Optimism and survivorship after esophageal cancer surgery
Author: Liu, Yangjun
Date: 2022-01-21
Location: Inghesalen, Widerströmska building, Tomtebodavägen 18a, Karolinska Institutet, Solna
Time: 10.00
Department: Inst för molekylär medicin och kirurgi / Dept of Molecular Medicine and Surgery
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Thesis (4.078Mb)
Abstract
Dispositional optimism is a personality trait that represents generally favorable expectations about the future. The main aim of this thesis was to examine whether higher dispositional optimism was related to better subjectively reported outcomes and better objectively measured outcomes. We used a self-reported scale, Life Orientation Test-Revised (LOT-R), to measure dispositional optimism in this thesis, with a higher LOT-R sum score representing higher dispositional optimism. Data for the four studies included in this thesis were from a prospective, Swedish nationwide, and population-based cohort entitled “Oesophageal Surgery on Cancer patients - Adaptation and Recovery (OSCAR)”.
Study I and II included 192 patients who underwent surgery for esophageal cancer during January 1, 2013 and February 28, 2018 in Sweden. Patients self-reported their dispositional optimism level at 1 year after surgery. At 1, 1.5, and 2 years after esophagectomy, patients repeatedly self-reported their psychological status and health related quality of life (HRQL). Latent growth curve model and linear mixed effects model were used in these two studies. We found that higher dispositional optimism predicted a lower risk of reporting clinically significant psychological distress (anxiety and/or depression) in study I. The odds ratio of reporting clinically significant psychological distress was 0.56 (95% confidence interval 0.40 to 0.79) for one unit increase in the LOT-R sum score. In Study II, we categorized patients into four subgroups with very high, moderately high, moderately low, and very low dispositional optimism based on the quartile of the LOT-R sum score. We found that patients with very high and moderately high dispositional optimism reported better HRQL in several aspects compared to patients with lower dispositional optimism.
Study III included 180 patients who underwent surgery for esophageal cancer during January 1, 2013 and February 28, 2018 in Sweden. Patients self-reported their psychological status and HRQL repeatedly at 1, 1.5, and 2 years after esophagectomy. We used fixed effects regression model with adjustment for all time-invariant covariates and observed time-varying confounders, and found that psychological distress was associated with worse HRQL in several aspects.
Study IV included 335 patients who underwent surgery for esophageal cancer between January 1, 2013 and December 31, 2019 in Sweden. Patients were followed up until the date of death or until December 31, 2020, whichever occurred first. Cox proportional hazards regression was used. We found that among patients with early and intermediate pathological tumor stages (Tis-II) and with follow-up period before the COVID-19 pandemic, the adjusted hazard ratio for all-cause mortality was 0.89 (95% confidence interval 0.81 to 0.98) for one unit increase in the LOT-R sum score. However, this association was not statistically significant for patients with tumor pathologically staged III-IV (hazard ratio 0.99, 95% confidence interval 0.92 to 1.07) and/or during the COVID-19 pandemic (hazard ratio 1.08, 95% confidence interval 0.94 to 1.25).
In conclusion, before the COVID-19 pandemic, higher dispositional optimism was associated with less self-reported clinically significant psychological distress and better HRQL; moreover, among patients with early and intermediate pathological tumor stages, higher dispositional optimism also predicted better overall survival. Measuring dispositional optimism may help identify vulnerable patients with potentially worse prognosis after surgery for esophageal cancer, thus contributing to the development of more tailored and timely interventions to improve postoperative survivorship.
Study I and II included 192 patients who underwent surgery for esophageal cancer during January 1, 2013 and February 28, 2018 in Sweden. Patients self-reported their dispositional optimism level at 1 year after surgery. At 1, 1.5, and 2 years after esophagectomy, patients repeatedly self-reported their psychological status and health related quality of life (HRQL). Latent growth curve model and linear mixed effects model were used in these two studies. We found that higher dispositional optimism predicted a lower risk of reporting clinically significant psychological distress (anxiety and/or depression) in study I. The odds ratio of reporting clinically significant psychological distress was 0.56 (95% confidence interval 0.40 to 0.79) for one unit increase in the LOT-R sum score. In Study II, we categorized patients into four subgroups with very high, moderately high, moderately low, and very low dispositional optimism based on the quartile of the LOT-R sum score. We found that patients with very high and moderately high dispositional optimism reported better HRQL in several aspects compared to patients with lower dispositional optimism.
Study III included 180 patients who underwent surgery for esophageal cancer during January 1, 2013 and February 28, 2018 in Sweden. Patients self-reported their psychological status and HRQL repeatedly at 1, 1.5, and 2 years after esophagectomy. We used fixed effects regression model with adjustment for all time-invariant covariates and observed time-varying confounders, and found that psychological distress was associated with worse HRQL in several aspects.
Study IV included 335 patients who underwent surgery for esophageal cancer between January 1, 2013 and December 31, 2019 in Sweden. Patients were followed up until the date of death or until December 31, 2020, whichever occurred first. Cox proportional hazards regression was used. We found that among patients with early and intermediate pathological tumor stages (Tis-II) and with follow-up period before the COVID-19 pandemic, the adjusted hazard ratio for all-cause mortality was 0.89 (95% confidence interval 0.81 to 0.98) for one unit increase in the LOT-R sum score. However, this association was not statistically significant for patients with tumor pathologically staged III-IV (hazard ratio 0.99, 95% confidence interval 0.92 to 1.07) and/or during the COVID-19 pandemic (hazard ratio 1.08, 95% confidence interval 0.94 to 1.25).
In conclusion, before the COVID-19 pandemic, higher dispositional optimism was associated with less self-reported clinically significant psychological distress and better HRQL; moreover, among patients with early and intermediate pathological tumor stages, higher dispositional optimism also predicted better overall survival. Measuring dispositional optimism may help identify vulnerable patients with potentially worse prognosis after surgery for esophageal cancer, thus contributing to the development of more tailored and timely interventions to improve postoperative survivorship.
List of papers:
I. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress after esophageal cancer surgery and the predictive effect of dispositional optimism: a nationwide population-based longitudinal study. Supportive Care in Cancer. 2021.
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II. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Higher dispositional optimism predicts better health-related quality of life after esophageal cancer surgery: a nationwide population-based longitudinal study. Annals of Surgical Oncology. 2021 Nov; 28(12): 7196-7205.
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III. Liu Y, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open. 2021 Jan 8; 5(1): zraa038.
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Pubmed
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IV. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Dispositional optimism and all-cause mortality after esophageal cancer surgery: a nationwide population-based cohort study. [Submitted]
I. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress after esophageal cancer surgery and the predictive effect of dispositional optimism: a nationwide population-based longitudinal study. Supportive Care in Cancer. 2021.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Higher dispositional optimism predicts better health-related quality of life after esophageal cancer surgery: a nationwide population-based longitudinal study. Annals of Surgical Oncology. 2021 Nov; 28(12): 7196-7205.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Liu Y, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open. 2021 Jan 8; 5(1): zraa038.
Fulltext (DOI)
Pubmed
View record in Web of Science®
IV. Liu Y, Pettersson E, Schandl A, Markar S, Johar A, Lagergren P. Dispositional optimism and all-cause mortality after esophageal cancer surgery: a nationwide population-based cohort study. [Submitted]
Institution: Karolinska Institutet
Supervisor: Lagergren, Pernilla
Co-supervisor: Schandl, Anna; Pettersson, Erik; Markar, Sheraz
Issue date: 2021-12-17
Rights:
Publication year: 2021
ISBN: 978-91-8016-438-2
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