Relationship between psychological distress and health-related quality of life at each point of the treatment of esophageal cancer
Abstract
Background Patients with esophageal cancer often feel depression or fear of death influenced by multiple clinical factors. This study sought to investigate the clinical factors associated with psychological distress, focusing on the influence of health-related quality of life (HRQOL) for better psychological management of patients with esophageal cancer.Methods In total, 102 of 152 consecutive patients surgically treated at Toranomon Hospital met the eligibility criteria for analysis. Questionnaires designed to identify psychological distress and QOL (EORTC QLQ C-30/OES18) were administered at five time points during the treatment course. Degree of psychological distress was assessed by Hospital Anxiety and Depression Scale (HADS).Results Patients with HADS score ≥ 11 at each visit showed significantly higher level of symptoms or problems measured by the score of EORTC QLQ C-30/OES18 compared with those with HADS score ≤ 10. Emotional status was a significant factor associated with psychological distress at all times. Although functional scales including global health status or QOL status and symptom scales associated with esophageal cancer were strongly associated with psychological distress before treatment, scales associated with changes in habitus after esophagectomy showed significant correlation with psychological distress after surgery. No significant correlation was observed between psychological distress and individual baseline characteristics, apart from history of surgery and pathological staging.Conclusions Psychological distress during treatment course of esophageal cancer is significantly associated with HRQOL influenced by esophagectomy. The current results may warrant prospective intervention through enhanced recovery after surgery to better manage patients undergoing highly invasive procedures for esophageal cancer.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Changes in psychological status of patients undergoing esophagectomy are significantly associated with changes in symptom experience and quality of life brought about by esophagectomy.
“Ohkura et al. longitudinally tracked changes in the psychological status of patients undergoing esophagectomy at fve time points and showed that changes in patients' psychological status were signifcantly associated with changes in symptom experience and quality of life brought about by esophagectomy [47,48].”
From Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study. (2023) · cites this paper as [47]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Dindo, D., Demartines, N., & Clavien, P.-A. (2004) · Annals of Surgery · doi:10.1097/01.sla.0000133083.54934.ae · Cited by 31,378 · see citing works
Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., & Bottomley, A. (2001) · Research at the University of Copenhagen (University of Copenhagen) · Cited by 2,520 · see citing works
Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (2013) · PsycTESTS Dataset · doi:10.1037/t03589-000 · Cited by 946 · see citing works
Impairment‐driven cancer rehabilitation: An essential component of quality care and survivorship
Silver, J. K., Baima, J. A., & Mayer, R. S. (2013) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21186 · Cited by 435 · see citing works
Batty, G. D., Russ, T. C., Stamatakis, E., & Kivimäki, M. (2017) · BMJ · doi:10.1136/bmj.j108 · Cited by 377 · see citing works
Screening for Psychological Distress in Japanese Cancer Patients
Kugaya, A., Akechi, T., Okuyama, T., Okamura, H., & Uchitomi, Y. (1998) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/28.5.333 · Cited by 367 · see citing works
Psychological distress and cancer mortality
Hamer, M., Chida, Y., & Molloy, G. J. (2009) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.11.002 · Cited by 282 · see citing works
Health‐related quality of life among patients cured by surgery for esophageal cancer
Lagergren, P., Avery, K. N. L., Hughes, R., Barham, C., Alderson, D., Falk, S., & Blazeby, J. (2007) · Cancer · doi:10.1002/cncr.22833 · Cited by 205 · see citing works
The prognostic value of quality of life scores during treatment for oesophageal cancer
Blazeby, J. M., Brookes, S. T., & Alderson, D. (2001) · Gut · doi:10.1136/gut.49.2.227 · Cited by 151 · see citing works
Hulbert-Williams, N., Neal, R. D., Morrison, V. L., Hood, K., & Wilkinson, C. (2011) · Psycho-Oncology · doi:10.1002/pon.1980 · Cited by 111 · see citing works
de Boer, A. D., Genovesi, P. I. O., Sprangers, M., van Sandick, J. W., Obertop, H., & van Lanschot, J. V. (2000) · British Journal of Surgery · doi:10.1046/j.1365-2168.2000.01600.x · Cited by 104 · see citing works
Subramaniam, S., Kong, Y., Chinna, K., Kimman, M., Ho, Y. Z., Sa’at, N., Malik, R. A., Taib, N. A. M., Abdullah, M. M., Lim, G., et al. (2018) · Psycho-Oncology · doi:10.1002/pon.4787 · Cited by 56 · see citing works
Kim, S. H., Oh, E. G., & Lee, W. H. (2006) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2005.11.012 · Cited by 52 · see citing works
