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Relationship of Tumor Burden and Patients’ Minimization of Distress in Facing Surgery for Gastric Cancer

Received Feb. 2, 2004; revision received July 22, 2004; accepted Aug. 12, 2004. From the Psychiatry Section, Institute of Clinical Neuroscience; the Health Care Research Unit, Institute of Internal Medicine; and the Department of Surgery, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden. Address correspondence and reprint requests to Dr. Svedlund, Department of Psychiatry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; jan.svedlund{at}neuro.gu.se (e-mail).

Patients with gastric cancer considered amenable to a curative surgical procedure on the basis of a conventional preoperative workup (N=98) answered health-related quality-of-life questionnaires and completed a psychiatrist’s interview before the intervention. All patients were blinded to the type of surgical procedure that would ultimately be performed; 64 patients eventually received a potentially curative resection, and 34 had palliative surgery. The curative resection group reported significantly more hopelessness before the operation than the palliative surgery group. The latter group had more eating dysfunction but minimized their distress to a greater degree than those with a more limited tumor burden. Eating dysfunction, hopelessness, and the tendency to minimize distress were independent predictors of prognosis. The findings highlight the need for careful medical interviewing to enhance patient-physician communication about symptoms and signs of malignant diseases.

Key Words: Gastric cancer • stress • coping • depression • quality of life

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