Article

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

ABSTRACT 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.

Download full-text

Full-text

Available from: Thomas Kuechler, Feb 18, 2014
0 Followers
 · 
80 Views
  • Source
    • "Psychische Komorbidität kann eine verringerte Therapiemotivation bedingen und damit auch ungünstigere Behandlungsverläufe nach sich ziehen. Küchler et al. (2007) "
    [Show abstract] [Hide abstract]
    ABSTRACT: The provision of oncology care by specialized medical practices is rapidly gaining importance. Currently outpatient support for tumour patients shows significant deficits with regard to area saturation as well as the effectiveness of services offered. Existing research into the situation of outpatient care for tumour patients in Germany focused mainly on unimodal interventions. An individualized coverage of the need for support can help in planning and implementation of adequate and demand-based interventions. Multimodal adjuvant therapy strategies represent a therapeutically valuable supplement to medical treatment.
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Depression, ranging from mild to severe, is the most frequently found psychological symptom among individuals with cancer. Depression in cancer patients has been known to mitigate emotional distress, quality of life, adherence to medical treatment, and overall health outcomes. Specifically, depression has been associated with impaired immune response and with poorer survival in patients with cancer. Various studies have found that psychotherapeutic interventions are effective in reducing symptoms of depression, which in turn could affect disease progression and mortality. This paper provides updated information on psychotherapeutic interventions geared towards cancer patients suffering from depressive disorders, and its impact on disease progression. PubMed, Cochrane Library database, PsycINFO and PsycARTICLES databases were searched from January 1980 through August 2013 using key words: psychotherapy, treatment, oncology, cancer, psycho-oncology, psychosocial issues, psychosocial stress, depression, mood disorder, and psychoneuroimmunology.
    International Review of Psychiatry 02/2014; 26(1):31-43. DOI:10.3109/09540261.2013.864259 · 1.80 Impact Factor
  • Source
    • "One study showed a 2-session stress management intervention (deep breathing, guided imagery and adaptive coping skills) offered to men prior to surgery for prostate cancer related to decreases in mood disturbance and increases in NKCC one week pre-to 48 h post-surgery (Cohen et al., 2011). This is an interesting finding in view of prior work showing that a psychosocial intervention initiated prior to surgery was associated with improved 10-year survival in patients treated for gastrointestinal cancer (Kuchler et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation changes (negative affect). Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion, and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and the quality of life of cancer patients. Some evidence suggests that psychosocial intervention can improve psychological and physiological adaptation indicators in cancer patients. However, less is known about whether these interventions can influence tumor activity and tumor growth-promoting processes and whether changes in these processes could explain the psychosocial intervention effects on recurrence and survival documented to date. Documenting that psychosocial interventions can modulate molecular activities (e.g., transcriptional indicators of cell signaling) that govern tumor promoting and tumor defense processes on the one hand, and clinical disease course on the other is a key challenge for biobehavioral oncology research. This mini-review will summarize current knowledge on psychological and physiological adaptation processes affected throughout the stress of the cancer experience, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioral processes that may mediate intervention effects on clinical cancer outcomes. Very recent intervention work in breast cancer will be used to illuminate emerging trends in molecular probes of interest in the hope of highlighting future paths that could move the field of biobehavioral oncology intervention research forward.
    Brain Behavior and Immunity 05/2012; 30. DOI:10.1016/j.bbi.2012.05.009 · 6.13 Impact Factor
Show more