Comparison Of Anxiety And Depression Scores Between 2-Week Wait And Barrett'S Surveillance Endoscopy Referrals

IntroductionBSG guidelines recommend endoscopic surveillance for patients with Barrett’s oesophagus (BE), due to the 0.5% annual risk of developing oesophageal adenocarcinoma.1 Approximately 10% of GP 2-week wait (2WW) referrals result in a cancer diagnosis, and patients on a 2WW pathway should be told of a theoretical risk of cancer.2 We therefore performed a case-control study, comparing outpatients referred to endoscopy for BE surveillance (BES) and GP 2WW referrals, to ascertain the effect of possible cancer on patients’ anxiety and depression under 2 different scenarios.MethodsPatients were recruited as part of the Saliva to Predict Disease Risk (SPIT) study. This is a multicentre study to improve non-invasive prediction of the risk of BE and oesophageal cancer. Ethical approval was gained from the Coventry and Warwickshire Regional Ethics Committee (17/WM/0079). Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS) questionnaire; this was completed at recruitment in the endoscopy department.3 This is a validated tool consisting of 14 questions, scored from 0 to 3, with 7 questions assigned to each domain. Ordinal logistic regression analysis was performed using R software v3.6.1 to account for the effect of age and gender on HADS.Results940 patients, split between 363 BES referrals and 577 2WW referrals were included in the final analysis. Median age was 69 for BES and 66 for NBS (p=0.002). 54% of patients were female in the 2WW group compared to 24% in the BES group (p<0.001). Accounting for both age and gender, mean HADS anxiety score was 4.76 for BES and 6.61 for 2WW (p<0.001, OR=1.76; 95%CI: 1.38–2.24). Mean HADS depression score was 3.57 for BES and 4.60 for 2WW (p<0.001, OR=1.51; 95%CI: 1.19–1.92). Interestingly, reduced age and female gender was associated with higher anxiety scores (p<0.001 for both), but not depression (p=ns).ConclusionsThese results suggest that 2WW patients undergoing endoscopy have higher baseline anxiety and depression than BES patients. Most patients on a BES list would have had at least one previous endoscopy, and may have developed expectations and adaptive mechanisms to their procedure. A previous study found a reduction in depression but not anxiety scores in patients with BE and non-specific symptoms undergoing OGD.4 Our study partially concurs with this; it may be that 2WW patients have an additional element of anxiety compared to a cohort with non-specific symptoms, which will need further clarification.ReferencesFitzgerald, R. et al. Gut63, 7–42 ( 2014). Cummings, R. et al. BJGP60, 689–690 ( 2010). Zigmond, A. et al. Acta Psychiatr. Scand. 67, 361–370 ( 1983). Essink-Bot, M. et al. Qual. Life Res. 16, 1309–1318 ( 2007).