1
|
Gamble LA, Grant RRC, Samaranayake SG, Fasaye GA, Koh C, Korman L, Asif B, Heller T, Hernandez JM, Blakely AM, Davis JL. Decision-making and regret in patients with germline CDH1 variants undergoing prophylactic total gastrectomy. J Med Genet 2023; 60:241-246. [PMID: 35817563 DOI: 10.1136/jmg-2022-108733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Prophylactic total gastrectomy (PTG) can eliminate gastric cancer risk and is recommended in carriers of a germline CDH1 pathogenic variant. PTG has established risks and potential life-long morbidity. Decision-making regarding PTG is complex and not well-understood. METHODS Individuals with germline CDH1 pathogenic or likely pathogenic variants who underwent surveillance endoscopy and recommended for PTG were evaluated. Factors associated with decision to pursue PTG (PTGpos) or not (PTGneg) were queried. A decision-regret survey was administered to patients who elected PTG. RESULTS Decision-making was assessed in 120 patients. PTGpos patients (63%, 76/120) were younger than PTGneg (median 45 vs 58 years) and more often had a strong family history of gastric cancer (80.3% vs 34.1%). PTGpos patients reported decision-making based on family history more often and decided soon after diagnosis (8 vs 27 months) compared with PTGneg. Negative endoscopic surveillance results were more common among PTGneg patients. Age >60 years, male sex and longer time to decision were associated with deferring PTG. Strong family history, a family member who died of gastric cancer and carcinoma on endoscopic biopsies were associated with decision to pursue PTG. In the PTGpos group, 30 patients (43%) reported regret which was associated with occurrence of a postoperative complication and no carcinoma detected on final pathology. CONCLUSION The decision to undergo PTG is influenced by family cancer history and surveillance endoscopy results. Regret is associated with surgical complications and pathological absence of cancer. Individual cancer-risk assessment is necessary to improve pre-operative counselling and inform the decision-making process. TRIAL REGISTRATION NUMBER NCT03030404.
Collapse
Affiliation(s)
- Lauren A Gamble
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert R C Grant
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah G Samaranayake
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Grace-Ann Fasaye
- National Cancer Institute, Genetics Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Koh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Louis Korman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Bilal Asif
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan M Hernandez
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew M Blakely
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeremy L Davis
- National Cancer Institute, Surgical Oncology Program, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
2
|
Tutty E, Forbes Shepherd R, Hoskins C, Purvis R, Shanahan M, Boussioutas A, Forrest LE. Becoming and being a parent with an inherited predisposition to diffuse gastric cancer: A qualitative study of young adults with a CDH1 pathogenic variant. J Psychosoc Oncol 2022; 41:286-302. [PMID: 35959852 DOI: 10.1080/07347332.2022.2104676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE This study explored the experiences of young people with hereditary diffuse gastric cancer (HDGC), an inherited cancer predisposition syndrome, as they navigate becoming and being a parent. DESIGN We used interpretive description and conducted semi-structured interviews with 13 young Australians (18-39 years) with a CDH1 pathogenic variant (PV). Data were analyzed using team-based, reflexive thematic analysis. FINDINGS Participants' reproductive decisions centered on the perceived manageability of HDGC, namely via gastrectomy, and timing of their genetic testing. Participants yet to have children and those with challenging gastrectomy experiences favored using reproductive technologies to prevent passing on their PV. Parents who had children before genetic testing described complicated decisions about having more children. Gastrectomy was considered a parental responsibility but recovery diminished parenting abilities. CONCLUSION Young people with HDGC face unique challenges navigating reproductive decision-making and parenting with gastrectomy. Findings lend credence to calls for longitudinal, developmentally sensitive genetic counseling services.
Collapse
Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Cass Hoskins
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Rebecca Purvis
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Mary Shanahan
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Alex Boussioutas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Parkville, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| |
Collapse
|
3
|
Emerging Adults Carrying A CDH1 Pathogenic or Likely Pathogenic Variant Face Diet and Lifestyle Challenges After Total Gastrectomy. J Acad Nutr Diet 2021; 122:913-917. [PMID: 34968751 DOI: 10.1016/j.jand.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/14/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
Emerging adults with a CDH1 pathogenetic or likely pathogenetic variant face a life altering decision to undergo prophylactic total gastrectomy (PTG) or to have frequent endoscopies for gastric cancer risk management. They are in a unique life stage with distinct characteristics, such as identity finding, career seeking, relationship exploring, establishing financial independence and planning for or pursuing pregnancy. Research has shown these emerging adults heavily weighed dietary and nutrition concerns after PTG on their decision making for both timing of surgery and whether they should or should not undergo the surgery. These concerns are valid because of the significant dietary and lifestyle modification that emerging adults need to commit to prevent common sequelae after PTG, which include early satiety, nausea, dumping syndrome, bile reflux, excessive weight loss, micronutrient deficiencies and metabolic bone disorders. Thus, working with a multidisciplinary team with expertise in CDH1 and hereditary diffuse gastric cancer, including a registered dietitian nutritionist, is essential for this population.
Collapse
|