Type D personality is associated with longer symptom duration, poor mental health status, and poor quality of life among rectal cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jiakui , LI Yongshuang , JIN Junzhe , LIU Jichao , ZHANG Chundong ,  DAI Dongqiu

Department of Gastroenterological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, P.R.China;

Corresponding author：

DAI Dongqiu, Email: daidq1963@sina.com

Keywords：

type D personality; rectal cancer; referrals; quality of life; mental health status

DOI：

10.7507/1007-9424.201607060

Video：

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Objective The aim of this research was to explore the relationship between type D personality and symptom duration/emergency admissions/mental health status/quality of life (QOL) in Chinese rectal cancer patients. Methods Rectal cancer patients who were treated in our hospital form Oct. 2010 to Oct. 2012 were selected prospectively, and then their type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QOL was assessed longitudinally by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. Comparison between the type D personality group and non-type D personality group in social-demographic characteristics, clinicopathological features, mental health status, and QOL was performed. Results Of the 596 patients (92%) who responded, 131 patients (22%) had type D personality. ① Compared with non-type D personality group, the proportions of patients with duration of symptoms ≥1 month, without medical insurance, and emergency admissions in type D personality group were all higher, as well as the poor economic situation and more complication ( P<0.050). ② EORTC QLQ-C30. At the baseline, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). In 6 months after diagnosis, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, insomnia, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ③ EORTC QLQ-CR38. At the baseline, score of expectation for the future in type D personality group was lower than that of non-type D personality group ( P<0.001), but score of urinary problems in type D personality group was higher in type D personality group than that of non-type D personality group ( P<0.001). In 6 months after diagnosis, scores of expectation for the future and sexual function in type D personality group were both lower than those of non-type D personality group ( P<0.050), but scores of urinary problems, gastrointestinal symptoms, male sexual dysfunction, and excretion difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ④ At the baseline and 6 months after diagnosis, the incidences of anxiety and depression in type D personality group were all higher than those of non-type D personality group at the same time point ( P<0.001). In type D personality group, the incidences of anxiety and depression in 6 months after diagnosis were both higher than baseline ( P<0.001). Conclusion Type D personality may be a general vulnerability factor to screen for subgroups at risk for longer SD and emergency admissions in clinical practice of rectal cancer patients, and it was associated with poor QOL and poor mental health status.

Citation： ZHANG Jiakui, LI Yongshuang, JIN Junzhe, LIU Jichao, ZHANG Chundong, DAI Dongqiu. Type D personality is associated with longer symptom duration, poor mental health status, and poor quality of life among rectal cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 297-306. doi: 10.7507/1007-9424.201607060 Copy

