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
