Developing patient-orientated Barrett’s oesophagus services: the role of dedicated services

Abstract

IntroductionBarrett’s oesophagus (BO) is common and is a precursor to oesophageal adenocarcinoma with a 0.33% per annum risk of progression. Surveillance and follow-up services for BO have been shown to be lacking, with studies showing inadequate adherence to guidelines and patients reporting a need for greater disease-specific knowledge. This review explores the emerging role of dedicated services for patients with BO.MethodsA literature search of PubMed, MEDLINE, Embase, Emcare, HMIC, BNI, CiNAHL, AMED and PsycINFO in regard to dedicated BO care pathways was undertaken.ResultsProspective multicentre and randomised trials were lacking. Published cohort data are encouraging with improvements in guideline adherence with dedicated services, with one published study showing significant improvements in dysplasia detection rates. Accuracy of allocation to surveillance endoscopy has been shown to hold cost savings, and a study of a dedicated clinic showed increased discharges from unnecessary surveillance. Training modalities for BO surveillance and dysplasia detection exist, which could be used to educate a BO workforce. Qualitative and quantitative studies have shown patients report high levels of cancer worry and poor disease-specific knowledge, but few studies have explored follow-up care models despite being a patient and clinician priority for research.ConclusionsCost–benefit analysis for dedicated services, considering both financial and environmental impacts, and more robust clinical data must be obtained to support this model of care in the wider health service. Greater understanding is needed of the root causes for poor guideline adherence, and disease-specific models of care should be designed around clinical and patient-reported outcomes to address the unmet needs of patients with BO.

Disproportionate cancer worries in ultra‐short‐segment Barrett's esophagus in Japan

“…Multivariate regression analyses consistently revealed that accompanying GERD symptoms are significantly associated with the degree of cancer worry in subjects with a BE diagnosis, which is consistent with those of recent studies from Western countries, 20,21 indicating that good control of symptoms can help reduce cancer worry in this cohort. In addition, at which institutes the subjects received the diagnosis may have made some impact on cancer worry among subjects (see Table S4).…”

“…Therefore, in order to relieve cancer worry among subjects, it is important for medical teams at each institute to have good communication skills, particularly with regard to verbal reassurance about the diagnosis and the accompanying appropriate cancer risks when diagnosing patients with BE. 20 An appropriate understanding of the cancer risk with BE is important to give BE patients an appropriate incentive to undergo surveillance. [19][20][21] Previous studies demonstrated that having an appropriate perception of cancer risk does not necessarily lead to excessive cancer worry.…”

“…4,5 In Western countries, endoscopic surveillance targeting those with BE is widely recommended. 4 In addition, some studies have investigated the psychological burden of being diagnosed with BE, [12][13][14][17][18][19][20][21] and demonstrated that while an appropriate amount of cancer worry was associated with increased motivation to undergo surveillance, excessive cancer worry resulting from an insufficient understanding of the disease or inaccurate perceptions of cancer risk may apply an unnecessary psychological burden on BE subjects.…”

“…20 An appropriate understanding of the cancer risk with BE is important to give BE patients an appropriate incentive to undergo surveillance. [19][20][21] Previous studies demonstrated that having an appropriate perception of cancer risk does not necessarily lead to excessive cancer worry. 15 This is supported by the findings of the current study, in which the understanding of BE carcinogenesis was only marginally associated with CWS.…”

“…The cancer worry scale (CWS) was originally developed to quantitatively assess concerns about cancer recurrence and the impact of these concerns on daily functioning in patients who had undergone treatment for cancers, 16,17 and more recently, it has been applied to assess the fear of developing cancers in those with precancerous conditions, such as familial adenomatous polyposis or BE. [18][19][20][21][22] The scale comprises six-item questions, with each rated on a 4-point Likert scale ranging from 1 ("never") to 4 ("almost always"). 18,22 Possible scores range from 6 to 24, with higher scores indicating more worry (Figure S1).…”