title: Patients' perception of diagnostic tests in the preoperative assessment of esophageal cancer.
abstract: OBJECTIVE
  Defining an optimal staging strategy requires an evaluation of the effectiveness and costs of diagnostic tests and may include the burden of these tests for patients. This study evaluated the burden of cervical ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT) and positron emission tomography (PET) in patients with esophageal carcinoma (EC).
  
  
  METHODS
  Consenting consecutive patients underwent a standard preoperative work-up. Burden of testing was evaluated with a self-report questionnaire addressing anxiety, embarrassment, and discomfort, each measured on a 1(none) to 5 (extreme) point-scale. An overall burden score was calculated by summing the three item scores. In addition, patients were asked to rank the four tests from least to most inconvenient. Statistical analysis was performed with nonparametric tests.
  
  
  RESULTS
  82 patients (67 , 15 ; mean age 64.3 yrs) participated. For most tests and most dimensions of burden, the large majority of subjects was in categories 1 and 2.With respect to anxiety, the rank order (from highest burden to lowest burden) was EUS, US, PET, and CT (average scores 1.7, 1.5, 1.4, and 1.2, respectively). For embarrassment, the rank order was EUS, PET, US, and CT (1.9, 1.5, 1.4, and 1.3 respectively). For discomfort, the rank order was EUS, PET, US and CT (2.0, 1.6, 1.4, and 1.2, respectively). And for total burden, the rank order was EUS, PET, US and CT (5.6, 4.6, 4.2, and 3.7). PET was ranked as least inconvenient by 35% of patients and as most inconvenient by 16% compared with the other tests.
  
  
  CONCLUSIONS
  Significant but small differences were observed in patient burden for imaging tests to evaluate EC. The perceived burden of PET was lower than that of EUS, but higher than the burden of CT. However absolute values were low for all tests and therefore patient burden will not be a key feature for the construction of an optimal staging algorithm for EC.
authors.affiliation: Departments of Surgery.
authors.forename: Marinke
authors.initials: M
authors.lastname: Westerterp
authors.forename: Henderik L
authors.initials: HL
authors.lastname: van Westreenen
authors.forename: Marije
authors.initials: M
authors.lastname: Deutekom
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Emile Fi
authors.initials: EF
authors.lastname: Comans
authors.forename: John Tm
authors.initials: JT
authors.lastname: Plukker
authors.forename: Patrick Mm
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Gerrit W
authors.initials: GW
authors.lastname: Sloof