Perioperative Comprehensive Supportive Care Interventions for Chinese Patients with Esophageal Carcinoma: a Prospective Study

  • Zhang, Xiao-Dan (Zhongshan School of Medicine, Sun Yat-sen University) ;
  • Zhao, Qing-Yu (Intensive Care Unit, Cancer Center, Sun Yat-sen University) ;
  • Fang, Yi (Intensive Care Unit, Cancer Center, Sun Yat-sen University) ;
  • Chen, Guan-Xuan (Intensive Care Unit, Cancer Center, Sun Yat-sen University) ;
  • Zhang, Hui-Fang (Zhongshan School of Medicine, Sun Yat-sen University) ;
  • Zhang, Wen-Xiao (Intensive Care Unit, Cancer Center, Sun Yat-sen University) ;
  • Yang, Xiao-Ping (Zhongshan School of Medicine, Sun Yat-sen University)
  • Published : 2013.12.31


Objective: To assess the effects of perioperative comprehensive supportive care interventions on outcome of Chinese esophageal cancer patients in a prospective study. Methods: 60 patients with primary esophageal carcinoma were randomized into an intervention group (IG, n=31) and a control group (CG, n=29). The Chinese version of symptom checklist-90 (SCL-90) was adopted to assess their psychological status. The interventions, including health education, psychological support, stress management, coping strategies and behavior training, were carried out in 3 phases (preoperative, postoperative I and postoperative II), and psychological effects were thereafter evaluated accordingly before surgery, and 1 week, 4 weeks and 24 weeks post-surgery. Medical costs were estimated at discharge. Survival of patients was estimated each year post-surgery. General health status and satisfaction-with-hospital were surveyed by a follow-up questionnaire 4 years post-surgery. Results: All the subjects demonstrated higher scores in the preoperative phase than the normal range of Chinese population concerning 7 psychological domains including somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety and paranoid ideation. Although no significant difference was observed between the two groups at admission, the scores of IG, which tended to decrease at a faster rate, were generally lower than those of CG at weeks 1, 4 and 24 post-surgery. The length of hospital stay and medical costs of IG were significantly less than those of CG and satisfaction-with-hospital was better. However, there was no significant difference in 4-year survival or health status between two groups. Conclusions: Appropriate perioperative comprehensive supportive care interventions help to improve the psychological state of Chinese patients with esophageal carcinoma, to reduce health care costs and to promote satisfaction of patients and their families with hospital.


