Costs of Cancer Prevention: Physical and Psychosocial Sequelae of Risk-Reducing Total Gastrectomy.

Autor:	Gallanis AF; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Gamble LA; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Samaranayake SG; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Lopez R; Clinical Center Nutrition Department, National Institutes of Health, Bethesda, MD., Rhodes A; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Rajasimhan S; Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, MD., Fasaye GA; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Juma O; ASRC Federal, Bethesda, MD., Connolly M; Clincal Center Nursing Department, National Institutes of Health, Bethesda, MD., Joyce S; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Berger A; Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD., Heller T; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD., Blakely AM; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Hernandez JM; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Davis JL; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2024 Feb 01; Vol. 42 (4), pp. 421-430. Date of Electronic Publication: 2023 Oct 30.
DOI:	10.1200/JCO.23.01238
Abstrakt:	Purpose: Risk-reducing surgery for cancer prevention in solid tumors is a pressing clinical topic because of the increasing availability of germline genetic testing. We examined the short- and long-term outcomes of risk-reducing total gastrectomy (RRTG) and its lesser-known impacts on health-related quality of life (QOL) in individuals with hereditary diffuse gastric cancer syndrome. Methods: Individuals who underwent RRTG as part of a single-institution natural history study of hereditary gastric cancers were examined. Clinicopathologic details, acute and chronic operative morbidity, and health-related QOL were assessed. Validated questionnaires were used to determine QOL scores and psycho-social-spiritual measures of healing. Results: One hundred twenty-six individuals underwent RRTG because of a pathogenic or likely pathogenic germline CDH1 variant between October 2017 and December 2021. Most patients (87.3%; 110/126) had pT1aN0 gastric carcinoma with signet ring cell features on final pathology. Acute (<30 days) postoperative major morbidity was low (5.6%; 7/126) and nearly all patients (98.4%) lost weight after total gastrectomy. At 2 years after gastrectomy, 94% (64/68) of patients exhibited at least one chronic complication (ie, bile reflux, dysphagia, and micronutrient deficiency). Occupation change (23.5%), divorce (3%), and alcohol dependence (1.5%) were life-altering consequences attributed to total gastrectomy by some patients. In patients with a median follow-up of 24 months, QOL scores decreased at 1 month after gastrectomy and returned to baseline by 6-12 months. Conclusion: RRTG is associated with life-changing adverse events that should be discussed when counseling patients with CDH1 variants about gastric cancer prevention. The risks of cancer-prevention surgery should not only be judged in the context of likelihood of death due to disease if left untreated, but also based on the real consequences of organ removal.
Databáze:	MEDLINE
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