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

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.)