Abstract
PurposeTo examine the trajectory of psychological distress from 1 to 2 years after esophageal cancer surgery, and whether dispositional optimism could predict the risk of postoperative psychological distress.MethodsThis Swedish nationwide longitudinal study included 192 patients who had survived for 1 year after esophageal cancer surgery. We measured dispositional optimism with the Life Orientation Test-Revised (LOT-R) 1 year post-surgery and psychological distress with the Hospital Anxiety and Depression Scale 1, 1.5, and 2 years post-surgery. Latent growth curve models were used to assess the trajectory of postoperative psychological distress and to examine the predictive validity of dispositional optimism.ResultsOne year after surgery, 11.5% (22 of 192) patients reported clinically significant psychological distress, and the proportion increased to 18.8% at 1.5 years and to 25.0% at 2 years post-surgery. Higher dispositional optimism predicted a lower probability of self-reported psychological distress at 1, 1.5, and 2 years after esophageal cancer surgery. For each point increase in the LOT-R sum score, the odds of psychological distress decreased by 44% (OR, 0.56; 95% CI, 0.40 to 0.79).ConclusionThe high prevalence and longitudinal increase of self-reported psychological distress after esophageal cancer surgery indicate the unmet demands for timely psychological screening and interventions. Measuring dispositional optimism may help identify patients at higher risk of developing psychological distress, thereby contributing to the prevention of postoperative psychological distress.
Highlights
Esophageal cancer is the seventh most common cancer globally [1]
The random intercept model with linear slope fit the data well, and the estimated probability of clinically significant psychological distress doubled from 1 year (11.8%) to 2 years (25.1%) after surgery, which is in line with the observed proportions (Fig. 1)
In the crude model, with 1 standard deviation (SD) increase in the dispositional optimism, the log-odds decreased 0.36 SD in the main analysis, whereas the log-odds decreased 0.55 SD in the sensitivity analysis (Table 2, model A). This difference is most likely because measurement error in the exposure could attenuate the observed coefficient [26], and the sensitivity analysis using latent factor has removed the measured error in the Life Orientation Test-Revised (LOT-R). This Swedish nationwide population-based longitudinal study showed that the proportion of self-reported clinically significant psychological distress roughly doubled from 1 to 2 years after esophageal cancer surgery
Summary
Esophageal cancer is the seventh most common cancer globally [1]. It carries poor overall 5-year survival rate (< 20%) [2] and ranks the sixth leading cause of cancerrelated death worldwide [1]. The life-threatening cancer diagnosis and major surgery are traumatic stressors for patients, leading to increased symptoms of psychological distress before and after esophageal cancer surgery [4,5,6]. Based on a prospective hospital-based cohort study carried out in London, 33%, 28%, and 37% of patients had anxiety prior to surgery, at 6 and 12 months after surgery, respectively [5]. Contrary to the stable trajectory of anxiety symptoms, depression symptoms first increase and level off [5].
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