1.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2.	Chen W, Zheng R, Zhang S, et al. Annual report on status of cancer in China, 2010. Chin J Cancer Res, 2014, 26(1): 48-58.
3.	How P, Stelzner S, Branagan G, et al. Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum, 2012, 55(4): 400-406.
4.	来龙祥, 宿娟, 陈军周, 等. 肿瘤微创消融新技术——不可逆性电穿孔. 中国普外基础与临床杂志, 2016, 23(3): 365-368.
5.	Mols F, Vingerhoets AJ, Coebergh JW, et al. Better quality of life among 10-15 year survivors of Hodgkin’s lymphoma compared to 5-9 year survivors: a population-based study. Eur J Cancer, 2006, 42(16): 2794-2801.
6.	Mongin C, Maggiori L, Agostini J, et al. Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis, 2014, 29(4): 459-467.
7.	Spiegel D. Mind matters in cancer survival. JAMA, 2011, 305(5): 502-503.
8.	Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom Med , 2005, 67(1): 89-97.
9.	Pedersen SS, Denollet J. Type D personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil, 2003, 10(4): 241-248.
10.	Schiffer AA, Denollet J, Widdershoven JW, et al. Failure to consult for symptoms of heart failure in patients with a type-D personality. Heart, 2007, 93(7): 814-818.
11.	Broström A, Strömberg A, Mårtensson J, et al. Association of type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS. J Sleep Res, 2007, 16(4): 439-447.
12.	Kim N, Hughes TL, Park CG, et al. Altered autonomic functions and distressed personality traits in male adolescents with internet gaming addiction. Cyberpsychol Behav Soc Netw, 2016, 19(11): 667-673.
13.	Mols F, Holterhues C, Nijsten T, et al. Personality is associated with health status and impact of cancer among melanoma survivors. Eur J Cancer, 2010, 46(3): 573-580.
14.	Metcalfe MS, Norwood MG, Miller AS, et al. Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis, 2005, 7(3): 275-278.
15.	Wong SK, Jalaludin BB, Morgan MJ, et al. Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum, 2008, 51(2): 223-230.
16.	Bass G, Fleming C, Conneely J, et al. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum, 2009, 52(4): 678-684.
17.	Elliss-Brookes L, McPhail S, Ives A, et al. Routes to diagnosis for cancer-determining the patient journey using multiple routine data sets. Br J Cancer, 2012, 107(8): 1220-1226.
18.	Zhang JK, Fang LL, Wu XM, et al. Factors associated with delaying medical assessment of patients and impacting the prognosis of rectal cancer. Eur J Cancer Prev, 2015, 24(5): 391-399.
19.	Chie WC, Yang CH, Hsu C, et al. Quality of life of lung cancer patients: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13. Qual Life Res, 2004, 13(1): 257-262.
20.	Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
21.	Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer, 1999, 35(2): 238-247.
22.	Zhao H, Kanda K. Translation and validation of the standard Chinese version of the EORTC QLQ-C30. Qual Life Res, 2000, 9(2): 129-137.
23.	Law CC, Tak Lam WW, Fu YT, et al. Validation of the Chinese version of the EORTC colorectal cancer-specific quality-of-life questionnaire module (QLQ-CR38). J Pain Symptom Manage, 2008, 35(2): 203-213.
24.	Fayers PM, Aaronson NK, Bjordal K, et al. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer, 2001.
25.	Olssøn I, Mykletun A, Dahl AA. The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry, 2005, 5: 46.
26.	Carey M, Noble N, Sanson-Fisher R, et al. Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles? Psychooncology, 2012, 21(3): 229-238.
27.	Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care, 2003, 41(5): 582-592.
28.	Bartels H, Pedersen SS, van der Laan BF, et al. The impact of type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. Otol Neurotol, 2010, 31(1): 11-18.
29.	Mols F, Denollet J. Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems. Health Qual Life Outcomes, 2010, 8: 9.
30.	Ken N. Understanding the process of adjustment to disability//Stubbins J. Social and psychological aspects of disability: a handbook for practitioners. London: University Park Press, 1977: 317-324.
31.	Carr AJ, Gibson B, Robinson PG. Measuring quality of life: is quality of life determined by expectations or experience? BMJ, 2001, 322(7296): 1240-1243.
32.	Downing A, Morris E, Richards M, et al. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol, 2015, 33(6): 616-624.
33.	Schiffer AA, Pedersen SS, Broers H, et al. Type D personality but not depression predicts severity of anxiety in heart failure patients at 1-year follow-up. J Affect Disord, 2008, 106(1-2): 73-81.
34.	Spindler H, Kruse C, Zwisler AD, et al. Increased anxiety and depression in Danish cardiac patients with a type D personality: cross-validation of the Type D Scale (DS14). Int J Behav Med, 2009, 16(2): 98-107.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
2. Chen W, Zheng R, Zhang S, et al. Annual report on status of cancer in China, 2010. Chin J Cancer Res, 2014, 26(1): 48-58.
