Patients’ perception of diagnostic tests in the preoperative assessment of esophageal cancer

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Authors: Marinke Westerterp, Henderik L van Westreenen, Marije Deutekom, Jaap Stoker, Paul Fockens, et al

Published Date April 2008 Volume 2008:2 Pages 157 - 162

DOI: http://dx.doi.org/10.2147/PPA.S

Marinke Westerterp^1,8, Henderik L van Westreenen², Marije Deutekom³, Jaap Stoker⁴, Paul Fockens⁵, Emile FI Comans⁶, John TM Plukker², Patrick MM Bossuyt⁷, J Jan B van Lanschot¹, Gerrit W Sloof⁸

¹Departments of Surgery, ³Social Medicine, ⁴Radiology, ⁵Gastroenterology, ⁷Clinical Epidemiology and Biostatistics, and ⁸Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands; ²Department of Surgery, Groningen University Medical Center, Groningen, The Netherlands; ⁶Department of Nuclear Medicine and PET research, VU University Medical Center, Amsterdam, The Netherlands

Objective: Defining an optimal staging strategy requires an evaluation of the effectiveness and costs of diagnostic tests and may include the burden of these tests for patients. This study evaluated the burden of cervical ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT) and positron emission tomography (PET) in patients with esophageal carcinoma (EC).

Methods: Consenting consecutive patients underwent a standard preoperative work-up. Burden of testing was evaluated with a self-report questionnaire addressing anxiety, embarrassment, and discomfort, each measured on a 1(none) to 5 (extreme) point-scale. An overall burden score was calculated by summing the three item scores. In addition, patients were asked to rank the four tests from least to most inconvenient. Statistical analysis was performed with nonparametric tests.

Results: 82 patients (67 male, 15 female; mean age 64.3 yrs) participated. For most tests and most dimensions of burden, the large majority of subjects was in categories 1 and 2. With respect to anxiety, the rank order (from highest burden to lowest burden) was EUS, US, PET, and CT (average scores 1.7, 1.5, 1.4, and 1.2, respectively). For embarrassment, the rank order was EUS, PET, US, and CT (1.9, 1.5, 1.4, and 1.3 respectively). For discomfort, the rank order was EUS, PET, US and CT (2.0, 1.6, 1.4, and 1.2, respectively). And for total burden, the rank order was EUS, PET, US and CT (5.6, 4.6, 4.2, and 3.7). PET was ranked as least inconvenient by 35% of patients and as most inconvenient by 16% compared with the other tests.

Conclusion: Significant but small differences were observed in patient burden for imaging tests to evaluate EC. The perceived burden of PET was lower than that of EUS, but higher than the burden of CT. However absolute values were low for all tests and therefore patient burden will not be a key feature for the construction of an optimal staging algorithm for EC.

Keywords: esophageal carcinoma, perceived burden, cervical ultrasonography, endoscopic ultrasonograhy, computed tomography, positron emission tomography