The Psychological Impact of Prophylactic Total Gastrectomy in Patients Who Are High Risk for Hereditary Diffuse Gastric Cancer: A Review of the Literature

TL;DR

This paper reviews how having a preventive stomach removal surgery affects the mental health of people at high risk for a rare type of stomach cancer.

Contribution

The paper provides a comprehensive review of psychological impacts of prophylactic total gastrectomy in HDGC patients.

Findings

PTG affects emotional functioning, anxiety, depression, and body image.

Long-term physical outcomes influence psychological well-being after PTG.

Persistent physical issues after surgery lead to worse mental health outcomes.

Abstract

High-risk patients for hereditary diffuse gastric cancer (HDGC) are commonly offered a prophylactic total gastrectomy (PTG). This includes patients with a germline CDH1 or CTNNA1 mutation and occasionally patients with variants of unknown pathogenicity. Whilst the psychological impact (PI) of curative total gastrectomy (TG) for gastric cancer (GC) has been well documented in the literature, there is a lack of consensus on how PTG affects this group of patients. Hence, this literature review aims to elucidate what is known about the PI of PTG.

A narrative review of the literature was carried out using a comprehensive search strategy on Ovid Medline, EMBASE, PubMed, SCOPUS, and Web of Science. After full-text screening, 12 citations were included to investigate the PI of PTG. Domains were classified for themes relating to the PI of PTG.

Themes that emerged for the PI of PTG included effects on emotional functioning, anxiety, depression, social life, body image, work and daily life, relationship with food, regret, cancer-related anxiety, and effects on intimate relationships.

All domains identified for the PI of PTG are complexly interlinked with the long-term clinical outcomes of PTG. All patients suffer from long-term morbidity, and those who tolerate PTG well, with improving physical symptoms over time, have better psychological outcomes. Alternatively, patients who experience persistent and severe long-term consequences of PTG have poorer psychological outcomes.

PTG is an established form of risk reduction, and care should be taken to address the PI of this procedure.

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