Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
Gastrointest Endosc. 2019 Mar;89(3):533-544. doi: 10.1016/j.gie.2018.09.026. Epub 2018 Sep 28.
To optimize therapeutic decision-making in early invasive colorectal cancer (T1 CRC) patients, it is important to elicit the patient's perspective next to considering medical outcome. Because empirical data on patient-reported impact of different treatment options are lacking, we evaluated patients' quality of life, perceived time to recovery, and fear of cancer recurrence after endoscopic or surgical treatment for T1 CRC.
In this cross-sectional study, we selected patients with histologically confirmed T1 CRC who participated in the Dutch Bowel Cancer Screening Programme and received endoscopic or surgical treatment between January 2014 and July 2017. Quality of life was measured using the European Organization for Research and Treatment 30-item Core Quality of Life Questionnaire and the 5-level EuroQoL 5-dimension questionnaire. We used the Cancer Worry Scale (CWS) to evaluate patients' fear of cancer recurrence. A question on perceived time to recovery after treatment was also included in the set of questionnaires sent to patients.
Of all 119 eligible patients, 92.4% responded to the questionnaire (endoscopy group, 55/62; surgery group, 55/57). Compared with the surgery group, perceived time to recovery was on average 3 months shorter in endoscopically treated patients after adjustment for confounders (19.9 days vs 111.3 days; P = .001). The 2 treatment groups were comparable with regard to global quality of life, functioning domains, and symptom severity scores. Moreover, patients in the endoscopy group did not report more fear of cancer recurrence than those in the surgery group (CWS score, 0-40; endoscopy 7.6 vs surgery 9.7; P = .140).
From the patient's perspective, endoscopic treatment provides a quicker recovery than surgery, without provoking more fear of cancer recurrence or any deterioration in quality of life. These results contribute to the shared therapeutic decision-making process of clinicians and T1 CRC patients.
为了优化早期浸润性结直肠癌（T1 CRC）患者的治疗决策，除了考虑医疗结果外，了解患者的观点非常重要。由于缺乏关于不同治疗选择对患者报告影响的经验数据，我们评估了 T1 CRC 患者接受内镜或手术治疗后生活质量、恢复时间感知和对癌症复发的恐惧。
在这项横断面研究中，我们选择了 2014 年 1 月至 2017 年 7 月期间在荷兰结直肠癌筛查计划中接受组织学证实的 T1 CRC 并接受内镜或手术治疗的患者。使用欧洲癌症研究与治疗组织 30 项核心生活质量问卷和欧洲五维健康量表 5 级问卷评估生活质量。我们使用癌症担忧量表（CWS）评估患者对癌症复发的恐惧。在发送给患者的问卷中还包括一个关于治疗后恢复时间感知的问题。
在所有 119 名符合条件的患者中，92.4%（内镜组 55/62；手术组 55/57）回答了问卷。调整混杂因素后，与手术组相比，内镜治疗患者的恢复时间平均缩短 3 个月（19.9 天 vs 111.3 天；P =.001）。两组在总体生活质量、功能领域和症状严重程度评分方面无差异。此外，内镜组患者的癌症复发恐惧程度并不比手术组高（CWS 评分，0-40；内镜组 7.6 分 vs 手术组 9.7 分；P =.140）。
从患者的角度来看，内镜治疗比手术恢复更快，不会引起更多的癌症复发恐惧或生活质量恶化。这些结果有助于临床医生和 T1 CRC 患者共同进行治疗决策。