Hong, J., Wei, Z., & Wang, W. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12816 · Cited by 50 · see citing works
Ayana, B. A., Negash, S., Yusuf, L. A., Tigeneh, W., & Haile, D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0157359 · Cited by 46 · see citing works
Symptoms affecting quality of life in women with gynecologic cancer
Tabano, M., Condosta, D., & Coons, M. (2002) · Seminars in Oncology Nursing · doi:10.1053/sonu.2002.34084 · Cited by 45 · see citing works
Oesophagus Including Oesophagogastric Junction
Sobin, L. H., Gospodarowicz, M. K., & Wittekind, C. (2010) · TNM Online · doi:10.1002/9780471420194.tnmc10.pub2 · Cited by 43 · see citing works
Hellstadius, Y., Lagergren, P., Lagergren, J., Johar, A. M., Hultman, C. M., & Wikman, A. (2014) · Psycho-Oncology · doi:10.1002/pon.3583 · Cited by 32 · see citing works
Fujita, T., Okada, N., Sato, T., Mayanagi, S., Kanamori, J., & Daiko, H. (2016) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyw040 · Cited by 19 · see citing works
Ochiai, Y., Akihisa, K., Nukariya, K., Nakayama, K., 落合, 結., 小堀, 聡., 忽滑谷, 和., & 中山, 和. (2016) · The Academic Repository of The Jikei University School of Medicine (Jikei University School of Medicine) · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis
Yu, H., Li, H., Zuo, T., Cao, L., Bi, X., Xing, H., Cai, L., Sun, J., & Liu, Y. (2022) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2022.04.008 · Cited by 55 · see citing works
The Physical Burden of Water Carrying and Women’s Psychosocial Well-Being: Evidence from Rural Nepal
Tomberge, V. M. J., Bischof, J. S., Meierhofer, R., Shrestha, A., & Inauen, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18157908 · Cited by 41 · see citing works
“The reason why physical burden was not directly related to quality of life may be that many other individual and contextual factors can influence quality of life [49,50].”
BackgroundLiu, Y. J., Schandl, A., Markar, S., Johar, A., & Lagergren, P. (2021) · BJS Open · doi:10.1093/bjsopen/zraa038 · Cited by 32 · see citing works
“EORTC QLQ-C30 Emotional function –19 (–25, –14)* Social function –17 (–24, –9)* Dyspnoea 11 (2, 20)* Physical function –8 (–12, –4) Role function –11 (–18, –4) Fatigue 12 (6, 18) Nausea/vomiting 2 (–4, 8) Pain 12 (5, 18) Insomnia 11 (1, 20) Diarrhoea 5 (–3, 14) Financial difficulty 8 (2, 13) Constipation 6 (–1, 14) EO…”
Pearson, S. E., Caimino, C., Shabbir, M., & Baguley, D. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-021-01089-5 · Cited by 29 · see citing works
Shao, M., Yao, L.-Q., Zhang, M., Zhou, H., Ding, Y., Bai, L., Ma, B., Li, T., Guo, S., Chen, C., et al. (2024) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2024.102518 · Cited by 21 · see citing works
Wu, Y. Z., Zhang, Y., & Zou, L. (2020) · Annals of Palliative Medicine · doi:10.21037/apm-20-1632 · Cited by 17 · see citing works
“0%) among the enrolled patients in the study were similar to previous studies involving cancer patients (10,14).”
ResultOhkura, Y., Shindoh, J., Ichikura, K., Udagawa, H., Ueno, M., & Matsushima, E. (2020) · World Journal of Surgical Oncology · doi:10.1186/s12957-020-02092-3 · Cited by 15 · see citing works
Self-citationDevelopment and validation of the Convalescence Symptom Assessment Scale for EsophageCtomy patients
Ge, H., Ma, X., Li, W., Wang, P., Zhang, Z., Qin, Q., & Li, S. (2024) · Nursing Open · doi:10.1002/nop2.2085 · Cited by 13 · see citing works
Effectiveness of lymphadenectomy along the thoracic duct for radical esophagectomy
Ohkura, Y., Ueno, M., Iizuka, T., & Udagawa, H. (2021) · Esophagus · doi:10.1007/s10388-021-00868-4 · Cited by 13 · see citing works
Self-citationWang, X., Wang, C., Han, W., Sun, J., Hui, Z., Lei, S., Wu, H., & Liu, X. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e23377 · Cited by 11 · see citing works
Cui, C., Wang, L., & Wang, X. (2024) · BMC Cancer · doi:10.1186/s12885-024-12138-4 · Cited by 10 · see citing works
Exploration of symptom cluster patterns and their trajectory in esophageal cancer surgery patients
Zhu, C., Wang, N., Xu, F., Song, H., Li, J., & Zhang, B. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102801 · Cited by 10 · see citing works
Ohkura, Y., Ichikura, K., Shindoh, J., Ueno, M., Udagawa, H., & Matsushima, E. (2022) · BMC Psychology · doi:10.1186/s40359-022-00914-5 · Cited by 8 · see citing works
“We also described the relationship between psychological distress and healthrelated quality of life (HRQOL) in esophageal cancer [9].”
BackgroundSelf-citationTriantafyllou, T., & Wijnhoven, B. P. L. (2020) · Annals of Gastroenterological Surgery · doi:10.1002/ags3.12350 · Cited by 8 · see citing works
Feasibility of OptiMaL, a Self-Management Programme for Oesophageal Cancer Survivors
King, E., Algeo, N., & Connolly, D. (2023) · Cancer Control · doi:10.1177/10732748231185002 · Cited by 6 · see citing works
Factors affecting quality of life among patients with corrosive injury
Hsu, W.-C., Cheng, H., Lin, C.-T., Lin, J., Chiu, H., Yu, W., & Lu, Y.-Y. (2024) · Medicine · doi:10.1097/md.0000000000036853 · Cited by 6 · see citing works
“Ohkura et al [18] studied patients with esophageal cancer.”
