Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study
Open accessAbstract
Background: Patients are at higher risk of suffering from psychological distress and reduced health-related quality of life (HRQoL) after oesophageal cancer surgery. This Swedish nationwide population-based longitudinal study aimed to evaluate the association between psychological distress and HRQoL up to 2 years after oesophageal cancer surgery. Methods: The study included patients with oesophageal cancer who had survived for 1 year after oesophageal cancer surgery. The exposure was psychological distress measured using the Hospital Anxiety and Depression Scale. Patients scoring at least 8 on either the anxiety or the depression subscale were classified as having psychological distress. The outcome was HRQoL assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire generic and disease-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Exposure and outcome were measured at 1, 1.5, and 2 years after operation. Fixed-effects models with adjustment for all time-invariant confounding and potential time-varying confounders were used to examine the mean score difference in HRQoL between patients with and without psychological distress. Results: In total, 180 patients were analysed. Clinically relevant, statistically significant and time-constant mean score differences were found in emotional function, social function, dyspnoea, anxiety, eating difficulty, eating in front of others, and weight loss (mean score difference range 10–29). Mean score differences for global quality of life, cognitive function, appetite loss, EORTC QLQ-C30 summary score, and trouble with taste increased over time, and reached clinical and statistical significance at 1.5 and/or 2 years after surgery. For body image, there was a clinically relevant decrease in mean score difference over time. Conclusion: Psychological distress was associated with several aspects of poor HRQoL up to 2 years after surgery for oesophageal cancer.
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The social aspect included only two subthemes, probably because untreated patients have not yet suffered from image disorders and social distress associated with esophageal cancer (e.g., indwelling nutrition tubes and hoarseness).
“Te social aspect included only two subthemes, probably because untreated patients have not yet sufered from the image disorders and social distress associated with esophageal cancer (e.g., indwelling nutrition tubes and hoarseness) [49].”
From Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study. (2023) · cites this paper as [49]
The Results (page unavailable) link psychological distress after oesophageal cancer surgery with worse social function and body-image concerns. The paper does not examine untreated patients or explain why a social aspect would have only two subthemes; the cited passages also do not link those concerns to indwelling nutrition tubes or hoarseness. (LLM, conf=0.82)
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- Authors
- Liu, Y. J., Schandl, A., Markar, S., Johar, A., & Lagergren, P.
- Affiliations
- Karolinska University Hospital (SE)
- Corresponding author
- Lagergren, P
- Venue
- BJS Open
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-01
- Volume
- 5
- Issue
- 1
- ISSN
- 2474-9842 (ISSN-L)
- PMC
- PMC7893460
- OpenAlex
- W3130965616
- Cited by
- 32
- References
- 42
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 6 · 2023: 9 · 2022: 2 · 2021: 5
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BJS Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Swedish Cancer Society
- Stockholm County Council
- Cancer Research Funds of Radiumhemmet
- Swedish Research Council
- Karolinska Institute and China Scholarship Council joint programme
- 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, esophagectomy, psychological distress, health-related quality of life, postoperative anxiety, postoperative depression, dyspnea, eating difficulties, body image, long-term outcomes
- MeSH terms
- Psychological Distress, Adult, Aged, Aged, 80 and over, Esophageal Neoplasms, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Sweden
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