RSS-Feed abonnieren
DOI: 10.1055/s-0029-1244222
© 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
Publikationsverlauf
submitted 7 December 2009
accepted after revision 15 April 2010
Publikationsdatum:
10. Juni 2010 (online)
![](https://www.thieme-connect.de/media/endoscopy/201007/lookinside/thumbnails/10.1055-s-0029-1244222-1.jpg)
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.
References
- 1 Drewitz D J, Sampliner R E, Garewal H S. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years. Am J Gastroenterol. 1997; 92 212-215
- 2 Hameeteman W, Tytgat G N, Houthoff H J, van den Tweel J G. Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology. 1989; 96 1249-1256
- 3 Shaheen N J, Crosby M A, Bozymski E M, Sandler R S. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus?. Gastroenterology. 2000; 119 333-338
- 4 Chan W H, Wong W K, Chan H S, Soo K C. Results of surgical resection of oesophageal carcinoma in Singapore. Ann Acad Med Singapore. 2000; 29 57-61
- 5 Gillison E W, Powell J, McConkey C C, Spychal R T. Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia. Br J Surg. 2002; 89 344-348
- 6 Daly J M, Fry W A, Little A G. et al . Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg. 2000; 190 562-572
- 7 Menke-Pluymers M B, Hop W C, Dees J. et al . Risk factors for the development of an adenocarcinoma in columnar-lined (Barrett) esophagus. The Rotterdam Esophageal Tumor Study Group. Cancer. 1993; 72 1155-1158
- 8 Edwards M J, Gable D R, Lentsch A B, Richardson J D. The rationale for esophagectomy as the optimal therapy for Barrett’s esophagus with high-grade dysplasia. Ann Surg. 1996; 223 585-589
- 9 Gockel I, Exner C, Junginger T. Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol. 2005; 3 37
- 10 Blazeby J M, Farndon J R, Donovan J, Alderson D. A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer. 2000; 88 1781-1787
- 11 Brooks J A, Kesler K A, Johnson C S. et al . Prospective analysis of quality of life after surgical resection for esophageal cancer: preliminary results. J Surg Oncol. 2002; 81 185-194
- 12 de Boer A G, van Lanschot J J, van Sandick J W. et al . Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol. 2004; 22 4202-4208
- 13 Hallas C N, Patel N, Oo A, Jackson M. et al . Five-year survival following oesophageal cancer resection: psychosocial functioning and quality of life. Psychol Health Med. 2001; 6 85-94
- 14 van Knippenberg F C, Out J J, Tilanus H W. et al . Quality of life in patients with resected oesophageal cancer. Soc Sci Med. 1992; 35 139-145
- 15 Lagergren P, Avery K N, Hughes R. et al . Health-related quality of life among patients cured by surgery for esophageal cancer. Cancer. 2007; 110 686-693
- 16 Headrick J R, Nichols 3rd F C, Miller D L. et al . High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thorac Surg. 2002; 73 1697-1702
- 17 De Meester S R. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol. 2006; 13 12-30
- 18 Kirby J D. Quality of life after oesophagectomy: the patients’ perspective. Dis Esophagus. 1999; 12 168-171
- 19 Peters F P, Kara M A, Rosmolen W D. et al . Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus. Gastrointest Endosc. 2005; 61 506-514
- 20 Buttar N S, Wang K K, Lutzke L S. et al . Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus. Gastrointest Endosc. 2001; 54 682-688
- 21 May A, Gossner L, Pech O. et al . Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol. 2002; 14 1085-1091
- 22 Pacifico R J, Wang K K, Wongkeesong L M. et al . Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2003; 1 252-257
- 23 Peters F P, Kara M A, Rosmolen W D. et al . Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol. 2006; 101 1449-1457
- 24 Peters F P, Kara M A, Curvers W L. et al . Multiband mucosectomy for endoscopic resection of Barrett’s esophagus: feasibility study with matched historical controls. Eur J Gastroenterol Hepatol. 2007; 19 311-315
