Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition

Figures & data

Figure 1 A flowchart describing the details of patient selection.

Table 1 The SAS and SDS Scores of the Participants

Item	N(%)	SAS (Mean±SD)	t/F	P	SDS (Mean±SD)	t/F	P
Gender
Male	176(51.9)	43.13±6.43	2.341	0.020	45.35±7.36	2.352	0.019
Female	163(48.1)	44.85±7.15			47.25±7.36
Age (year)
<60	194(57.2)	44.04±6.37	0.266	0.790	46.61±7.85	0.977	0.329
≥60	145(42.8)	43.84±7.43			45.81±6.94
BMI (kg/m^2)
<24	208(61.4)	44.11±7.14	0.509	0.611	46.66±7.50	1.240	0.216
≥24	131(38.6)	43.72±6.34			45.63±7.41
Monthly household income (yuan)
<5000	170(50.1)	45.39±7.60	3.971	0.000	46.75±7.57	1.205	0.229
≥5000	169(49.9)	42.51±5.63			45.78±7.37
Education level
High School and below	166(49.0)	43.19±5.97	2.023	0.044	46.18±7.30	0.204	0.838
High School or above	173(51.0)	44.69±7.52			46.35±7.66
Marital status
Spouse	257(75.8)	44.02±6.83	−0.322	0.748	46.11±7.57	0.665	0.506
No spouse	82(24.2)	43.74±6.89			46.74±7.19
With underlying diseases or not
Yes	151(44.5)	43.85±6.73	0.245	0.807	46.86±7.63	1.628	0.104
No	188(55.5)	44.04±6.94			45.53±7.23
History of smoking
Yes	74(21.8)	44.30±6.35	−0.486	0.627	46.39±7.46	0.570	0.566
No	265(78.2)	43.86±6.97			45.82±7.55
History of alcohol consumption
Yes	118(34.8)	43.31±7.42	1.282	0.201	46.19±7.18	0.127	0.899
No	221(65.2)	44.30±6.49			46.30±7.64
Whether to undergo surgery
Yes	129(38.1)	45.19±7.42	−2.620	0.009	47.49±7.69	−2.378	0.018
No	210(61.9)	43.20±6.31			45.51±7.25
Tumor diameter (cm)
<5	243(71.7)	43.19±6.90	−3.334	0.001	45.53±7.46	−2.895	0.004
≥5	96(28.3)	45.60±6.28			48.11±7.23
TNM staging
<II stage	194(57.2)	42.55±5.86	−4.499	0.000	45.32±7.04	−2.706	0.007
≥II stage	145(42.8)	45.83±7.57			47.52±7.87
Pathological type
Squamous cell carcinoma	198(58.4)	44.12±7.36	0.844	0.431	46.43±7.23	1.630	0.198
Adenocarcinoma	99(29.2)	43.28±5.71			45.32±7.10
Adenosquamous carcinoma	42(12.4)	44.79±6.69			47.71±9.20
Primary tumor site
Cervical segment	75(22.1)	43.77±7.24	2.396	0.068	45.43±7.58	1.109	0.345
Upper thorax	101(29.8)	44.13±6.26			46.86±7.97
Middle thorax	100(29.5)	42.81±6.24			45.67±6.77
Lower thorax	63(18.6)	45.71±7.83			47.25±7.57
Concomitant gastrointestinal symptoms
1	194(57.2)	43.60±5.95	−1.116	0.265	45.44±6.66	−2.359	0.019
≥2	145(42.8)	44.43±7.85			47.37±8.34
Radiation dose
50–60 Gy	183(54.0)	43.05±5.69	−2.653	0.008	45.37±7.11	−2.402	0.017
>60 Gy	156(46.0)	45.01±7.86			47.31±7.77
Simultaneous chemotherapy or not
Yes	101(29.8)	45.18±8.10	−2.157	0.032	47.75±7.84	−2.403	0.017
No	238(70.2)	43.44±6.17			45.63±7.24
Sleep status
Well	210(61.9)	43.25±6.25	−2.452	0.015	45.88±6.90	−1.210	0.227
Poor	129(38.1)	45.11±7.57			46.89±8.32
With swallowing disorder or not
Yes	155(45.7)	45.01±7.70	−2.621	0.009	46.97±7.90	−1.195	0.233
No	184(54.3)	43.07±5.88			45.82±7.10

Abbreviations: BMI, body mass index; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale.

