OGC P36 Unmet needs in survivorship: Increased anxiety post oesophago-gastric cancer surgery
Authors: Cuffe Raymond , Kwon Hyerim , Anbalakan Ponmalar , Noor Zainab 
Published: December 2022

Abstract

Background
Oesophago-Gastric (OG) cancer is an aggressive malignant disease, and patients are offered extensive surgical treatment often in combination with neoadjuvant and adjuvant oncological intervention. The treatment process is emotionally demanding and affects treatment outcomes (Fangand, & Schnoll, 2002). However, the available research is concentrated on generalised anxiety and depression (Hellstadius et al, 2017), despite the unique concerns of this cohort. This study examines the trajectory of patients’ unique OG symptoms related anxiety through utilising a specialist measure.

Methods
The Oesophageal Anxiety and Hypervigilence Scale (EHAS) is a newly validated self-report questionnaire that detects oesophageal anxiety in patience with GI disorders. It has been shown to demonstrate good internal consistency and validity (Taft et al, 2018).
Patients with oesophageal cancer were recruited from at Guy's and St Thomas’ Hospital, London. As part of their routine clinic appointments between September 2021-February 2022, patients completed the EHAS measure across four key time points within their treatment trajectory; diagnosis (Time 1), pre-operatively (Time 2), two weeks post operatively (Time 3), and 6–12 months post operatively, often termed ‘survivorship’ (Time 4).

Results
A total of 106 EHAS measures were completed by 83 patients (79% male, 20% female, mean age = 64) at different stages within their treatment trajectory, representing a between-subjects design. 61% of patients underwent oesophagectomy, 22% total gastrectomy, 10% subtotal gastrectomy and 7% underwent other surgeries including sigmoid colectomy, and jejunal resection.
Pooling the sample z-score, the cut off score for clinical significance was calculated at 33. The EHAS outcomes revealed high anxiety at Time 1 (T1 mean = 28/33) which decreased by 32% from to Time 2 (T2 mean = 19/33). Anxiety remained low in the period between Time 2 to Time 3 (T3 mean = 21/33). Surprisingly, anxiety scores increased by 42% from Time 3 to Time 4 (T4 mean = 29/33), matching the elevated levels observed at Time 1.
Other important findings related to the proportion of patients that scored above clinical cut off. Whilst 12% of patients scored above cut off at Time 1, this rose to 32% at Time 4, indicating marked anxiety during the phase of recovery greater than that experienced at diagnosis. At this level of analysis there is no evidence to indicate a relationship between type of surgery and elevated anxiety.

Conclusions
With the use of a specialist anxiety measure, we demonstrate that oesophageal anxiety is common among OG cancer patient cohort. The trajectory of anxiety observed in this study has clinical implications for the timing of support and enhanced recovery programme; this study revealed that OG anxiety fluctuated across the treatment pathway, and peaked at two distinct time points; diagnosis and survivorship. This challenges the often held assumption that patients anxiety increases pre-operatively (Hellstadius et al, 2017), and instead refocuses the need for input at both the diagnosis and survivorship periods. The high anxiety observed at the survivorship stage may also affect patients’ ability to process and adhere to treatment advice, further exacerbating their symptoms and jeopardising their physical recovery. Patients are monitored less during their survivorship period as the intensity of treatment cease, however the results indicate need for continued input.