Quality of life following radiofrequency ablation of dysplastic Barrett's esophagus.
OBJECTIVE
The impact of the diagnosis and treatment of dysplastic Barrett's esophagus on quality of life (QoL) is poorly understood. This study assessed the influence of dysplastic Barrett's esophagus on QoL and evaluated whether endoscopic treatment of dysplastic Barrett's esophagus with radiofrequency ablation (RFA) improves QoL.


METHODS
We analyzed changes in QoL in the AIM Dysplasia Trial, a multicenter study of patients with dysplastic Barrett's esophagus who were randomly allocated to RFA therapy or a sham intervention. We developed a 10-item questionnaire to assess the influence of dysplastic Barrett's esophagus on QoL. The questionnaire was completed by patients at baseline and 12 months.


RESULTS
127 patients were randomized to RFA (n = 84) or sham (n = 43). At baseline, most patients reported worry about esophageal cancer (71 % RFA, 85 % sham) and esophagectomy (61 % RFA, 68 % sham). Patients also reported depression, impaired QoL, worry, stress, and dissatisfaction with the condition of their esophagus. Of those randomized, 117 patients completed the study to the 12-month end point. Compared with the sham group, patients treated with RFA had significantly less worry about esophageal cancer ( P=0.003) and esophagectomy ( P =0.009). They also had significantly reduced depression ( P=0.02), general worry about the condition of their esophagus ( P≤0.001), impact on daily QoL ( P=0.009), stress ( P=0.03), dissatisfaction with the condition of their esophagus ( P≤0.001), and impact on work and family life ( P=0.02).


CONCLUSIONS
Inclusion in the treatment group of this randomized, sham-controlled trial of RFA was associated with improvement in disease-specific health-related quality of life. This improvement appears secondary to a perceived decrease in the risk of cancer.
Shaheen
N J
NJ
University of North Carolina School of Medicine and School of Public Health, Chapel Hill, NC 27599, USA. nshaheen@med.unc.edu
Peery
A F
AF
Hawes
R H
RH
Rothstein
R I
RI
Spechler
S J
SJ
Galanko
J A
JA
Campbell
M
M
Carr
C
C
Fowler
B
B
Walsh
J
J
Siddiqui
A A
AA
Infantolino
A
A
Wolfsen
H C
HC
D000368:Aged; D001007:Anxiety / Q000209:etiology; D001471:Barrett Esophagus / Q000523:psychology* / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000517:prevention & control; D011788:Quality of Life / Q000523:psychology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires