Clinics and Research in Hepatology and Gastroenterology (2013) 37, 283288

Available online at

www.sciencedirect.com

ORIGINAL ARTICLE

Effects of psychological nursing intervention on

personality characteristics and quality of life of
patients with esophageal cancer
Qiao-mei Cheng , Cun-quan Kong , Shu-ying Chang , Ai-huan Wei
Department of Nursing, The Peoples Hospital of Henan Province, Zhengzhou 450003, Henan Province, P. R. China
Available online 30 October 2012

Summary
Objective: This study examined the effects of a psychological nursing intervention on personality characteristics and quality of life of esophageal cancer patients.
Methodology: Esophageal cancer patients (n = 86) were randomized into either an intervention
group (n = 45) or a control group (n = 41). Patients in the control group were given routine
nursing care, and those in the intervention group were provided with psychological nursing
interventions in addition to routine nursing care. Personality characteristics, assessed through
Eysenck Personality Questionnaire, and quality of life, assessed through EORTC QLQ-C30, were
compared between the two groups.
Results: The results showed that personality characteristics were closely related to quality of
life. After the psychological nursing intervention, the main factors were neurosis, psychosis or
mood instability, and personality stability. However, introverted and extroverted personality
characteristics were not associated with quality of life. The psychological nursing intervention
was associated with decreased P-scale and E-scale scores of personality characteristics and
improved quality of life in each dimension scored.
Conclusions: A psychological nursing intervention can affect the personality characteristics of
esophageal cancer patients and improve their quality of life; this approach is worthy of further
study and clinical application.
2012 Elsevier Masson SAS. All rights reserved.

Introduction
The incidence of esophageal cancer in China ranks rst in the
world and continues to increase annually [1]. Importantly,

Corresponding author. The Peoples Hospital of Henan Province,

Zhengzhou 450003, Henan Province, P. R. China.
E-mail address: chengqm2011@126.com (C.-q. Kong).

survival of cancer patients has signicantly improved with

advances in medical science [2], and quality of life during the survival period has become an area of increasing
research focus [35]. Cancer patients with higher quality
of life have better prognosis and longer survival [6]. However, quality of life is a multi-dimensional concept related
to a variety of factors. Healthy quality of life means that
the individual has healthy physical, psychological, and social
functioning during their survival period [7]. As an abstract

2210-7401/$ see front matter 2012 Elsevier Masson SAS. All rights reserved.
http://dx.doi.org/10.1016/j.clinre.2012.08.009

284
concept, quality of life should be assessed by the patients
themselves [8] and can inuence the clinical treatment for
esophageal cancer [911].
Personality is the composite of an individuals psychological characteristics and is the intrinsic behavior pattern
of daily interpersonal interactions [12]. Personality characteristics have been reported to be closely related with
the occurrence and development of cancer [13]. Indeed,
personality characteristics and psychological types affect
physiology and disease pathology [1416]. However, no
study has focused on the relationship between personality characteristics and quality of life in patients with
esophageal cancer.
In addition to physical harm, cancer causes anxiety,
depression, and many other psychological problems [17].
Once aware of their disease, cancer patients will suffer
from psychological pressures in varying degrees that can
negatively affect their prognosis [18]. Thus, in addition
to treatment, psychological care is also extremely important to clinical outcome; indeed, improving mental health
can improve outcomes [19]. Clinical evaluations of cancer
patients subjective experiences are becoming standard of
care.

Purpose
This study investigated the association of personality characteristics and the effect of psychological intervention on
quality of life in patients with esophageal cancer.

