Assessment Of Psychological Effects Caused By Radiotherapy In Esophageal Cancer Patients

BackgroundIt is well known that cancer is a kind of body and physiologic disease. The occurrence and development of cancer have assignable relationship with social psychological factors. The cancer itself is a source of stress for patients, which can also bring heavy mental pressure, produce all kinds of psychological symptoms, affect the patient's quality of life and physical recovery, and may accelerate the development of disease. Esophageal cancer patients were reported incidence of depression was 55.6%, significantly higher than incidence of depression 15.1%-22.5% in normal people, and is also above common disease.Studies have shown that IL-2 was detected lower in esophageal cancer patients with significant anxiety than those without anxiety or low anxiety group. TNF was detected lower in patients with moderate and severe depression group than the non-and mild depression group, which indicated that severe psychological stress lead to damaged cellular immune function of cancer patients.ObjectiveThe main purpose of this investigation was to evaluate the change of esophageal cancer patients in psychological distress before and after radiotherapy, to discuss effect of radiotherapy on anxiety and depression and the associated social factors; therefore more mental and behavioral intervention is needed to enhance psychological care.MethodsA total of 116 patients who were consecutively found to have esophageal cancer between 1 January 2007 and 30 July 2007 at Qilu Hospital of Shandong University in Jinan(China), excluding dying patients or patients not completing radiotherapy, were included in the longitudinal study. Radiotherapy was delivered using three-dimensional conformal plans. The treatment was administered by a high energy, linear accelerator(10 MV photons)and irradiation was delivered using a standard irradiation(2 Gy/day for five days/week). The total dose was 50 Gy for patients after esophageal radical surgery,60～66 Gy for radical radiotherapy patients. When they underwent radiotherapy,in pre-radiotherapy, in radiotherapy starting for 1 month and in radiotherapy starting for 2 months, they were endorsed in the 3 time points to complete the Hospital Anxiety and Depression Scale(HAD). We observed the change of psychological distress along with time. This research used the Hospital Anxiety and Depression Scale (HAD) before treatment and at different intervals to determine the patient's psychological distress. The t-test was used to compare the differences in psychological distress at a 5% significance level.Results1. It was found that the anxiety scores in pre-radiotherapy, radiotherapy starting for 1 month and radiotherapy starting for 2 months, were separately 11.0,5.0,5.0; the depression scores at the 3 time points were separately 11.5,5.2,3.8. Anxiety and depression before radiotherapy was separately 11.0 and 11.5, significantly abnormal (normal 0-7).2.At different time points, Hospital Anxiety and Depression Scale (HAD)scores of anxiety subscale showed statistical significance between pre-radiotherapy and radiotherapy starting for 1 month in the level of anxiety(P<0.05).The level of depression also showed statistical significance between pre-radiotherapy and radiotherapy starting for 1 month, and between pre-radiotherapy and radiotherapy starting for 2 months(P<0.05).3.We studied patients in different ages, anxiety scores of below 55 years old,55-65 years old and above 65 years groups were separately 6.2,5.8 and 3.3 (P>0.05), depression scores of the 3 age groups were calculated 7.2,5.4 and 5.2 (P>0.05). Age differences on anxiety and depression scores were not statistically significant. Anxiety scores of male and female were 5.7 and 3.7 (P>0.05), while depression scores were 6.5 and 1.0 (P<0.05).So gender does not affect anxiety scores, but effect depression scores, shown in table 2 and Figure 2. Anxiety scores in patients with medical insurance and no medical insurance were 5.6429 and 4.6000 (P>0.05), while depression scores were 5.6 and 8.2 (P> 0.05).It mean that medical insurance did not affect anxiety or depression scores.Conclusion1. Patients with esophageal cancer expressed severe psychological anxiety and depression before radiotherapy (normal is 0-7). Therefore patients before radiotherapy should arouse the concern of the general staff, to give the necessary psychological and behavioral interventions and nursing, which has important clinical significance. So before radiotherapy doctors should actively help patients in reducing psychological anxiety and depression. Important psychological care before radiotherapy including: educating and training the new patients targeted to eliminate fear in patients with tension; introducing radiotherapy procedures by doctors, leading the visit to radiotherapy in patients about radiation therapy equipment, engine room and explaining the side effects of radiation and its prevention and treatment approaches, and highlighting the importance of treatment to persist in body position and reasons to stay indoors individually, and encourage patients to ask questions.2. The study confirms that radiotherapy played an important role in reducing psychological anxiety and depression and stabling psychological distress. It is conformed that radiotherapy can improve anxiety and depression in patients, it may be because that radiotherapy may improve the quality of life of patients and thus have the trust of patients, and therefore it should be noted in the clinical monitoring of the quality of life for patients, by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-esophageal supplementary mode table (EORTC QLQ-OES18) and Hospital Anxiety and Depression Scale (HAD), so doctors can in a timely manner acknowledge about the quality of life of patients and adjust the treatment.3. This study shows that gender does not affect anxiety scores, but the impact of depression scores. The depression level of male patients is higher than female patients. This may be related to men in family status. It may remind us to pay more attention to male patients. It is suggested that mental state should be detected by a hospital anxiety and depression scale questionnaire in a timely manner, to ensure the mental disorders be early detected, early diagnosed, early intervened and cared for.