Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett's esophagus.
OBJECTIVE
Endoscopic treatment of early neoplasia in Barrett's esophagus preserves the esophagus and is minimally invasive compared with surgical treatment. However, the influence of endoscopic therapy on quality of life (QOL) and fear of cancer recurrence is unknown. We explored QOL and fear of cancer recurrence 12 - 60 months after endoscopic and surgical treatment for early Barrett's neoplasia, using a cross-sectional design.


METHODS
A total of 81 patients with early Barrett's neoplasia underwent endoscopic treatment and 33 patients underwent surgery. The choice of treatment was based on tumor size, depth of penetration or patient preference. QOL was measured using the SF-36, EORTC-QLQ-C30, and the EORTC-QLQ-OES18 questionnaires. Anxiety and fear of recurrence were measured using the Hospital Anxiety and Depression Scale (HADS) and the Worry Of Cancer Scale (WOCS).


RESULTS
In total, 66 endoscopy patients and 29 surgery patients were eligible for the study. Questionnaires were completed by 64/66 (97 %) endoscopy patients and 27 / 29 (93 %) surgery patients. Multivariate analyses were conducted, with sex, age, comorbidity, and histology of the resected specimen used as covariates. Patients in the surgery group reported significantly more eating problems (OR = 18.3; P < 0.001) and reflux symptoms (OR = 3.4; P = 0.05) on the EORTC-OES18 questionnaire, whereas endoscopy patients reported more fear of recurrence on the WOCS than surgery patients ( P = 0.003). No significant differences were found between the two groups on the other outcomes.


CONCLUSIONS
Preservation of the esophagus after endoscopy treatment, which is preferred from a clinical perspective, may induce fear of cancer recurrence. Proper patient education with specific attention to fear of cancer recurrence may therefore be required.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
W D
WD
Rosmolen
K R
KR
Boer
R J
RJ
de Leeuw
C J
CJ
Gamel
M I
MI
van Berge Henegouwen
J J
JJ
Bergman
M A
MA
Sprangers
D000230:Adenocarcinoma / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D000368:Aged; D001007:Anxiety; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D016629:Esophagectomy / Q000523:psychology; D004945:Esophagoscopy / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011788:Quality of Life; D012008:Recurrence