Materials and methods

Study sample
The study was conducted at The Peoples Hospital of Henan
Province from January 2009 to May 2011. By pathological
examination, a total of 97 patients were newly diagnosed
with esophageal cancer; none had received any surgery,
radiotherapy, chemotherapy, or other treatment. Patients
who had serious diseases, including heart (n = 2), liver (n = 1),
kidney (n = 2), lung disease (n = 2), or cognitive or mental
disorders (n = 3) were excluded from the study. In total, 86
patients were included and were hospitalized for treatment.
Patients were randomly divided into two groups according to
a random number table: an intervention group (n = 45) and
a control group (n = 41). The intervention group consisted
of 30 males and 15 females, ages 37 to 68 years, with a
mean age of 47.8 15.6 years. The control group consisted
of 28 males and 13 females, ages 34 to 75 years, with a
mean age of 46.4 16.8 years. Patients in the two groups
were comparable in age, gender, disease condition, and
other general information; no demographics were statistically different (P > 0.05). According to clinical AJCC/UISS
TNM staging guidelines for esophagus cancer (2009), there
were nine cases in stage I, 18 in stage IIa, eight in stage
IIb, eight in stage III, and two in stage IV in the intervention
group, and eight cases in stage I, 16 in stage IIa, seven in
stage IIb, eight in stage III, and two in stage IV in the control
group. TNM stages were not statistically different between
the two groups (P > 0.05). This study was approved by the

Q.-m. Cheng et al.

hospital Ethics Committee and all subjects provided written
informed consent.

Methods
Patients in the control group received conventional nursing care, while the intervention group received appropriate
psychological nursing interventions in addition to conventional nursing care. The psychological nursing interventions
included the following objectives:
communicate one-on-one with the patients and listen
patiently to provide a caring atmosphere and to promote
relaxation and a positive, optimistic attitude. The goal
was to gradually establish a relationship of mutual trust
between the nurses and the patient;
promote health education through brochures, multimedia
technologies, and other approaches supplied by People s
Medical Publishing House Co., LTD (Beijing, China). Nurses
explained the disease, as well as the surgical procedures,
precautions, and possible adverse effects, to patients and
their families in detail. The health education programs
were adjusted as necessary according to the patients
needs and demands;
create a harmonious and friendly ambience to transfer the
patients focus from cancer. As related to the different
emotions of patients, nurses played appropriate relaxing
music and videos and encouraged patients to participate
in their favorite activities to avoid the accumulation of
anxiety, tension, and other negative emotions. Patients
were encouraged to chat with each other and were taught
methods to drain negative emotions, such as listening to
music or crying to heal;
strive for cooperation from the patients family and their
social supports. Most cancer patients will go through a
long and painful treatment process, and the illness, pain,
high medical costs, and fear of death will impose an
invisible spiritual burden. Thus, support and understanding from their sources of social support and family play
an invaluable role during treatment. During treatment,
nurses could contact the patients family or support unit
(by follow-up, telephone, etc.) and communicate with
them about the patients psychological problems. The
goal was to try to ease the patients negative emotions
with supportive assistance.

Assessment methods
Quality of life was assessed at admission, one month after
admission, and six months after admission using the 30question European Organization for Research and Treatment
of Cancer Quality of Life Scale (EORTC QLQ-C30) [20], which
included ve dimensions (somatic function, role function,
emotion function, cognitive function, and social function).
Higher scores indicate a higher quality of life. Personality characteristics were assessed using the 48-question
EPQ (Eysenck Personality Questionnaire-Revised, Short Scale
for Chinese, EPQ-RSC) consisting of four dimensions (introversion and extroversion (E), neuroticism or emotion (N),
psychoticism (P), and personality stablity (L)). Higher scores

Psychological nursing on esophageal cancer

285

indicate greater psychoticism and neuroticism, less stable

emotions, and extroversion.

Statistical analysis
SPSS 16.0 software was used for statistical analysis. The
quality of life and personality characteristics before and
after admission were compared by repeat-measures analysis
of variance, and the inter-group comparison was performed
with q test. The correlation between personality characteristics and quality of life was analyzed by linear correlation
analysis. A P value < 0.05 was considered statistically significant.

Results
Personality characteristics
Personality characteristics were measured at baseline, one
month after admission, and six months after admission.
At admission, the personality characteristics of the two
groups were not statistically different (P > 0.05) (Table 1). In
the control group, personality characteristic scores did not
change over time (P > 0.05). In the intervention group, the
personality characteristic scores were not different between
one month and six months after admission (P > 0.05). However, the differences between baseline and six months were
signicant in this group; specically, the P scale and E values were statistically signicant (P < 0.05). The changes in
N scale and L scale values over time were not statistically
signicant (P > 0.05).

