Identifying Support Needs of Patients with Esophageal Carcinomas Prior to Surgical Intervention: An Exploratory Study

Saturday, 28 October 2017

Sung E. Whang, MSN
Department of Surgery, Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, PA, USA

With any diagnosis of cancer comes emotional distress and increased risk of anxiety and depression. During treatment, one third of call cancer patients suffer from some type of psychiatric disorder (Singer, Das-Munshi, & Brahler, 2010). Limited studies have shown patient distress from the time of cancer diagnosis to elevated anxiety remaining up to four years (Hellstadius et. al., 2014). Predictably, fatal cancers report even higher associations with anxiety and depression (Hellstadius et. al., 2015). Esophageal cancer in particular has poor prognosis, even after multiple treatment modalities including concurrent chemotherapy and radiation, and later, extensive surgery with the possibility of additional adjuvant therapy. About half of patients report emotional problems following surgery and persisting even at five years post-treatment (Hellstadius et. al., 2014). Adjusting to a new physical self and acceptance of social challenges such as being unable to work, withdrawing from the company of family and friends, and going out in public has psychological impact (McCorry et. al., 2009; Bouras et. al., 2016). Additionally, those experiencing any postoperative symptoms other than dysphagia show an increased risk of associated anxiety and depression (Bouras et. al., 2016). Even new onset psychiatric morbidity following esophagectomy appears higher when compared to the general population and is associated with poorer postoperative survival (Hellstadius et. al., 2015).

To date, studies esophageal cancer patients primarily evaluate physical consequences of the disease and treatment. Very few studies have investigated emotional distress, specifically anxiety, among surgically treated esophageal cancer patients (Wikman, Smedfods, & Lagergren, 2013). Patients report decreased anxiety when participating in support groups in qualitative studies, however support programs are often underutilized without clear understanding of the reasons. The purpose of this study is to assess the implications of participation in a preoperative focus group for patients with esophageal carcinomas scheduled to undergo esophagectomy for esophageal cancer to identify unmet support needs. Should this qualitative study identify these needs, practitioners are able to optimize current pre- and postoperative algorithms to enhance patient-centered care.