  1. Au A, Lam W, Tsang J, et al (2013). Supportive care needs in Hong Kong Chinese women confronting advanced breast cancer. Psychooncology, 22, 1144-51.
  2. Bergguist H, Ruth M, Hammerlid E (2007). Psychiatric morbidity among patients with cancer of the esophagus or the gastro-esophageal junction: a prospective, longitudinal evaluation. Dis Esophagus, 20, 523-9.
  3. Blazeby JM, Farndon JR, Donovan J, et al (2000). A prospective longitudinal study examining the quality of life of patients with esophageal cancer. Cancer, 88, 1781-7.<1781::AID-CNCR4>3.0.CO;2-G
  4. Blazeby JM, Avery K, Sprangers M, et al (2006). Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol, 24, 3178-86.
  5. Brooks JA, Kesler KA, Johnson CS, et al (2002). Prospective analysis of quality of life after surgical resection for esophageal cancer: preliminary results. J Surg Oncol, 81, 185-94.
  6. Cameron LD, Booth RJ, Schlatter M, et al (2007). Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer. Psychooncology, 16, 171-80.
  7. Cao S, Zhao G, Cui J, et al (2012). Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer, 21, 707-14.
  8. Capozzo MA, Martinis E, Pellis G, et al (2010). An early structured psychoeducational intervention in patients with breast cancer. Cancer Nurs, 33, 228-34.
  9. Chan CW, Richardson A, Richardson J (2012). Evaluating a complex intervention: a process evaluation of a psychoeducation program for lung cancer patients receiving palliative radiotherapy. Contemp Nurse, 40, 234-44.
  10. Chan HY, Lee LH, Chan CW (2012). The perceptions and experiences of nurses and bereaved families towards bereavement care in an oncology unit. Support Care Cancer, 21, 1551-6.
  11. Cheng KK, Lee DT (2011). Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer. Crit Rev Oncol Hematol, 78, 127-37.
  12. Cherny NI, Catane R, Kosmidis P (2003). ESMO Taskforce on Supportive and Palliative Care. EMSO takes a stand on supportive and palliative care. Ann Oncol, 14, 1335-7.
  13. Dempster M, McCorry NK, Brennan E, et al (2012). Psychological distress among survivors of esophageal cancer: the role of illness cognitions and coping. Dis Esophagus, 25, 222-7.
  14. Derogatis LR, Morrow GR, Fetting J, et al (1983). The prevalence of psychiatric disorders among cancer patients. JAMA, 249, 751-7.
  15. Edwards MJ (1998). Access to quality cancer care: consensus statement of the American Federation of Clinical Oncologic Societies. Ann Surg Oncol, 5, 657-9.
  16. Fielding R, Lam WW, Shun SC, et al (2013). Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors. PLoS One, 8, e65009.
  17. Ford DW, Koch KA, Ray DE, et al (2013). Palliative and endof-life care in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practive guidelines. Chest, 143, e498S-512S.
  18. Gil F, Costa G, Hilker I, et al (2012). First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment. Stress Health, 28, 362-7.
  19. Given BA, Given CW, Kozachik S (2001). Family support in advanced cancer. CA Cancer J Clin, 51, 213-31.
  20. Goerling U, Foerg A, Sander S, et al (2011). The impact of short-term psycho-oncological interventions on the psychological outcome of cancer patients of a surgicaloncology department-a randomised controlled study. Eur J Cancer, 47, 2009-14.
  21. Iwatani T, Matsuda A, Kawabata H, et al (2013). Predictive factors for psychological distress related to diagnosis of breast cancer. Psychooncology, 22, 523-9.
  22. Jemal A, Murray T, Ward E, et al (2005). Cancer statistics, 2005. CA Cancer J Clin, 55, 10-30.
  23. Jin H, Wu WY, Zhang MY (1986). Preliminary analyses of SCL-90 results of Chinese normal people. Chin J Nerv Ment Dis, 12, 260-3 (in Chinese).
  24. Lam WW, Au AH, Wong JH, et al (2011). Unmet supportive care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer. Breast Cancer Res Treat, 130, 531-41.
  25. Lerman R, Jarski R, Rea H, et al (2011). Improving symptoms and quality of life of female cancer survivors: A randomized controlled study. Ann Surg Oncol, 19, 373-8.
  26. Lurati C, Riva M, Resega R, et al (2012). A mono-institutional prospective study on the effectiveness of a specialist psychotherapeutic intervention (POI) started at the diagnosis of cancer. Support Care Cancer, 20, 475-81.