- 25 Conio M, Sorbi D, Batts K P, Gostout C J. Endoscopic circumferential esophageal mucosectomy in a porcine model: an assessment of technical feasibility, safety, and outcome. Endoscopy. 2001; 33 791-794
- 26 Kamler J P, Borsatto R, Binmoeller K F. Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment. Gastrointest Endosc. 2002; 55 923-928
- 27 Bergman J J. Endoscopic treatment of high-grade intraepithelial neoplasia and early cancer in Barrett oesophagus. Best Pract Res Clin Gastroenterol. 2005; 19 889-907
- 28 Dulai G S, Jensen D M, Cortina G. et al . Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett’s esophagus. Gastrointest Endosc. 2005; 61 232-240
- 29 Ackroyd R, Brown N J, Davis M F. et al . Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomised, placebo controlled trial. Gut. 2000; 47 612-617
- 30 Ackroyd R, Tam W, Schoeman M. et al . Prospective randomized controlled trial of argon plasma coagulation ablation vs. endoscopic surveillance of patients with Barrett’s esophagus after antireflux surgery. Gastrointest Endosc. 2004; 59 1-7
- 31 Bergman J J, Fockens P. Ablating Barrett’s metaplastic epithelium: are the techniques ready for clinical use?. Gut. 2006; 55 1222-1223
- 32 Gondrie J J, Pouw R E, Sondermeijer C M. et al . Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients. Endoscopy. 2008; 40 359-369
- 33 Sharma V K, Wang K K, Overholt B F. et al . Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc. 2007; 65 185-195
- 34 Conio M, Cameron A J, Chak A. et al . Endoscopic treatment of high-grade dysplasia and early cancer in Barrett’s oesophagus. Lancet Oncol. 2005; 6 311-321
- 35 McHorney C A, Ware Jr. J E, Raczek A E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993; 31 247-263
- 36 Ware Jr. J E, Gandek B, Kosinski M. et al . The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998; 51 1167-1170
- 37 Aaronson N K, Ahmedzai S, Bergman B. et al . The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993; 85 365-376
- 38 Osoba D, Aaronson N, Zee B. et al . Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. The Study Group on Quality of Life of the EORTC and the Symptom Control and Quality of Life Committees of the NCI of Canada Clinical Trials Group. Qual Life Res. 1997; 6 103-108
- 39 Blazeby J M, Alderson D, Winstone K. et al . Development of an EORTC questionnaire module to be used in quality of life assessment for patients with oesophageal cancer. The EORTC Quality of Life Study Group. Eur J Cancer. 1996; 32A 1912-1917
- 40 Mellon S, Northouse L ULL. Family survivorship and quality of life following a cancer diagnosis. Res Nurs Health. 2001; 24 446-459
- 41 Northouse L L. Mastectomy patients and the fear of cancer recurrence. Cancer Nurs. 1981; 4 213-220
- 42 Herrmann C. International experiences with the Hospital Anxiety and Depression Scale – a review of validation data and clinical results. J Psychosom Res. 1997; 42 17-41
- 43 Zigmond A S, Snaith R P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67 361-370
- 44 Gottlieb S S, Khatta M, Friedmann E. et al . The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. 2004; 43 1542-1549
- 45 Wan G J, Counte M A, Cella D F. et al . An analysis of the impact of demographic, clinical, and social factors on health-related quality of life. Value Health. 1999; 2 308-318
- 46 Peters F P, Kara M A, Rosmolen W D. et al . Endoscopic treatment of high-grade dysplasia and early cancer in Barrett esophagus. Gastrointest Endosc. 2005; 61 506-514
- 47 Gondrie J J, Pouw R E, Sondermeijer C M. et al . Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system. Endoscopy. 2008; 40 370-379
- 48 Pouw R E, Gondrie J J, Sondermeijer C M. et al . Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection. J Gastrointest Surg. 2008; 12 1627-1636
- 49 Ell C, May A, Pech O. et al . Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007; 65 3-10
- 50 Peters F, Kara M, Rosmolen W. et al . Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in Barrett esophagus after endoscopic resection. Endoscopy. 2005; 37 418-424
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