Anxiety and Cancerophobia in Patients With Small Gastrointestinal Subepithelial Lesions and Tumours: Baseline Results of a Prospective Study (QUALI-BANDING-SET)

Abstract

Introduction: Small subepithelial gastrointestinal lesions (SEL), often defined as submucosal tumours, or subepithelial tumours (SET) confirmed once characterized by endoscopic ultrasound (EUS), could generate anxiety and fear of cancer. Aims & Methods: The main aim was to assess the anxiety burden and cancerophobia in patients with a small-sized SEL diagnosis or SET in periodic EUS surveillance. Secondary aims: to evaluate possible factors or patients characteristics influencing on anxiety or fear of cancer degree. Methods: Observational prospective study. Consecutive inclusion of all patients with a small-sized SEL diagnosis (requiring an EUS performance), or patients with a previously catalogued SET under echoendoscopy surveillance. Evaluation of the anxiety-distress degree and fear of cancer using two specific designed and validated instruments-questionnaires: Hospital Anxiety and Depression Scale (HADS), anxiety and depression subscales [0-7 points normal;8-10 borderline;11-21 pathologic], and global-distress scale [0-10 points normal;11-17 borderline;18-42 pathologic];and Cancer Worry Scale (CWS) [6-10 points low;11-15 moderate;16-20 high;21- 24 very high]. ClinicalTrials.gov register: NCT04316000. Due to SARS-CoV2 (Covid-19) pandemia and its implications for outcomes bias, the study was prematurely suspended. Results: Two participating centres, 40 patients (inclusion period: September 2019-February 2020). Mean HADS-anxiety: 7.2 (+/- 4.3) [= borderline anxiety];HADS-distress: 11.4 (+/- 7.7) [= borderline distress];CWS: 11.0 (+/- 4.1) [= moderate concern]. Belief on probability of having GI cancer now: 20.7% (+/- 23.6);belief on probability of getting GI cancer in 10 years: 28.6% (+/- 24.3). Impact on quality of life: Yes 40% (16/40). Female sex (n- 26) vs. male (n-14) subanalysis: HADS-anxiety 8.0 vs. 5.9;HADS-distress 12.7 vs. 9.0;CWS 11.5 vs. 9.9. Family history of cancer YES (n-29) vs. NO (n- 11) subanalysis: HADS-anxiety 8.1 vs. 5.0;HADS-distress 12.7 vs. 8.0;CWS 11.7 vs. 9.1. Conclusion: Patients with SEL diagnosis or SET under EUS surveillance present a moderate anxiety-distress degree and a moderate concern about having cancer, partially affecting their quality of life. Family history of cancer and female gender are factors that can increase anxiety and cancerophobia degree. Modifying the submucosal tumour term use for subepithelial lesion in conventional endoscopy reports, and suggesting the SETs removal in case of significant anxiety-cancerophobia, could be measures to be adopted, providing a transversal approach to patients' health.