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Information Providing to Patients With Esophageal Cancer in a Tertiary Referral Center
Eleonora Pinto, Luca Maria Saadeh, MariaCristina Bellissimo, Rita Alfieri, Francesco Cavallin, Matteo Cagol, Carlo Castoro, Marco Scarpa*
Oncological Surgery Unit, Regional Centre for Oesophageal Disease, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
Background:
Esophageal cancer is an increasingly common cancer with a poor prognosis. At least one third of patients are advanced and not curable at diagnosis and thus they are proposed only a palliative treatment. Information about the disease and the prognosis is part of current management of oncological patients during the pre-operative period and tertiary referral center may also play a role in improving this delicate communication.
Aim and methods
The aim of this study was to analyze how patients perceive disease information provided by the primary and secondary care health workers according their possibility of cure. Eighty-eight consecutive patients who presented for the first time at the multidisciplinary evaluation in a tertiary care unit at the Veneto Institute of Oncology for esophageal cancer have been enrolled in this prospective study from September 2014 to November 2015. Patients answered to quality of life questionnaires before the visit while waiting. The Italian version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, OG25 and INFO25 were used and satisfaction with provided information was the primary endpoint. Data about patients’ characteristics, cancer site and stage and prognosis were retrieved. Non parametric statistics was performed.
Results:
In the whole study group, global quality of life and emotional function were directly correlated with satisfaction with provided information (tau=0.34, p=0.003 and tau=0.26, p=0.007, respectively). The multidisciplinary evaluation was the first contact with a tertiary referral center for 52 (59.1%) patients, while 36 (40.9%) had already experienced a contact with a tertiary referral center. Patients at their first contact with a tertiary referral center had clinically lower satisfaction with information received (mean±SD 53.3±28.8 vs. 66.7±27.2 in others, p=0.05) and clinically lower information about the disease (mean±SD 52.2±26.5 vs. 63.9±22.5 in others, p=0.03).
In our study group, 75 (85.2%) patients were judged potentially curable while 13 (14.8%) had distant metastasis at diagnosis. Patients in the potentially curable group were clinically more satisfied with information received (mean±SD 61.0±29.2 vs. 45.5±22.7 in distant metastasis group, p=0.08) but had similar information about the disease (mean±SD 57.8±26.3 vs. 51.6±20.0 in distant metastasis group, p=0.51).
Conclusions:
Patients at their first contact with a tertiary referral center are less satisfied by the information received so far. When health care workers provide better information, patient’s emotional function improves. Campaigns to improve communication among primary and secondary care health workers should be considered. Communication should specifically consider advanced esophageal cancer patient’s expectations about how to spend lifespan, in addition to amount of information.
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