Table 2 Comparison of the Complications Between the Groups of Patients

Item N(%)	Radiation Esophagitis		Radiation Dermatitis		Radiation Pneumonia		Gastrointestinal Symptoms		Edema
	No	Yes	No	Yes	No	Yes	No	Yes	No	Yes
With negative emotions	3(4.8)	59(95.2)	5(8.1)	57(91.9)	6(9.7)	56(90.3)	3(4.8)	59(95.2)	6(9.7)	56(90.3)
Without negative emotions	10(3.6)	267(96.4)	6(2.2)	271(97.8)	9(3.2)	268(96.8)	11(4.0)	266(96.0)	10(3.6)	267(96.4)
X^2	0.207		5.614		4.950		0.096		4.147
P	0.649		0.018		0.026		0.756		0.042

Table 3 Comparison of Laboratory Indicators Between the Groups of Patients

Item (Mean±SD)	Pre-Radiotherapy Hb (g/L)	Hb after Radiotherapy (g/L)	Pre-Radiotherapy Alb (g/L)	Alb After Radiotherapy (g/L)
With negative emotions	131.90±10.06	115.86±11.31	38.69±3.77	28.48±5.44
Without negative emotions	129.67±10.03	119.62±10.79	37.89±3.40	30.43±3.54
t	−1.578	2.385	−1.635	3.505
P	0.116	0.019	0.103	0.001
	Pre-radiotherapy PAB (mg/L)	PAB after radiotherapy (mg/L)	Pre-radiotherapy TF (g/L)	TF after radiotherapy (g/L)
With negative emotions	217.42±22.57	204.37±22.57	2.62±0.24	1.79±0.28
Without negative emotions	214.42±20.91	201.35±20.83	2.66±0.25	1.88±0.29
t	−0.864	−1.015	0.953	2.247
P	0.388	0.311	0.341	0.024

Abbreviations: Hb, hemoglobin; Alb, albumin; PAB, prealbumin; TF, transferrin.

Table 4 Comparison of the PG-SGA Scores Between the Groups of Patients Before and After Treatment

Item (Mean±SD)	PG-SGA Scores Before Treatment	PG-SGA Scores 1 Month After Treatment	PG-SGA Scores 3 Month After Treatment	PG-SGA Scores 6 Month After Treatment
With negative emotions	1.95±1.66	2.79±1.88	3.47±2.25	4.21±2.58
Without negative emotions	1.68±1.94	1.97±2.11	2.19±2.42	2.56±2.67
t	−1.025	−2.834	−3.809	−4.432
P	0.306	0.005	0.000	0.000

Abbreviation: PG-SGA, Patient-Generated Subjective Global Assessment.

Table 5 Binary Logistic Regression Analysis of the Negative Emotions of Patients

Related factor	B	SE	Wald	P	OR	95% CI
						Upper	Lower
Gender	0.305	0.327	0.868	0.351	1.356	2.573	0.715
Monthly household income (yuan)	−0.756	0.330	5.244	0.022	0.470	0.897	0.246
Education level	−0.177	0.320	0.304	0.582	0.838	1.570	0.447
Whether to undergo surgery	−0.065	0.337	0.037	0.848	0.937	1.816	0.484
Tumor diameter (cm)	0.312	0.350	0.795	0.373	1.366	2.713	0.688
TNM staging	0.708	0.352	4.045	0.044	2.030	4.048	1.018
Concomitant gastrointestinal symptoms	0.728	0.322	5.111	0.024	2.071	3.891	1.102
Radiation dose	0.605	0.331	3.354	0.067	1.832	3.502	0.958
Sleep status	0.932	0.317	8.661	0.003	2.540	4.724	1.365
Simultaneous chemotherapy or not	−0.011	0.363	0.001	0.977	0.989	2.015	0.486
With swallowing disorder or not	0.652	0.329	3.915	0.048	1.919	3.659	1.006
Radiation dermatitis	1.478	0.716	4.265	0.039	4.384	17.828	1.078
Radiation pneumonia	1.154	0.625	3.407	0.065	3.171	10.799	0.931
Edema	1.814	0.621	8.539	0.003	6.133	20.700	1.817

Abbreviations: SE, standard error; OR, odds ratio; CI, confidence interval.

