Psychological responses to gastrointestinal cancer

Sammanfattning: The overall aim of the present thesis is to gain knowledge about psychological distress and adjustment in gastrointestinal cancer patients (colon, rectum, gastric, pancreatic or biliary) at various phases of their disease.Reactions to the diagnosis, anxiety, depression and coping were investigated in newly diagnosed patients (n=139). Repeated assessments were performed throughout the fast year after the diagnosis. Only a limited group reported high levels of anxiety (17%) and depression (21%) close to the diagnosis. Patients with colon or rectal cancer, most of whom were potentially cured, had a more confronting attitude to their diagnosis and reported more 'Fighting Spirit' than patients with gastric and pancreatic/biliary cancer. These responses were associated with better emotional well-being. The former group also reported less `Hopeless/helplessness' and 'Anxious preoccupation', which were related to higher levels of psychological distress. There were no changes over time in mean levels of anxiety and depression and virtually no changes in mean values of the coping subscales. In a separate group (n=141), overall levels of anxiety, depression and worry were low in conjunction to a medical follow-up control visit approximately two years after diagnosis.Levels of anxiety and depression at diagnosis predicted a similar status six months later. A model based on standardised cut-off scores of moderate or high levels of anxiety or depression and intrusive thoughts close to the diagnosis was used to identity patients with prolonged psychological distress.A psychometric analysis was performed of the Mental Adjustment to Cancer (MAC) scale (n=868 patients with various cancers). The reliability of the original subscales was satisfying. A confirmatory factor analysis revealed a factor structure including 28 of the original 40 items in four factors. Both versions of the MAC confound coping efforts and emotional outcomes, preventing analyses of coping-outcome relations.The main conclusion is that a majority of gastrointestinal cancer patients cope well with their disease in the short as well as in the long run.