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- Hellstadius, Ylva, et al.
(författare)
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Reflecting a crisis reaction : Narratives from patients with oesophageal cancer about the first 6 months after diagnosis and surgery
- 2019
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 6:4, s. 1471-1480
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the study was to describe patients' experiences of emotional adaption following treatment for oesophageal cancer from diagnosis to 6 months after surgery. Design: A qualitative interview study using an inductive approach was carried out. Methods: Participants were recruited from two university hospitals in Sweden. Ten patients who had been operated for oesophageal cancer with curative intent 6 months earlier and consented to participate in the study were included. Patients who had a disease recurrence were not eligible for inclusion. Participants were interviewed with a semi-structured interview approach. Data were analysed using qualitative content analysis. Results: One overarching theme was identified; Experiencing a crisis reaction, which comprised three key categories; (a) From emotionally numb to feeling quite alright; (b) From a focus on cure to reflections about a whole new life; and (c) From a severe treatment to suffering an emaciated, non-compliant body, derived from 14 distinct sub-categories. Conclusion: This study highlights the process of emotional adaptation following oesophageal cancer surgery that patients describe when reflecting back on the first 6 months postoperatively pointing to a crisis reaction in this early postoperative period.
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| 2. |
- Hellstadius, Ylva, et al.
(författare)
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A longitudinal assessment of psychological distress after oesophageal cancer surgery
- 2017
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 56:5, s. 746-752
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychological distress is common among patients with oesophageal cancer. However, little is known about the course and predictors of psychological distress among patients treated with curative intent. Therefore, the aim of this study was to explore the prevalence, course and predictors of anxiety and depression in patients operated for oesophageal cancer, from prior to surgery to 12 months post-operatively. Methods: A prospective cohort of patients with oesophageal cancer (n ¼ 218) were recruited from one high-volume specialist oesophago-gastric treatment centre (St Thomas’ Hospital, London, UK). Anxiety and depression were assessed prior to surgery, 6 and 12 months post-operatively. Mixed-effects modelling was performed to investigate changes over time and to estimate the association between clinical and socio-demographic predictor variables and anxiety and depression symptoms. Results: The proportion of patients with anxiety was 33% prior to surgery, 28% at 6 months, and 37% at 12 months. Prior to surgery, 20% reported depression, 27% at 6 months, and 32% at 12-month follow-up. Anxiety symptoms remained stable over time whereas depression symptoms appeared to increase from pre-surgery to 6 months, levelling off between 6 and 12 months. Younger age, female sex, living alone and more severe self-reported dysphagia (i.e., difficulty swallowing) predicted higher anxiety symptoms. In-hospital complications, greater limitations in activity status and more severe selfreported dysphagia were predictive of higher depression. Conclusions: Many patients report psychological distress during the first year following oesophageal cancer surgery. Whether improving the experience of swallowing difficulties may also reduce distress among these patients warrants further study.
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| 3. |
- Hellstadius, Ylva
(författare)
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Psychological distress following oesophageal cancer treatment : is there a need for psychological support?
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oesophageal cancer is associated with a poor prognosis, an extensive treatment pathway and a difficult recovery process. Previous studies have shown that oesophageal cancer patients suffer from great physical impact of the disease and treatment from the early rehabilitation process up to ten years following curatively intended treatment. Thus, affecting all aspects of their life situation. In addition, major adjustments in food intake and eating habits are required, negatively affecting the patients’ wellbeing. Even though evidence regarding poor recovery and deterioration in Health related quality of life, have been established during the past years. The psychological distress experienced by oesophageal cancer patients has not yet been thoroughly investigated. Therefore, the overarching aim of this thesis was to describe the psychological distress experienced by patients undergoing curatively intended treatment for oesophageal cancer in an attempt to evaluate if psychological support is needed? Study I was a cross-sectional study using data from a prospective cohort study carried out at St Thomas’ Hospital in London, England. Using data from the data collection at St Thomas’ Hospital, Study II was longitudinal in design. Study III used data from a prospective cohort study based on Swedish data. Study IV was a qualitative interview study carried out in Sweden. Studies I-III used self-report questionnaires aiming to assess anxiety and depression (using the The Hospital Anxiety and Depression scale) and aspects of emotional functioning (i.e., four items; tension, worry, irritation and depressed mood) from the EORTC QLQ-C30. In Study I anxiety and depression were assessed pre-surgery, in Study II the same outcomes were measures at pre-surgery and then at six and 12 months post-surgery. In Study III aspects of emotional functioning were assessed at six months and five years following the operation. In Study IV in-depth interviews were completed at six months post-surgery. Logistic regression models were carried out in studies Study I and III, in order to assess the association between potential clinical and socio-demographic risk factors and anxiety and depression (Study I) or aspects of emotional functioning (Study III). In Study II mixed-effects models were used to evaluate the influence of clinical and socio-demographic variables on psychological distress (i.e., anxiety and depression). The interviews in Study IV were analysed using qualitative content analysis. A significant proportion of patients report anxiety and depression prior to surgery and then at six and 12 months following treatment (Studies I and II). Anxiety symptoms seem to remain stable from prior to surgery and up to 12 months post-surgery. However, depression symptoms seem to increase from pre-treatment to six months following surgery and then level off at 12 months after treatment (Study II). Younger age, female sex, limitations in activity status and dysphagia are some of the risk factors observed for psychological distress at the different time points (Studies I and II). Further, tension, worry, irritation and depressed mood are prevalent symptoms at six months and even after five years post-surgery Study III). Risk factors included for example low educational level. The patients’ narratives at 6 months following oesophageal cancer surgery described reflections of undergoing a crisis reaction (final theme, Study IV). In conclusion, oesophageal cancer patients report psychological distress during the treatment trajectory, partially influenced by factors related to previous known risk factors for psychological morbidity. Considering the findings of this thesis, the many patients suffering psychological distress throughout recovery and beyond, are likely in need of targeted psychological support to improve their overall well-being and adaptation to the consequences of this disease and treatment.
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