Elevated cancer risk perceptions among patients with Barrett's esophagus: do psychological factors play a role?

Anxiety and depression in patients with Barrett's esophagus: estimates of disorder rates and associations with symptom load and treatment-seeking

BACKGROUND

Patients with Barrett's esophagus (BE) may experience psychological burden from living with a chronic medical condition, which has been identified as the most important risk factor for esophageal adenocarcinoma. The aim of this study was to estimate rates of depression and anxiety in a large sample of patients with BE.

METHODS

A total of 794 patients with endoscopically and histologically confirmed diagnosis of BE completed validated screening instruments for depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). Screening rates in the study sample were compared to general population estimates. Multivariable regression analyses were used to model associations between outcome variables and respondents' sociodemographic characteristics, BE-related symptom load and incidence of inpatient treatment due to BE in the last 12 months.

RESULTS

Rates of positive screens were 14.2% for depression and 9.9% for anxiety. For several age by sex subgroups, rates of depression and anxiety were about three to five times higher in the study sample than in the general population. BE-related reflux and pain symptoms showed strong associations with higher levels of depressive and anxiety symptoms, while the effect of treatment was small.

CONCLUSION

Study results indicate that a relevant proportion of patients with BE is at an increased risk for depression and anxiety, compared to general population controls. Lacking information on patients' disease characteristics limited generalizability of results.

Psychosocial risk factors associated with esophageal cancer in Chinese cohort: A systematic review and meta-analysis

ABSTRACT

Previous studies were controversial about the role of psychosocial factors in the pathogenesis of esophageal cancer (EC). This study aimed to systematically evaluate the effect size of psychosocial risk factors for EC in Chinese cohort.A literature search was conducted in both English and Chinese databases, and odds ratios (OR) with the corresponding 95% confidence intervals (CI) were pooled using a random-effects model.28 studies were identified with a total of 6951 EC cases and 7469 controls. The meta-analysis indicated a higher risk of EC among the individuals with psychological trauma (OR: 2.36, 95% CI: 1.71-3.26), Type A behavior (OR: 1.40, 95% CI: 1.17-1.67), depression (OR: 4.00, 95% CI: 2.44-6.55), melancholy (OR: 2.06, 95% CI: 1.32-3.20), always in sulks (OR: 2.49, 95% CI: 1.21-5.12), and irritable personality (OR: 2.13, 95% CI: 1.58-2.89). A lower EC risk was found in the individuals with good interpersonal relationship (OR: 0.35, 95% CI: 0.17-0.70) and outgoing personality (OR: 0.39, 95% CI: 0.19-0.78).This meta-analysis suggested a potential association between psychosocial factors and EC risk. For the individuals with psychosocial risk factors, physicians should pay more attention to EC screening.

Precision care for Barrett's esophagus

Modern recognition and management of Barrett's esophagus, a precursor to esophageal adenocarcinoma depends on diagnostic accuracy, risk assessment, technical expertise and consideration of many options to best tailor therapy for every patient. Concomitant management of acid reflux is essential, frequently with proton pump inhibitors. Ablation and resection favorably affect the evolution towards cancer. Using precision medicine tools, such as imaging, molecular diagnostics and analytics may lead to cost- and comparatively-effective therapies ultimately aiming at cancer prevention. Knowledge of the risk factors for Barrett's esophagus and progression to dysplasia and cancer can help tailor a precision medicine approach with more aggressive screening and surveillance targeted at patients that are most likely to benefit.