AIM: To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway. METHODS: An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett's oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders. RESULTS: Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively). CONCLUSION: The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.
Bibliographical noteWe appreciate the contributions made by the study participants and their families. We would like to thank the clinicians who were contacted throughout the study period and their secretaries for administrative support. We acknowledge the contribution of Miss Siobhan Reynolds, Ms Majella Gallagher, Ms Carol Anderson and Mr. Martin McAnaespie and Dr. Damian McManus. Thanks to the Northern Ireland Cancer Registry and National Cancer Registry Ireland for their support and involvement in the research. The FINBAR study group members include Johnston BT, Watson RGP, McGuigan J, Ferguson HR (Belfast Health and Social Care Trust, Belfast, County Antrim, United Kingdom), Murphy SJ (Craigavon Hospital, Northern Ireland), JV Reynolds (St James” Hospital, Dublin, Ireland) and H Comber (National Cancer Registry of Ireland, Cork, Ireland).
- Barrett's oesophagus
- Oesophageal adenocarcinoma
- Psychosocial factors
- Reflux oesophagitis