Quality of life
At admission, the quality of life scores at each dimensionality between the two groups were not signicantly
different (P > 0.05) (Table 2). For patients in the control
group, the time-related changes in quality of life scores
at each dimensionality were not statistically signicant
(P > 0.05). For patients in the intervention group, the quality
of life scores (at each dimensionality) obtained one month
after admission were not statistically different from preadmission values (P > 0.05). However, quality of life scores
(at each dimensionality) obtained six months after admission were signicantly different from pre-admission values
(P < 0.05).

Table 1

In the intervention group, there was no correlation between

personality characteristics and overall quality of life both
before and after the intervention (P > 0.05) (Table 3). Furthermore, there was no correlation between personality
characteristics and QOL cognitive function both before and
after the intervention (P > 0.05). At admission, the personality characteristic N scale was positively correlated with the
QOL physical function, role function, and social function. P
scale was positively correlated with QOL emotion function.
One month after admission, the personality characteristics
P scale was positively correlated with QOL emotion function, and N scale was positively correlated with QOL physical
function, role function, and social function. Six months
after admission, the personality characteristic N scale and P
scale were positively correlated with QOL physical function,
and L scale was negatively correlated with QOL emotion
function.

Discussion
Personality is closely related to the individuals psychology,
and the patients mental health status can be reected by
assessment of personality [21]. The P scale can reect the
patients neuroticism or emotional stability; smaller P scale
scores suggest an introverted personality that may relate
to apathy and social isolation [22]. However, such patients
may also respond more calmly to major events compared
to those with an outgoing personality (higher P scale). The
E scale represents the patients extroversion (E), N scale
represents the patients autonomic nervous function, and L
scale reects the patients masked affection of personality
characteristics. This study showed that a psychological nursing intervention decreased the P scale and E scale scores of
patients with esophageal cancer. This suggests that patients
treated with the psychological nursing intervention had signicant introversion. Such patients have a quiet nature and
pessimistic characteristics. However, such subjects may also
have a scrupulous nature and have mental endurance. Of
course, these characteristics also may be related to the living environment, occupation and other general background
of patients and their families [23].
Patients in both the control and intervention groups had
no change in L scale scores from pre-treatment to posttreatment and had persistently higher L scores. Higher L
scores indicate that patients have low psychological masked
affection and high authenticity. In contrast, high N scale

Comparison the personality characteristics of patients in the two groups before and after admission.
At admission
Intervention group

P scale
E scale
N scale
L scale

Correlation between personality characteristics

and quality of life (QOL) in the intervention group

5.97
9.85
6.53
9.86

2.11
1.18
1.75
1.70

Control group
5.81
9.13
7.01
8.97

2.34
1.54
1.63
1.37

One month after admission

Six months after admission

Intervention group

Intervention group

5.91
9.87
7.06
9.34

3.18
2.13
1.56
1.23

Control group
6.01
9.56
7.03
9.13

1.86
1.37
1.67
1.39

2.83
6.13
6.67
9.53

1.17
2.11
1.94
1.15

Control group
5.96
9.34
6.23
9.12

1.87
1.27
1.36
1.81

286

Q.-m. Cheng et al.

Table 2

Comparison of the quality of life of patients between the two groups (scores, x s).
At admission
Intervention
group

Overall quality of life

Somatic function
Role function
Emotion function
Cognitive function
Social function

Table 3

54.72
62.71
48.24
60.34
55.68
48.34

15.73
11.98
20.05
14.38
14.48
12.26

Control group
55.81
64.06
45.43
65.11
57.89
44.20

15.47
10.27
21.19
14.09
12.04
12.64

One month after admission

Six months after admission

Intervention
group

Intervention
group

53.04
60.38
50.35
56.49
59.73
47.24

14.76
11.91
20.20
15.16
12.35
14.44

Control group
52.42
56.28
47.37
56.06
57.93
47.35

14.60
1.67
16.31
16.96
13.28
14.23

77.40
83.17
74.24
84.49
80.13
73.28

14.47
8.17
14.82
13.91
12.03
10.56

Control group
55.73
67.95
45.83
66.15
64.87
55.34

17.60
10.85
18.69
13.86
14.15
11.69

Analysis of personality characteristics and quality of life of patients in the intervention group after admission.

