title: Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial.
abstract: OBJECTIVE
  The impact of psychotherapeutic support on survival time in patients with gastrointestinal cancer undergoing surgery was studied.
  
  
  METHODS
  A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany. Two hundred and seventy-one consenting patients with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas or colon/rectum were stratified by gender 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. Patients in both groups completed the EORTC-Quality of Life questionnaire pre-operatively, post-operatively, and at 3, 6, 12, and 24 months following surgery. Date of death, if applicable, was also recorded. Unadjusted and adjusted survival analyses were performed.
  
  
  RESULTS
  Kaplan-Meier survival curves demonstrated better survival for the experimental group than for the control group. The unadjusted significance level for group differences was p = 0.002 for survival up to 2 years. Cox regression models that took TNM Staging or the Residual Tumor Classification into account also found significant differences at the 2-year follow-up. Secondary analyses found that most of the differences in favor of the experimental group occurred in females and in patients with stomach, pancreatic, primary liver or colorectal cancer.
  
  
  CONCLUSIONS
  The results of this study indicate that patients with gastrointestinal cancer, particularly those who are female and those who undergo surgery for stomach, pancreatic, primary liver or colorectal cancer, benefit from a formal program of psychotherapeutic support in terms of survival.
authors.affiliation: Klinik fur Allgemeine und Thoraxchirurgie, Christian-Albrechts-Universitat, Kiel, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kuchler
authors.forename: D
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: S
authors.initials: S
authors.lastname: Rappat
authors.forename: J
authors.initials: J
authors.lastname: Graul
authors.forename: K
authors.initials: K
authors.lastname: Holst
authors.forename: J I
authors.initials: JI
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Wood-Dauphinee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D011613:Psychotherapy; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016019:Survival Analysis