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Influence of Treatment Caused Impairments on Anxiety and Depression in Patients with Cancer of the Esophagus or the Esophagogastric Junction

  • Thomas KieferEmail author
  • Dorothea Krahl
  • Carsten Hirt
  • Heinz Völler
  • Lorenz Völkel
  • Georg Daeschlein
Original Research
  • 5 Downloads

Abstract

Purpose

After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated.

Method

Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed.

Results

We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0–13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0–15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety.

Conclusions

Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression.

Keywords

Anxiety Depression Esophagus carcinoma Exocrine pancreas insufficiency Rehabilitation Steatorrhea 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there is no conflict of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent of the patients for being included in the study is not necessary since we present data of retrospectively analyzed data. No informed written consent was obtained.

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Wolf MC, Zehentmayr F, Schmidt M, Holzel D, Belka C. Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre. Radiat Oncol. 2012;7:60–5.CrossRefGoogle Scholar
  2. 2.
    Rouvelas I, Zeng W, Lindblad M, Viklund P, Ye W, Lagergren J. Survival after surgery for oesophageal cancer: a population-based study. Lancet Oncol. 2005;6:864–70.CrossRefGoogle Scholar
  3. 3.
    Rutegard M, Charonis K, Lu Y, Lagergren P, Lagergren J, Rouvelas I. Population-based esophageal cancer survival after resection without neoadjuvant therapy: an update. Surgery. 2012;152:903–10.CrossRefGoogle Scholar
  4. 4.
    Derogar M, Orsini N, Sadr-Azodi O, Lagergren P. Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery. J Clin Oncol. 2012;30:1615–9.CrossRefGoogle Scholar
  5. 5.
    Dempster M, McCorry NK, Brennan E, Donnelly M, Murray L, Johnston BT. Psychological distress among survivors of esophageal cancer: the role of illness cognitions and coping. Dis Esophagus. 2012;25:222–7.CrossRefGoogle Scholar
  6. 6.
    Hellstadius Y, Lagergren P, Lagergren J, Johar A, Hultman CM, Wikman A. Aspects of emotional functioning following oesophageal cancer surgery in a population-based cohort study. Psychooncology. 2015;24:47–53.CrossRefGoogle Scholar
  7. 7.
    McCorry NK, Dempster M, Clarke C, Doyle R. Adjusting to life after esophagectomy: the experience of survivors and carers. Qual Health Res. 2009;19:1485–94.CrossRefGoogle Scholar
  8. 8.
    Bergquist H, Ruth M, Hammerlid E. Psychiatric morbidity among patients with cancer of the esophagus or the gastro-esophageal junction: a prospective, longitudinal evaluation. Dis Esophagus. 2007;20:523–9.CrossRefGoogle Scholar
  9. 9.
    Dunn LB, Aouizerat BE, Cooper BA, Dodd M, Lee K, West C, et al. Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy. Eur J Oncol Nurs. 2012;16:1–9.CrossRefGoogle Scholar
  10. 10.
    Hulbert-Williams N, Neal R, Morrison V, Hood K, Wilkinson C. Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust? Psychooncology. 2012;21:857–67.CrossRefGoogle Scholar
  11. 11.
    Carlson LE, Waller A, Groff SL, Giese-Davis J, Bultz BD. What goes up does not always come down: patterns of distress, physical and psychosocial morbidity in people with cancer over a one year period. Psychooncology. 2013;22:168–76.CrossRefGoogle Scholar
  12. 12.
    Lloyd-Williams M, Friedman T. Depression in palliative care patients--a prospective study. Eur J Cancer Care (Engl). 2001;10:270–4.CrossRefGoogle Scholar
  13. 13.
    Parker PA, Baile WF, de MC, Cohen L. Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology. 2013;12:183–93.CrossRefGoogle Scholar
  14. 14.
    Hellstadius Y, Lagergren J, Zylstra J, Gossage J, Davies A, Hultman CM, et al. A longitudinal assessment of psychological distress after oesophageal cancer surgery. Acta Oncol. 2017;56:746–52.CrossRefGoogle Scholar
  15. 15.
    Huddy JR, Macharg FM, Lawn AM, Preston SR. Exocrine pancreatic insufficiency following esophagectomy. Dis Esophagus. 2013;26:594–7.CrossRefGoogle Scholar
  16. 16.
    Kiefer T, Krahl D, Osthoff K, Thuss-Patience P, Bunse J, Adam U, et al. Importance of pancreatic enzyme replacement therapy after surgery of cancer of the esophagus or the esophagogastric junction. Nutr Cancer. 2017;1–4.Google Scholar
  17. 17.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefGoogle Scholar
  18. 18.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefGoogle Scholar
  19. 19.
    Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;126:335–48.CrossRefGoogle Scholar
  20. 20.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik am SeeRüdersdorf beiGermany
  2. 2.Department of Internal Medicine C, Hematology/OncologyUniversity of GreifswaldGreifswaldGermany
  3. 3.Center of Rehabilitation ResearchUniversity of PotsdamPotsdamGermany
  4. 4.Department of DermatologyUniversity Medicine GreifswaldGreifswaldGermany

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