  27. Macvean ML, White VM, Pratt S, et al (2007). Reducing the unmet needs of patients with colorectal cancer: a feasibility study of The Pathfinder Volunteer Program. Support Care Cancer, 15, 293-9.
  28. Maguire R, Papadopoulou C, Kotronoulas G, et al (2013). A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs, 17, 449-64.
  29. Malmstrom M, Ivarsson B, Johansson J, et al (2013). Long-term experiences after oesophagectomy/gastrectomy for cancer-a focus group study. Int J Nurs Study, 50, 44-52.
  30. Mok E, Lau KP, Lai T, et al (2012). The meaning of life intervention for patients with advanced-stage cancer: development and pilot study. Oncol Nurs Forum, 39, E480-8.
  31. Peveler RC, Fairburn CG (1990). Measurement of neurotic symptoms by self-report questionnaire: validity of the SCL-90R. Psychol Med, 20, 873-9.
  32. Pitceathly C, Maguire P, Fletcher I, et al (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Ann Oncol, 20, 928-34.
  33. Prins JB, Bleijenberg G, Bazelmans E, et al (2001). Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomized controlled trial. Lancet, 357, 841-7.
  34. Schimitz N, Kruse J, Heckrath C, et al (1999). Diagnosing mental disorders in primary care: The General Health Questionnaire (GHQ) and the Symptom Check List (SCL-90-R) as screening instruments. Soc Psychiatry Psychiatr Epidemiol, 34, 360-6.
  35. Siegel J (1998). Doctor-patient relationship in oncological illness: the “talking medicine”. Croat Med J, 39, 371-8.
  36. So WK, Chan CW, Choi KC, et al (2013). Perceived unmet needs and health-related quality of life of Chinese cancer survivors at 1 year after treatment. Cancer Nurs, 36, E23-32.
  37. Stauder MC, Romero Y, Kabat B, et al (2013). Overall survival and self-reported fatigue in patients with esophageal cancer. Support Care Cancer, 21, 511-9.
  38. Steele R, Fitch MI (2008). Supportive care needs of women with gynecologic cancer. Cancer Nurs, 31, 284-91.
  39. Stefanek ME, Palmer SC, Thombs BD, et al (2009). Finding what is not there: unwarranted claims of an effect of psychosocial intervention on recurrence and survival. Cancer, 115, 5612-6.
  40. Sussman J, Howell D, Bainbridge D, et al (2011). The impact of specialized oncology nursing on patient supportive care outcomes. J Psychosoc Oncol, 29, 286-307.
  41. Tross S, Herndon J, Korzun A, et al (1996). Psychological symptoms and disease-free and overall survival in women with stage II breast cancer. J Natl Cancer Inst, 88, 661-7.
  42. Wang ZY (1984). Symptom check-list 90 (SCL-90). Shanghai Arch Psych, 2, 68-70 (in Chinese).
  43. Whelan TJ, Mohide EA, Willan AR, et al (1997). The supportive care needs of newly diagnosed cancer patients attending a regional cancer Center. Cancer, 80, 1518-24.<1518::AID-CNCR21>3.0.CO;2-7
  44. Yavuzsen T, Karadibak D, Cehreli R, et al (2012). Effect of group therapy on psychological symtoms and quality of life in Turkish patients with breast cancer. Asian Pac J Cancer Prev, 13, 5593-7.
  45. Yun YH, Shon EJ, Yang AJ, et al (2013). Needs regarding care and factors associated with unmet needs in disease-free survivors of surgically treated lung cancer. Ann Oncol, 24, 1552-9.
  46. Zabora J, BrintzenmhofeSzoc K, Curbow B, et al (2001). The prevalence of psychological distress by cancer site. Psychooncology, 10, 19-28.<19::AID-PON501>3.0.CO;2-6

Cited by

  1. Impact of a Clinical Pathway on Hospital Costs, Length of Stay and Early Outcomes after Hepatectomy for Hepatocellular Carcinoma vol.15, pp.13, 2014,
  2. Clinical Determinants of Weight Loss in Patients with Esophageal Carcinoma During Radiotherapy: a Prospective Longitudinal View vol.15, pp.5, 2014,
  3. Impact of Enhanced Recovery Program on Colorectal Cancer Surgery vol.15, pp.8, 2014,
  4. Current Situation and Associated Factors of Withdrawing or Withholding Life Support to Patients in an Intensive Care Unit of Cancer Center in China vol.9, pp.5, 2014,
  5. Toward improved survivorship: supportive care needs of esophageal cancer patients, a literature review vol.29, pp.8, 2015,
  6. Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy vol.104, pp.10, 2017,
  7. Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review vol.35, pp.1, 2018,