Patient perspectives on repeated MRI and PET/CT examinations during neoadjuvant treatment of esophageal cancer

Objective: The perceived burden of diagnostic tests by patients during the assessment of esophageal cancer warrants attention with the current increase in repeated imaging for purposes of disease monitoring during and after treatment. The purpose of this prospective study was to evaluate the experienced burden associated with repeated MRI and positron emission tomography with integrated CT (PET/CT) examinations during neoadjuvant treatment for esophageal cancer from the perspective of the patient. Methods: In 27 patients receiving neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer MRI and PET/CT examinations were performed before nCRT, during nCRT and before surgery. The experienced burden during repeated MRI and PET/CT examinations was evaluated with a self-report questionnaire addressing discomfort, pain, anxiety and embarrassment, each measured on a 5-point Likert scale (1 = none; up to 5 = very much). In addition, a comparative assessment was used to rank MRI, PET/CT and baseline endoscopy. Results: All scans were performed without the occurrence of an adverse event. Few patients experienced discomfort (mean score ±SD: 1.9 ± 1.0 for MRI vs 2.0 ± 1.0 for PET/CT, p = 0.586), pain (1.1 ± 0.4 for MRI vs 1.3 ± 0.7 for PET/CT, p = 0.059), anxiety (1.0 ± 0.2 for MRI vs 1.0 ± 0.2 for PET/CT, p = 1.000) and embarrassment (1.0 ± 0 for MRI vs 1.0 ± 0.2 for PET/CT, p = 0.317) during both MRI and PET/CT. Patients preferred MRI over PET/CT (67% vs 22%, respectively, p = 0.023), and MRI over endoscopy (59% vs 19%, respectively, p = 0.027). In the comparison between PET/CT and endoscopy, 59% of patients preferred PET/CT and 26% preferred endoscopy (p = 0.093). Conclusion: Repeated imaging with both MRI and PET/CT is generally well-tolerated for the assessment of response to treatment in esophageal cancer patients. Shorter acquisition times and altered body positioning during scanning will likely improve patient experience. Advances in knowledge: This paper demonstrates that MRI and PET/CT are generally well-tolerated imaging procedures for the assessment of response to treatment in esophageal cancer patients. When asked to rank different tests, patients preferred MRI over PET/CT and endoscopy.