Patient Preferences in Screening for Recurrent Disease after Potentially Curative Esophagectomy

Abstract

Background: Routine imaging (RI) as part of follow-up after potentially curative esophagectomy is currently not widely accepted. If detected recurrent disease could be adequately treated, it remains unclear whether patients would want to take part in a screening program. The aim of this study was to determine the extent to which patients who underwent esophagectomy prefer follow-up with or without RI. Methods: Patients who underwent esophagectomy for carcinoma without evidence of recurrent disease were included. An interview-administered questionnaire was used to assess fear of recurrence and elicit patient preferences for the frequency and duration of follow-up and hypothetical changes of survival chances (1–10%). Results: 45/54 eligible patients (83%) participated in this study. The majority of patients preferred follow-up with RI (67%) even if screening would not provide a survival benefit; this proportion increased up to 93% if the proposed chances of survival improved. Younger patients and patients with a lower histopathological tumor stage were more likely to desire follow-up with RI. Conclusion: Most patients who underwent esophagectomy preferred RI as part of follow-up over outpatient clinic visits only, even if such screening would not provide a survival benefit. Further research is needed to determine the most accurate screening modality and most efficient follow-up interval.

A qualitative study of patient and clinician attitudes regarding surveillance after a resection of pancreatic and periampullary cancer

“…Patients express an intense desire for reassurance and derive this from their follow‐up, despite additional anxiety related to the investigations. This is consistent with the literature from other cancer sites . The clinicians interviewed in our study recognized this need for reassurance in their patients and provide intensive follow‐up in response; however, they do acknowledge the limited evidence to support the benefits of surveillance in this patient population and the potential harms of surveillance.…”

“…This is consistent with the literature from other cancer sites. [29][30][31][32][33][34][35] The clinicians interviewed in our study recognized this need for reassurance in their patients and provide intensive follow-up in response; however, they do acknowledge the limited evidence to support the benefits of surveillance in this patient population and the potential harms of surveillance. The clinicians also suggest follow-up has secondary benefits including maintaining the doctor-patient relationship.…”

Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer

“…Computed tomography surveillance at least once a year was performed in many studies and patients were also expected to choose to receive surveillance in many instances . Diagnostic imaging using CT at least once a year should therefore be recommended.…”

Annual computed tomography scans do not improve outcomes following esophagectomy for cancer: a 10-year UK experience

“…A recent survey of patients' preferences for follow‐up found that two‐thirds wanted some form of routine imaging after esophagectomy, regardless of whether it had any benefit . Clinical opinion seems to polarize to an intensive approach with a small potential survival benefit, with attendant risks, costs, and psychological impact, or a more pragmatic, solely clinical follow‐up .…”

“…11,24 A recent survey of patients' preferences for followup found that two-thirds wanted some form of routine imaging after esophagectomy, regardless of whether it had any benefit. 25 Clinical opinion seems to polarize to an intensive approach with a small potential survival benefit, with attendant risks, costs, and psychological impact, or a more pragmatic, solely clinical followup. 10,11,13,24 The best strategy probably involves customized programs based on the treatment offered for recurrence and other network-specific resources, as well as the views of the informed patient.…”