Quality-of-life implications of risk-reducing cancer surgery

Abstract

Background: Modern advances in genetic sequencing techniques have allowed for increased availability of genetic testing for hereditary cancer syndromes. Consequently, more people are being identified as mutation carriers and becoming aware of their increased risk of malignancy. Testing is commonplace for many inheritable cancer syndromes, and with that comes the knowledge of being a gene carrier for some patients. With increased risk of malignancy, many guidelines recommend that gene carriers partake in risk reduction strategies, including risk-reducing surgery for some syndromes. This review explores the quality-of-life consequences of genetic testing and risk-reducing surgery.Methods: A narrative review of PubMed/MEDLINE was performed, focusing on the health-related quality-of-life implications of surgery for hereditary breast and ovarian cancer, familial adenomatous polyposis and hereditary diffuse gastric cancer.Results: Risk-reducing surgery almost uniformly decreases cancer anxiety and affects patients' quality of life. Conclusion:Although the overwhelming quality-of-life implications of surgery are neutral to positive, risk-reducing surgery is irreversible and can be associated with short-and long-term side-effects.

Combination of Sulindac and Eflornithine Delays the Need for Lower Gastrointestinal Surgery in Patients With Familial Adenomatous Polyposis: Post Hoc Analysis of a Randomized Clinical Trial

“…43,44 Both IRA and IPAA also alter patients' bowel habits, resulting in more frequent bowel movements (on average 4 and 6 per day after IRA and IPAA) and a higher risk of nocturnal fecal incontinence. 7,8,26,27 In recent years, laparoscopic methods have improved outcomes with quicker postoperative recovery and reduced impact on reproductive potential. Nevertheless, all colectomies and proctocolectomies are life-altering surgeries with significant comorbidities that often result in reduced QoL.…”

“…Although prophylactic colectomy remains the standard of care for patients with severe colorectal polyposis that is not amenable to endoscopic control, this can be associated with morbidity, mortality, and lower QoL. [6][7][8][9][10] Regardless of the type of surgery, the risk for desmoid tumors (the second leading cause of FAP-related deaths) and serious morbidity increases with each surgery in patients with FAP, particularly those with certain APC mutations. 43,44 Both IRA and IPAA also alter patients' bowel habits, resulting in more frequent bowel movements (on average 4 and 6 per day after IRA and IPAA) and a higher risk of nocturnal fecal incontinence.…”

“…[4][5][6] In addition to the spectrum of potential complications associated with surgery, neither IRA nor IPAA are a cure for FAP. [6][7][8][9][10] Furthermore, they do not eliminate the need for continued surveillance [6][7][8][9][10] or additional surgery. [10][11][12][13] The surgical procedures negatively affect patients' quality of life (QoL).…”

Poliposis adenomatosa familiar. Estado actual y reporte de caso

“…Debe tomarse en cuenta que la proctectomía está asociada a un mayor riesgo de disfunción urinaria y sexual, disminución de la fertilidad en las mujeres y menor calidad de vida en general. 10 Un porcentaje pequeño de pacientes desarrolla cáncer en la zona de transición anal o en la zona de anastomosis del reservorio ileal. Se ha propuesto la mucosectomía como alternativa, pero si ésta no se realiza de forma adecuada puede fallar en su propósito.…”

Cancer surgery in the genomic era

“…If gastrectomy cannot be performed with complete removal of the gastric mucosa, this may be a disappointing proposition for these unfortunate patients facing a major alteration in their day‐to‐day life, with longstanding implications for health. The implications of this from quality‐of‐life and practical perspectives are dealt with, along with prophylactic thyroidectomy for germline mutations, which in some instances requires paediatric surgery. Similarly, image guidance, enhanced definition of surgical extent, based on the underlying genetic defect (for example, phaeochromocytoma), and the molecular definition of tumour margins will help to define optimal surgical practice for several other tumour types.…”