title: Quality of life and fear of cancer recurrence after endoscopic treatment for early Barrett's neoplasia: a prospective study.
abstract: Endoscopic therapy is the treatment of choice for high grade intraepithelial neoplasia (HGIN) or early cancer (≤T1sm1) in Barrett's esophagus (BE). We prospectively evaluated the effect of endoscopic treatment on quality of life (QOL) and fear of cancer (recurrence) and compared this with the effect of Barrett's surveillance or surgery. Patients treated endoscopically for early Barrett's neoplasia (n = 42, HGIN - T1sm1N0M0) were compared with three groups: patients with non-dysplastic BE undergoing surveillance (n = 44); patients treated surgically for early BE neoplasia (HGIN - T2N0M0, n = 21); patients treated surgically for advanced BE cancer (T1N1M0 - T3N1M0, n = 19). QOL (SF-36; EORTC-QLQ-C30; EORTC-QLQ-OES18) and fear of cancer recurrence (Worry of Cancer Scale [WOCS] and the Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 2 and 6 months after treatment. The endoscopic treatment group reported significantly better QOL in both physical and mental scales of SF-36 and EORTC-QLQ-C30 and less esophageal cancer related symptoms compared to both surgical groups. The endoscopic treatment group reported significant more worry for cancer recurrence (WOCS) compared to the early surgical group. Their scores on the WOCS were comparable with the scores of the advanced surgical group. Endoscopic treatment of early esophageal cancer has less negative impact on QOL and esophageal cancer symptoms than surgery. However, endoscopically treated patients worry as much about cancer recurrence as patients treated surgically for advanced cancer.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Wilda D
authors.initials: WD
authors.lastname: Rosmolen
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Pouw
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
mesh_terms: D000230:Adenocarcinoma / Q000523:psychology / Q000601:surgery; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000523:psychology* / Q000601:surgery; D055088:Early Detection of Cancer / Q000523:psychology; D004938:Esophageal Neoplasms / Q000209:etiology / Q000523:psychology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000523:psychology; D004945:Esophagoscopy / Q000379:methods / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011159:Population Surveillance / Q000379:methods; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: BE: Barrett's Esophagus; FORS: fear of recurrence scale; HADS: hospital anxiety and depression scale; HGIN: high grade intraepithelial neoplasia; LGIN:low grade intraepithelial neoplasia; QOL: quality of life; RFA: radiofrequency ablation; WOCS: worry of cancer scale