Effect of Behavioral Activation on Stigma and Quality of Life in Patients With Advanced Esophageal and Gastric Cancer: A Randomized Controlled Trial

ABSTRACT Background Esophageal cancer and gastric cancer patients require researchers' attention to address and resolve the issue of stigma. The aim of this study was to investigate whether behavioral activation (BA), an emerging psychosocial intervention method, can mitigate the stigma experienced by these patients and enhance their quality of life (QoL). Methods One hundred fifty‐three patients with advanced esophageal cancer and gastric cancer were recruited and randomly assigned to either the BA plus care as usual group (BA + CAU group) or the care as usual group (CAU group). Pre‐ and post‐intervention questionnaires, including the Social Impact Scale (SIS), as well as all functional areas and global health and QoL modules from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30, version3). Results Generalized estimating equation analysis revealed that compared to usual care alone, combining BA with usual care significantly reduced stigma (time‐by‐group interaction, T1: β = −10.584, p < 0.001; T2: β = −22.619, p < 0.001) while improving physical, role, emotional, social functioning and global health and QoL particularly at T2 time point. Additionally, it also has the potential to decelerate the progressive decline of cognitive functioning. Furthermore, correlation analysis demonstrated a significant association between stigma levels and all functional areas as well as global health and QoL. Conclusion The issue of stigma among esophageal cancer and gastric cancer patients warrants increased attention due to its close relationship with patient QoL. This study presents a promising psychosocial intervention approach suitable for clinical application that deserves further promotion among cancer patients. Trial Registration NCT06348940.