Time

Overall quality
of life

Somatic
function

Role function

Emotion
function

Cognitive
function

Social
function

At admission
P
N
E
L

0.081
0.121
0.093
0.023

0.187
0.344a
0.056
0.119

0.021
0.429a
0.111
0.145

0.326a
0.163
0.112
0.246

0.187
0.201
0.131
0.129

0.231
0.405a
0.149
0.043

One month after admission

P
N
E
L

0.121
0.109
0.098
0.021

0.204
0.312a
0.057
0.027

0.093
0.419a
0.172
0.149

0.326a
0.187
0.092
0.214

0.231
0.169
0.087
0.091

0.161
0.363a
0.025
0.079

Six months after admission

P
N
E
L

0.089
0.081
0.045
0.207

0.236a
0.430a
0.055
0.079

0.084
0.329
0.176
0.081

0.148
0.101
0.014
0.243a

1.032
1.112
1.981
1.763

0.136
0.276
0.079
0.142

P < 0.05.

scores indicate that patients were characterized by emotional instability and can easily and strongly respond to
various stimuli.
In general, cancer patients have greater stress and psychological burden that affect the quality of life [17]. The
individuals subjective evaluation is inuenced by selfexperience. In this study, patients in both groups had quality
of life scores < 60 at admission, indicating that patients with
esophageal cancer had lower quality of life scores. The quality of life for patients in the control group were not affected
over time, while patients in the intervention group showed
improved quality of life dimensionalities after the psychological intervention.
Patients with esophageal cancer will develop various
postoperative complications [2427], and previous studies [2832] suggested that quality of life of patients with
esophageal cancer is improved by reducing their postoperative complications. Different surgical methods can
also affect patients quality of life [33]. This study found
that appropriate psychological nursing interventions can
also improve quality of life for patients with esophageal
cancer. Cancer patients can have great emotional uctuations that may include periods of pessimism, despair, and

self-abandonment [13]. Such emotions will strongly impact

both their psychological and physiologic status, including
immune function, which can negatively affect cancer treatment [1416]. Thus, pre- and post-operative psychological
care should be provided in anticipation of these needs.
Health care providers should acknowledge patients when
they express high emotions and encourage them when they
have doubts about treatment. Under similar treatment conditions, we found that patients treated with psychological
interventions have higher evaluation scores in quality of life
and are more satised with their overall status.
Personality includes multi-dimensional concepts and
is affected by many factors, including genetic determinants and social environment [12]. Among subjects with
esophageal cancer, this study found that the N factor of the
personality characteristics was positively correlated with
their somatic function, role function, and emotion function both before and after treatment. The P factor was
positively correlated with emotion function at admission
and with physical function six months after admission. The
L factor was negatively correlated with emotion function
six months after treatment. These results indicated that
patient personality characteristics were closely related to

Psychological nursing on esophageal cancer

their quality of life. The main relevant factors were neuroticism or emotion, psychoreaction, and personality stability,
while introversion and extroversion were not related to quality of life.
This study has certain limitations. For example, the
impact of patient personality characteristics on quality of
life still requires further investigation to determine whether
personality characteristics have direct or indirect effects on
quality of life or mainly has a regulating action. In contrast, the strength of the study is the demonstration of a
link between quality of life and personality characteristics,
a dimension that has not been studied in esophageal cancer
previously.
In summary, esophageal cancer patient personality characteristics were closely related to their quality of life.
Psychological nursing intervention can positively affect
the personality characteristics of patients with esophageal
cancer to further improve their quality of life. It is recommended to apply this approach in clinical practice.

287

[12]
[13]

[14]

[15]

[16]

[17]

[18]

Disclosure of interest
[19]

The authors declare that they have no conicts of interest

concerning this article.

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