Abstract:

Objective To explore the trajectories of psychological distress and its influencing factors among esophageal cancer patients undergoing radiotherapy. Methods A total of 226 esophageal cancer patients undergoing radiotherapy in the Oncology Radiotherapy Center of a tertiary hospital in Henan Province were recruited by convenience sampling from September 2022 to October 2023. The Distress Thermometer(DT) and other tools were employed to investigate patients’ levels of psychological distress at four time points:before the first radiotherapy session(T1),the 15th radiotherapy session(T2),at the end of radiotherapy(T3),and one month after the completion of radiotherapy(T4). Growth mixture modeling(GMM) was utilized to identify potential classes of psychological distress trajectories,and multinomial logistic regression (backward elimination) was conducted to analyze the factors influencing these trajectory classes. Results A total of 199 esophageal cancer patients completed the follow-up. Their psychological distress trajectories were categorized into four potential classes:“Low-Level Stable Group” (C1,23.6%),“Low-Level Fluctuating Group”(C2,17.1%),“Moderate-Level Declining Group”(C3,28.6%),and “Moderate-to-High-Level Stable Group”(C4,30.7%). Taking C1 as the reference,a monthly family income per capita <2 000 yuan compared to ≥3 000 yuan was a protective factor for C2;a history of surgery was a risk factor for C4;concurrent chemoradiotherapy was a risk factor for both C2 and C4;high family care scores were protective factors for C2,C3,and C4;high average symptom burden scores were risk factors for C2,C3,and C4;and high illness perception scores was a risk factor for C4(P<0.05). Conclusion Heterogeneity exists in the psychological distress trajectories of esophageal cancer patients undergoing radiotherapy. Healthcare teams can develop precise intervention programs based on the characteristics and influencing factors of patients’ psychological distress trajectories to reduce their levels of psychological distress.

Key words: Esophageal Cancer, Radiotherapy, Psychological Distress, Trajectories, Root Cause Analysis, Growth Mixture Modeling