title: Aspects of emotional functioning following oesophageal cancer surgery in a population-based cohort study.
abstract: OBJECTIVE
  The aim of this study was to establish the proportion of patients reporting emotional problems following oesophagectomy for cancer and identify the risk characteristics for emotional problems.
  
  
  METHODS
  A Swedish population-based cohort study of patients with surgically treated oesophageal cancer was used. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 was used to assess tension, worry, irritation and depressed mood at 6 months and 5 years after surgery. Potential risk characteristics were retrieved from medical notes and data linkages to Swedish health registries. Multivariable logistic regression analyses were performed to examine risk characteristics for poor emotional recovery.
  
  
  RESULTS
  Of 401 patients included at 6 months, 49% reported problems with tension, 61% worry, 62% irritation and 63% depressed mood. Of the 140 (35%) patients who completed the 5-year follow-up, 39% reported problems with tension and about half of the patients reported problems with worry, irritation, and depressed mood (49, 45 and 52%, respectively). Squamous cell carcinoma was identified as a risk characteristic for tension (OR 2.15, 95% CI 1.30-3.55), worry (OR 2.02, 95% CI 1.19-3.40) and depressed mood (OR 1.71, 95% CI 1.01-2.90) at 6 months compared with adenocarcinoma. Compared with higher education, lower education was associated with tension (upper secondary schooling: OR 1.97, 95% CI 1.02-3.79 and 9-year compulsory: OR 2.46, 95% CI 1.28-4.74), while non-cohabitating patients were less likely to report problems with worry at 6 months (OR 0.53, 95% CI 0.34-0.84) compared with cohabitating patients.
  
  
  CONCLUSIONS
  A substantial proportion of patients reports emotional problems following oesophagectomy, and risk characteristics include squamous cell carcinoma histology and low educational level.
authors.affiliation: Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Hellstadius
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.forename: Christina M
authors.initials: CM
authors.lastname: Hultman
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
mesh_terms: D000230:Adenocarcinoma / Q000523:psychology* / Q000601:surgery; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D002294:Carcinoma, Squamous Cell / Q000523:psychology* / Q000601:surgery; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D004522:Educational Status; D004644:Emotions; D004938:Esophageal Neoplasms / Q000523:psychology* / Q000601:surgery; D016629:Esophagectomy / Q000523:psychology*; D005260:Female; D006801:Humans; D007508:Irritable Mood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D013548:Sweden
keywords: HRQOL; emotional distress; oesophageal cancer; oesophagectomy; oncology; prospective