3. How P, Stelzner S, Branagan G, et al. Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum, 2012, 55(4): 400-406.
4. 来龙祥, 宿娟, 陈军周, 等. 肿瘤微创消融新技术——不可逆性电穿孔. 中国普外基础与临床杂志, 2016, 23(3): 365-368.
5. Mols F, Vingerhoets AJ, Coebergh JW, et al. Better quality of life among 10-15 year survivors of Hodgkin’s lymphoma compared to 5-9 year survivors: a population-based study. Eur J Cancer, 2006, 42(16): 2794-2801.
6. Mongin C, Maggiori L, Agostini J, et al. Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis, 2014, 29(4): 459-467.
7. Spiegel D. Mind matters in cancer survival. JAMA, 2011, 305(5): 502-503.
8. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom Med , 2005, 67(1): 89-97.
9. Pedersen SS, Denollet J. Type D personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil, 2003, 10(4): 241-248.
10. Schiffer AA, Denollet J, Widdershoven JW, et al. Failure to consult for symptoms of heart failure in patients with a type-D personality. Heart, 2007, 93(7): 814-818.
11. Broström A, Strömberg A, Mårtensson J, et al. Association of type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS. J Sleep Res, 2007, 16(4): 439-447.
12. Kim N, Hughes TL, Park CG, et al. Altered autonomic functions and distressed personality traits in male adolescents with internet gaming addiction. Cyberpsychol Behav Soc Netw, 2016, 19(11): 667-673.
13. Mols F, Holterhues C, Nijsten T, et al. Personality is associated with health status and impact of cancer among melanoma survivors. Eur J Cancer, 2010, 46(3): 573-580.
14. Metcalfe MS, Norwood MG, Miller AS, et al. Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis, 2005, 7(3): 275-278.
15. Wong SK, Jalaludin BB, Morgan MJ, et al. Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum, 2008, 51(2): 223-230.
16. Bass G, Fleming C, Conneely J, et al. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum, 2009, 52(4): 678-684.
17. Elliss-Brookes L, McPhail S, Ives A, et al. Routes to diagnosis for cancer-determining the patient journey using multiple routine data sets. Br J Cancer, 2012, 107(8): 1220-1226.
18. Zhang JK, Fang LL, Wu XM, et al. Factors associated with delaying medical assessment of patients and impacting the prognosis of rectal cancer. Eur J Cancer Prev, 2015, 24(5): 391-399.
19. Chie WC, Yang CH, Hsu C, et al. Quality of life of lung cancer patients: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13. Qual Life Res, 2004, 13(1): 257-262.
20. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5): 365-376.
21. Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer, 1999, 35(2): 238-247.
22. Zhao H, Kanda K. Translation and validation of the standard Chinese version of the EORTC QLQ-C30. Qual Life Res, 2000, 9(2): 129-137.
23. Law CC, Tak Lam WW, Fu YT, et al. Validation of the Chinese version of the EORTC colorectal cancer-specific quality-of-life questionnaire module (QLQ-CR38). J Pain Symptom Manage, 2008, 35(2): 203-213.
24. Fayers PM, Aaronson NK, Bjordal K, et al. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer, 2001.
25. Olssøn I, Mykletun A, Dahl AA. The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry, 2005, 5: 46.
26. Carey M, Noble N, Sanson-Fisher R, et al. Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles? Psychooncology, 2012, 21(3): 229-238.
27. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care, 2003, 41(5): 582-592.
28. Bartels H, Pedersen SS, van der Laan BF, et al. The impact of type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. Otol Neurotol, 2010, 31(1): 11-18.
29. Mols F, Denollet J. Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems. Health Qual Life Outcomes, 2010, 8: 9.
30. Ken N. Understanding the process of adjustment to disability//Stubbins J. Social and psychological aspects of disability: a handbook for practitioners. London: University Park Press, 1977: 317-324.
31. Carr AJ, Gibson B, Robinson PG. Measuring quality of life: is quality of life determined by expectations or experience? BMJ, 2001, 322(7296): 1240-1243.
32. Downing A, Morris E, Richards M, et al. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol, 2015, 33(6): 616-624.
33. Schiffer AA, Pedersen SS, Broers H, et al. Type D personality but not depression predicts severity of anxiety in heart failure patients at 1-year follow-up. J Affect Disord, 2008, 106(1-2): 73-81.
34. Spindler H, Kruse C, Zwisler AD, et al. Increased anxiety and depression in Danish cardiac patients with a type D personality: cross-validation of the Type D Scale (DS14). Int J Behav Med, 2009, 16(2): 98-107.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Type D personality is associated with longer symptom duration, poor mental health status, and poor quality of life among rectal cancer patients

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