Logistic regression models were carried out in studies Study I and III, in order to assess the association between potential clinical and socio-demographic risk factors and anxiety and depression (Study I) or aspects of emotional functioning (Study III). In Study II mixed-effects models were used to evaluate the influence of clinical and socio-demographic variables on psychological distress (i.e., anxiety and depression). The interviews in Study IV were analysed using qualitative content analysis. A significant proportion of patients report anxiety and depression prior to surgery and then at six and 12 months following treatment (Studies I and II). Anxiety symptoms seem to remain stable from prior to surgery and up to 12 months post-surgery. However, depression symptoms seem to increase from pre-treatment to six months following surgery and then level off at 12 months after treatment (Study II). Younger age, female sex, limitations in activity status and dysphagia are some of the risk factors observed for psychological distress at the different time points (Studies I and II). Further, tension, worry, irritation and depressed mood are prevalent symptoms at six months and even after five years post-surgery Study III). Risk factors included for example low educational level. The patients’ narratives at 6 months following oesophageal cancer surgery described reflections of undergoing a crisis reaction (final theme, Study IV). In conclusion, oesophageal cancer patients report psychological distress during the treatment trajectory, partially influenced by factors related to previous known risk factors for psychological morbidity. Considering the findings of this thesis, the many patients suffering psychological distress throughout recovery and beyond, are likely in need of targeted psychological support to improve their overall well-being and adaptation to the consequences of this disease and treatment