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Endoscopy 2010; 42(7): 525-531
DOI: 10.1055/s-0029-1244222
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett’s esophagus

W.  D.  Rosmolen1 , K.  R.  Boer2 , R.  J.  R.  de Leeuw3 , C.  J.  Gamel3 , M.  I.  van Berge Henegouwen4 , J.  J.  G.  H.  M.  Bergman1 , M.  A.  G.  Sprangers5
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 2Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
  • 3Department of Health Sciences, University Medical Center, Utrecht, The Netherlands
  • 4Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  • 5Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
Further Information

Publication History

submitted 7 December 2009

accepted after revision 15 April 2010

Publication Date:
10 June 2010 (online)

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Background and study aims: 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.

Patients and 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.

Conclusion: 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.

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J. J. G. H. M. BergmanMD, PHD 

Department of Gastroenterology
Academic Medical Center

The Netherlands

Fax: +31-20-5669156

Email: j.j.bergman@amc.uva.nl