Barrett Esophagus: Quality of life and factors associated with illness perception

Abstract

Background Health‐related Quality of life (HRQoL) in patients with Barrett's esophagus (BE), a premalignant condition, may be influenced by gastroesophageal reflux disease (GERD) symptoms and the risk of developing esophageal adenocarcinoma. Methods We aim to investigate HRQoL in non‐dysplastic Barrett Esophagus (NDBE) patients, identify factors associated with a negative illness perception of the diagnosis BE and compare outcomes between patients treated in a specialized BE center with non‐expert centers. In this multi‐center cross‐sectional study, HRQoL of NDBE patients were assessed using the Short Form 36, Hospital Anxiety and Depression Scale, Cancer worry Scale, and Reflux Disease Questionnaire. A multivariable, linear regression analysis was conducted to assess factors associated with illness perception (Illness perception scale) of the BE diagnosis. Outcome parameters of patients from expert centers were compared to non‐expert centers. Results A total of 859 NDBE patients (mean age 63.6% and 74.5% male), of which 640 from BE expert centers were included. BE patients scored similar or higher means (i.e. better) on generic HRQoL in comparison with a Dutch norm population. The multivariable regression model showed that cancer worry, GERD symptoms, signs of anxiety and depression, and female gender were associated with a negative illness perception of BE. GERD symptoms were reported in the minority (22.4%) of BE patients. Levels of anxiety symptoms were comparable to a Dutch norm population (mean 3.7 vs. 3.9 p 0.183) and lower for depression symptoms (mean 6.8 vs. 7.6 p < 0.001). Overall, there were no differences found on outcomes between expert centers and non‐expert centers. Conclusion NDBE patients scored similar or better on generic HRQoL, anxiety and depression than an age and gender matched norm population. The presence of cancer worry, gastrointestinal symptoms, anxiety and depression, and female gender are factors associated with a negative illness perception of the diagnosis BE.

Quality of life measures in dysplastic Barrett’s oesophagus are comparable to patients with non-dysplastic Barrett’s oesophagus and do not improve after endoscopic therapy

“…Other studies confirm this and have shown that anxiety and depression appear to be associated with greater cancer worry; likewise, a high symptom burden is seen in those with high cancer worry. 13 19 Despite their high CWS, a large proportion of the pretreatment and post-treatment groups underestimate their risk (79.7% pre and 57.9% post therapy); this may be reflective of patients finding the understanding of numerical estimates of risk difficult to interpret. 27 …”

“…There was an unfortunate loss of recruited subjects between pre and post groups, this was in part due to the clinical picture changing but there was a considerable issue with COVID-19 causing delays to treatment and some patients were still awaiting their ET at completion of the study. A similar cohort study halted their recruitment during the initial phase of the pandemic 13 ; however, as ET procedures were protected in the UK, we continued recruitment during this time. Nonetheless, fewer patients were seen face to face in clinic, front-line working was required of the clinical research staff and research nurses were redeployed.…”

“…Currently, there is no disease-specific Barrett’s PROM and studies so far have relied on using a combination of tools to cover different disease aspects. 13 20 21 This study may help to define key areas of need for BO patients, to support development of a Barrett’s-specific PROM.…”

“…Qualitative and quantitative data show BO patients have a burden of anxiety about their risk of cancer, about the symptoms they experience and around their endoscopic surveillance tests. 13–15 Patients report their education around this condition has varied in its quality with many patients feeling their disease-specific knowledge is lacking. 15 The situation is compounded by misleading or alarming information on the internet or from other sources.…”

Worry for cancer in association with gastro-esophageal reflux symptoms in patients endoscopically treated for Barrett’s neoplasia. A cross-sectional questionnaire study

“…BE is known is a result of longstanding GERD. Previous studies found the majority of the non-dysplastic BE cohort reported good re ux symptom control 9,11 . A previous study showed re ux symptoms as an important factor for negative illness perception on BE 11. To the best of our knowledge there are no data on GI symptoms related to cancer worry or cancer recurrence in patients during the period after receiving ET for BE dysplasia or early esophageal cancer.…”