Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer

Abstract

Background: The quality of life (QOL) of patients who survive early gastric cancer (EGC) is an area of increasing interest.

Objective: To compare the QOL and degree of worry of cancer recurrence in EGC patients who underwent endoscopic submucosal dissection (ESD) or surgery.

Design: Cross-sectional study.

Settings: A tertiary referral center.

Patients: A total of 565 patients with EGC who received ESD or surgery.

Intervention: Questionnaires.

Main outcome measurements: QOL was evaluated using the Short-form Health Survey and the European Organization for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and EORTC-QLQ-STO22). Mood disorders and the worry of cancer recurrence were estimated using the Hospital Anxiety and Depression Scale (HADS) and Worry of Cancer Scale, respectively.

Results: Questionnaires were completed by 55.7% of the ESD (137/246) and 58.9% of the surgery (188/319) patients. The surgery group had more QOL-related symptomatic and functional problems, including fatigue (P=.044), nausea/vomiting (P=.032), appetite loss (P=.023), diarrhea (P<.001), pain (P=.013), reflux symptoms (P=.005), eating restrictions (P<.001), anxiety (P=.015), taste impairment (P=.011), and poor body image (P<.001). The ESD group had significantly higher worry of cancer recurrence scores after adjusting for covariates, especially when visiting their physicians. The HADS results did not differ between the groups.

Limitations: Cross-sectional design.

Conclusions: Endoscopic treatment for EGC provides a better QOL, but stomach preservation might provoke cancer recurrence worries. Endoscopists should address this issue for relieving a patient's concern of cancer recurrence during follow-up period after ESD. (

Clinical trial registration number: WHO ICTRP KCT0000791.).