‘High burden’ of cancer worry in patients with BE, regardless of risk for progression
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Key takeaways:
- Patients with Barrett’s esophagus had high levels of cancer worry, despite treatment or risk for progression.
- Findings highlight the need to improve education and health-related quality of life for patients.
Patients with all stages of Barrett’s esophagus had similar cancer worry, highlighting the need for improved health-related quality of life through education, reassurance and follow-up care, according to data in BMJ Open Gastroenterology.
“Health-related quality of life (HRQOL) has become a key domain in assessment of burden of disease,” Elizabeth Ratcliffe, of Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, and colleagues wrote. “Qualitative and quantitative data show Barrett’s esophagus patients have a burden of anxiety about their risk of cancer, about the symptoms they experience and around their endoscopic surveillance tests.”
They added, “Patients report their education around this condition has varied in its quality, with many patients feeling their disease-specific knowledge is lacking. The situation is compounded by misleading or alarming information on the internet or from other sources.”
In a multicenter cohort study, Ratcliffe and colleagues compared HRQOL among patients with dysplastic BE before and after endoscopic therapy (ET) by administering questionnaires, comprised of the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Score (HADS), Cancer Worry Scale (CWS) and Short Form-36 (SF-36).
Researchers also compared the pre-ET BE group with other cohorts with non-dysplastic BE (NDBE, n = 379), colonic polyps (n = 152) and gastroesophageal reflux disease (n = 132), as well as health volunteers (n = 48).
According to results, 69 patients returned questionnaires before ET and 42 of those completed questionnaires after ET. Researchers reported “no significant difference” in total CWS among patients in the pre-ET (median, 13) vs. post-ET (median, 13.5) groups, although there was significant CWS among 66.7% of patients before treatment and 75% after. Nearly 80% of patients underestimated their risk for esophageal adenocarcinoma before ET compared with 57.9% after ET.
Results also showed no significant difference between pre- and post-treatment scores for GSRS (median, 4 vs. 5), SF-36 (53.8 vs. 51.5) and HADS (7 vs. 8.5).
When researchers compared pre-treatment dysplastic BE with other groups, CWS was lower among those with colonic polyps (–1.29; 95% CI, –2.53 to –0.05), GERD (–3.3; 95% CI, –4.61 to –1.98) and healthy volunteers (–4.26; 95% CI, –6 to –2.52). Results also showed GSRS scores were higher among patients in the GERD group (1.88; 95% CI, 0.22-3.54) and lower in healthy volunteers (–5.93; 95% CI, –8.14 to –3.72).
Only healthy volunteers had “significantly higher” SF-36 scores (OR = 5.76; 95% CI, 2.04-16.24) and “significantly lower” HADS scores (–5.04; 95% CI, –7.53 to –2.55) compared with the pre-treatment dysplastic BE group, researchers wrote.
“To the authors knowledge, this is the largest U.K. multi-cohort, multicenter study of [dysplastic BE] patients comparing to other disease states and the first to explore the pre-post [dysplastic BE] experience prospectively,” Ratcliffe and colleagues concluded. “Our study shows high burdens of cancer worry across all stages of BE and a need for improved education, reassurance and follow-up care for these patients.”
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