Abstract
BackgroundThe aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients.MethodsThe study population included 229 gastric cancer patients visiting Yonsei Cancer Center between November 2009 and March 2011. The distress was measured by available tools including the Modified Distress Thermometer (MDT), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies–Depression Scale (CES-D). Patients with psychological distress were defined as those who scored above the cut-off values in both the MDT and either one of the HADS or CES-D.ResultsThe median age of patients was 56 (range, 20 to 86) and 97 (42.4%) patients were with stage IV disease status at enrollment. The overall prevalence of psychological distress was 33.6% (95% CI: 27.5–39.8%) in 229 gastric cancer patients. In multiple logistic regression analysis, lower education level (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.11–5.17, P = 0.026) and higher disease stage (OR 2.72; 95% CI 1.47–5.03, P = 0.001) were associated with psychological distress. In stage I-III disease, patients with psychological distress had worse disease-free survival (DFS) (5-year DFS rate: 60% vs 76%, P = 0.49) compared with those without psychological distress. In stage IV disease (n = 97), patients with psychological distress showed poorer overall survival than those without psychological distress (median OS (Overall Survival): 12.2 vs. 13.8 months, P = 0.019).ConclusionPsychological distress is common in patients with all stages of gastric cancer and is associated with worse outcomes.
Highlights
The aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients
We previously reported the prevalence and associated factors of psychological distress in all types of cancer patients and found that 28.3% of gastric cancer patients had psychological distress [14]
The Cox multivariate analysis model including age, gender, Eastern Cooperative Oncology Group (ECOG), adjuvant chemotherapy, marriage, education, employment, and psychological distress in stage III disease showed that adjuvant chemotherapy (Hazzard ratio [HR] 7.23, 95% Confidence interval (CI) 2.27–22.95, P < 0.001) and psychological distress (HR 2.47, 95% CI 1.07–5.68, P = 0.034) were associated with shorter disease free survival (Table 4)
Summary
The aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients. Cancer diagnosis and treatment is a significantly stressful event that generates psychological distress in a large number of cancer patients. Psychological distress is generally defined as a state of emotional suffering characterized by symptoms of depression and anxiety [1]. 20–40% of cancer patients show a significant level of psychological distress [2, 3]. Most patients with gastric cancer have advanced to an incurable stage at the time of diagnosis, which induces tremendous psychological stress. Even if the patient is diagnosed with early-stage gastric cancer, they suffer from the diagnosis of cancer and surgery itself [12].
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