Background and Aims

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.

Methods

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.

Results

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).

Conclusions

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.

中文翻译：

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内镜或手术切除的T1大肠癌患者的生活质量和对癌症复发的恐惧

背景和目标

为了优化早期浸润性大肠癌（T1 CRC）患者的治疗决策，重要的是在考虑医学结局的基础上征求患者的观点。由于缺乏有关患者报告的不同治疗方案影响的经验数据，因此我们评估了患者的生活质量，知觉的恢复时间以及对内镜或手术治疗T1 CRC后癌症复发的恐惧。

方法

在这项横断面研究中，我们选择了经过组织学确认的T1 CRC的患者，这些患者参加了2014年1月至2017年7月的荷兰肠癌筛查计划，并接受了内窥镜或手术治疗。生活质量的测定采用了欧洲研究与治疗组织30项核心生活质量调查表和5级EuroQoL 5维问卷。我们使用癌症忧虑量表（CWS）评估患者对癌症复发的恐惧。发送给患者的问卷中还包括一个关于治疗后恢复时间的问题。

结果

在所有119名合格患者中，有92.4％回答了问卷（内镜组55/62；手术组55/57）。与手术组相比，经校正混杂因素后，经内镜治疗的患者的恢复时间平均缩短了3个月（19.9天vs 111.3天；P  = .001）。在总体生活质量，功能范围和症状严重程度评分方面，这两个治疗组具有可比性。此外，内窥镜检查组患者对癌症复发的恐惧没有外科手术组更高（CWS评分为0-40；内窥镜检查7.6 vs外科手术9.7；P  = .140）。

结论

从患者的角度来看，内窥镜治疗比手术提供更快的恢复速度，而不会引起对癌症复发或生活质量下降的更多恐惧。这些结果有助于临床医生和T1 CRC患者共同的治疗决策过程。