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Impact of Psychotherapeutic Support for Patients With Gastrointestinal Cancer Undergoing Surgery: 10-Year Survival Results of a Randomized Trial

Thomas Küchler, Beate Bestmann, Stefanie Rappat, Doris Henne-Bruns, Sharon Wood-Dauphinee

From the Department of General and Thoracic Surgery, University Hospitals of Schleswig-Holstein, Kiel; Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg; Department of Visceral and Transplantation Surgery, University Hospital of Ulm, Ulm, Germany; and the School of Physical and Occupational Therapy, Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada

Address reprint requests to Thomas Küchler, PhD, Referenzzentrum Lebensqualität in der Onkologie, Klinik für Allgemeine und Thoraxchirurgie, Universitätskliniken Schleswig-Holstein, Arnold-Heller-Str. 7, 24105 Kiel, Germany; e-mail: tkuechler{at}chirurgie-sh.de

Purpose The impact of psychotherapeutic support on survival for patients with gastrointestinal cancer undergoing surgery was studied.

Patients and Methods A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany, from January 1991 to January 1993. Consenting patients (N = 271) with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas, or colon/rectum were stratified by sex 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. From June 2003 to December 2003, the 10-year follow-up was conducted. Survival status for all patients was determined from our own records and from three external sources: the Hamburg cancer registry, family doctors, and the general citizen registration offices.

Results Kaplan-Meier survival curves demonstrated better survival for the experimental group than the control group. The unadjusted significance level for group differences was P = .0006 for survival to 10 years. Cox regression models that took TNM staging or the residual tumor classification and tumor site into account also found significant differences at 10 years. Secondary analyses found that differences in favor of the experimental group occurred in patients with stomach, pancreatic, primary liver, or colorectal cancer.

Conclusion The results of this study indicate that patients with gastrointestinal cancer, who undergo surgery for stomach, pancreatic, primary liver, or colorectal cancer, benefit from a formal program of psychotherapeutic support during the inpatient hospital stay in terms of long-term survival.

Supported by the Hamburg Cancer Society (Hamburger Krebsgesellschaft).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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