Impact of Psychotherapeutic Support for Patients With Gastrointestinal Cancer Undergoing Surgery: 10-Year Survival Results of a Randomized Trial

Department of General and Thoracic Surgery, University Hospitals of Schleswig-Holstein, Kiel, Germany.
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2007; 25(19):2702-8. DOI: 10.1200/JCO.2006.08.2883
Source: PubMed


The impact of psychotherapeutic support on survival for patients with gastrointestinal cancer undergoing surgery was studied.
A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany, from January 1991 to January 1993. Consenting patients (N = 271) with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas, or colon/rectum were stratified by sex and randomly assigned to a control group that received standard care as provided on the surgical wards, or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay. From June 2003 to December 2003, the 10-year follow-up was conducted. Survival status for all patients was determined from our own records and from three external sources: the Hamburg cancer registry, family doctors, and the general citizen registration offices.
Kaplan-Meier survival curves demonstrated better survival for the experimental group than the control group. The unadjusted significance level for group differences was P = .0006 for survival to 10 years. Cox regression models that took TNM staging or the residual tumor classification and tumor site into account also found significant differences at 10 years. Secondary analyses found that differences in favor of the experimental group occurred in patients with stomach, pancreatic, primary liver, or colorectal cancer.
The results of this study indicate that patients with gastrointestinal cancer, who undergo surgery for stomach, pancreatic, primary liver, or colorectal cancer, benefit from a formal program of psychotherapeutic support during the inpatient hospital stay in terms of long-term survival.

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Available from: Thomas Kuechler, Feb 18, 2014
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    • "One study showed that depression measured at the initiation of treatment for head and neck cancer is prognostic for early recurrence/mortality (Lazure et al., 2009). Another study that invites further inquiry is a randomized trial that demonstrated a 10-year survival benefit of psychiatric care during hospitalization for gastrointestinal cancer surgery (Küchler et al., 2007). The period of cancer diagnosis, surgery, and the initiation of post-surgical treatment may be acutely stressful. "
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    • "Psychische Komorbidität kann eine verringerte Therapiemotivation bedingen und damit auch ungünstigere Behandlungsverläufe nach sich ziehen. Küchler et al. (2007) "
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    • "during both the pre-and post-operative inpatient hospital stay had a signifi cantly benefi cial impact on 10-year survival rates in patients with gastrointestinal cancer, who underwent surgery for stomach, pancreatic , primary liver, or colorectal cancer. The original study (Kuchler et al., 1999) found that the patients in the intervention group had a signifi cantly higher rate of survival (69/136; p ϭ 0.002) than those in the control group (45/135). They also found signifi cant differences in Tumor, node, metastases staging or the residual tumour classifi cation, in favour of the intervention patients. "
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