Figure 2 Binary logistic regression analysis of the negative emotion of patients.

Table 6 Binary Logistic Regression Analysis of the Patients Suffering from Malnutrition

Related factor	B	SE	Wald	P	OR	95% CI
						Upper	Lower
With negative emotion or not	0.935	0.450	4.319	0.038	2.547	1.055	6.149
Gender	−0.106	0.313	0.115	0.734	0.899	1.661	0.487
Age (year)	0.825	0.320	6.660	0.010	2.281	4.267	1.219
BMI (kg/m^2)	−0.094	0.319	0.086	0.769	0.911	1.702	0.487
Monthly household income (yuan)	−0.023	0.311	0.005	0.941	0.977	1.797	0.531
Education level	0.250	0.308	0.659	0.417	1.284	2.347	0.702
Marital status	−0.301	0.349	0.743	0.389	0.740	1.467	0.374
With underlying diseases or not	0.582	0.309	3.555	0.059	1.790	3.280	0.977
History of smoking	0.011	0.364	0.001	0.975	1.012	2.064	0.496
History of alcohol consumption	0.213	0.325	0.429	0.512	1.237	2.337	0.655
Whether to undergo surgery	0.324	0.335	0.935	0.334	1.382	2.663	0.717
Tumor diameter (cm)	0.903	0.353	6.539	0.011	2.468	4.931	1.235
TNM staging	0.551	0.347	2.522	0.112	1.735	3.425	0.879
Pathological type
Adenocarcinoma	−0.564	0.494	1.302	0.254	0.569	1.499	0.216
Adenosquamous carcinoma	−0.288	0.453	0.404	0.525	0.750	1.823	0.308
Primary tumor site
Upper thorax	−0.058	0.423	0.019	0.892	0.944	2.161	0.412
Middle thorax	−0.216	0.423	0.261	0.610	0.806	1.846	0.352
Lower thorax	−0.085	0.466	0.033	0.855	0.918	2.290	0.368
Concomitant gastrointestinal symptoms	0.731	0.317	5.322	0.021	2.077	3.864	1.116
Radiation dose	1.039	0.312	11.115	0.001	2.827	5.209	1.535
Simultaneous chemotherapy or not	−0.103	0.367	0.079	0.779	0.902	1.854	0.439
Sleep status	0.448	0.316	2.011	0.156	1.566	2.910	0.843
With swallowing disorder or not	0.675	0.310	4.733	0.030	1.963	3.605	1.069
Radiation esophagitis	2.459	0.864	8.100	0.004	11.696	63.609	2.150
Radiation dermatitis	0.991	0.879	1.270	0.260	2.693	15.082	0.481
Radiation pneumonia	1.079	0.846	1.625	0.202	2.940	15.439	0.560
Gastrointestinal symptoms	0.205	0.781	0.069	0.793	1.228	5.679	0.265
Edema	1.299	0.737	3.111	0.078	3.666	15.531	0.865
Pre-radiotherapy Hb (g/L)	0.127	0.032	15.468	0.000	1.135	1.209	1.066
Hb after radiotherapy (g/L)	−0.126	0.031	16.778	0.000	0.881	0.936	0.829
Pre-radiotherapy Alb (g/L)	−0.107	0.046	5.391	0.020	0.898	0.983	0.821
Alb after radiotherapy (g/L)	−0.046	0.040	1.354	0.244	0.955	1.032	0.883
Pre-radiotherapy PAB (mg/L)	−0.016	0.050	0.106	0.744	0.984	1.086	0.891
PAB after radiotherapy (mg/L)	0.012	0.050	0.057	0.811	1.012	1.117	0.917
Pre-radiotherapy TF (g/L)	−2.156	1.329	2.631	0.105	0.116	1.567	0.009
TF after radiotherapy (g/L)	1.895	1.123	2.845	0.092	6.651	60.142	0.736

Abbreviations: BMI, body mass index; Hb, hemoglobin; Alb, albumin; PAB, prealbumin; TF, transferrin; SE, standard error; OR, odds ratio; CI, confidence interval.

Figure 3 Binary logistic regression analysis of the patients suffering from malnutrition.

Figure 4 Kaplan-Meier survival curves of the patients in the negative emotion group and those in the non-negative emotion group.