BackgroundResultGe, H., Zhang, L., Ma, X., Li, W., & Li, S. (2023) · European Journal of Cancer Care · doi:10.1155/2023/6506917 · Cited by 5 · see citing works
“…longitudinally tracked changes in the psychological status of patients undergoing esophagectomy at fve time points and showed that changes in patients’ psychological status were signif-cantly associated with changes in symptom experience and quality of life brought about by esophagectomy [47, 48].”
Liu, H., Zhang, X., Qiu, J., Lu, Z., & Chen, C. (2025) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100710 · Cited by 3 · see citing works
“42 Therefore, screening for and intervening in distress during the early stages of oral intake rehabilitation post-surgery may be a crucial fi rst step in mitigating its long-term impact on patients.”
Organ Preservation in Esophageal Cancer: Current Strategies, Challenges, and Future Directions
Liu, W., Zhang, B., Wang, C., Yu, X., Du, L., Yu, Z., & Kang, M. (2025) · Cancers · doi:10.3390/cancers17213559 · Cited by 4 · see citing works
“Additional challenges include access disparities to advanced therapies like proton therapy, which is limited to specialized centers [42], and the psychological burden of surveillance on patients, with anxiety rates reported up to 40% in cohort studies [43].”
Cheng, C., Zheng, M., Fan, Y., Wu, Y., Li, T., Cao, Z., Yue, J., Chen, P., Zheng, Z., Fan, T., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-69027-w · Cited by 2 · see citing works
“Our findings indicate a significant negative impact of PD on QoL, consistent with previous studies 58,59 .”
ResultSadeghi, F., Hussey, J. M., & Doyle, S. L. (2025) · Healthcare · doi:10.3390/healthcare13162057 · Cited by 1 · see citing works
“Furthermore, psychological symptoms are often associated with malnutrition and a reduced quality of life in cancer patients [22,23].”
Yu, H., Zuo, T., Bi, X., Liu, H., Xing, H., Cao, L., Cai, L., Sun, J., & Liu, Y. (2020) · Research Square · doi:10.21203/rs.3.rs-98521/v1 · Cited by 1 · see citing works
Ohkura, Y., Ichikura, K., Shindoh, J., Ueno, M., Udagawa, H., & Matsushima, E. (2022) · Research Square · doi:10.21203/rs.3.rs-1286187/v1
Self-citationFrailty and Mental Health in Older Patients with Gastrointestinal Cancer
Okumura, M., & Ono, R. (2022) · Springer eBooks · doi:10.1007/978-981-19-6710-8_19
Ji, Y., Zhang, Y., Shi, Z., Wang, P., Chen, T., Fan, Z., & Jiang, E. (2023) · Research Square · doi:10.21203/rs.3.rs-3711048/v1
Janati, A. I., Gigliotti, J., Sanders, J. J., Makhoul, N. M., Emami, E., Martel, M. O., Gosselin, N. H., Cailhol, L., Brown-Johnson, A., Karra, N., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-4151906/v1
Deng, X., Hu, Y., Xiong, Y.-J., Mao, N., Hong, B., & He, G. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i9.104813
Otieno, S. K., Desta, H. T., & Saleem, Y. A. (2023) · Bulletin of pioneering researches of medical and clinical science · doi:10.51847/xtj2jhvxww
Li, S., Luo, Y., Wu, S., Yuen-Shan, H., Takemura, N., Yorke, J., Li, J., Li, S., & Ye, Z. (2026) · Annals of Surgical Oncology · doi:10.1245/s10434-026-20727-9
- Authors
- Ohkura, Y., Ichikura, K., Shindoh, J., Ueno, M., Udagawa, H., & Matsushima, E.
- Affiliations
- Tokyo Medical and Dental University (JP)
- Toranomon Hospital (JP)
- Okinaka Memorial Institute for Medical Research (JP)
- Corresponding author
- Ohkura, Yu
- Venue
- Esophagus
- Published
- 2020-01-02
- Volume
- 17
- Issue
- 3
- Pages
- 312-322
- ISSN
- 1612-9059 (ISSN-L)
- 1612-9067
- OpenAlex
- W2998148818
- Cited by
- 29
- References
- 21
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 4
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Esophagus (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gastric Cancer Management and Outcomes
- Keywords
- esophageal cancer, psychological distress, health-related quality of life, esophagectomy, depression, anxiety, emotional state, Hospital Anxiety and Depression Scale, pathological staging, enhanced recovery after surgery, psychological management
- MeSH terms
- Psychological Distress, Adult, Aged, Aged, 80 and over, Depression, Esophageal Neoplasms, Fear, Female, Health Status, Humans, Japan, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Risk Factors, Esophagectomy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review