Psychosocial Impacts of Prophylactic Total Gastrectomy for Hereditary Diffuse Gastric Cancer: A Narrative Review

Pathogenic or likely pathogenic (P/LP) CDH1 germline genetic variants are causally linked to early onset diffuse gastric cancer and prophylactic total gastrectomy (PTG) is a recommended intervention for (P/LP) CDH1 variant carriers. However, PTG introduces fundamental challenges to a patient's quality of life (QOL) and psychological well-being. There is a growing need for evidence-based recommendations to address the psychosocial needs of PTG patients. The present review summarizes published literature on psychosocial sequelae and quality of life reported post-PTG in germline (P/LP) CDH1 variant carriers.

Articles were extracted from the PubMed database using the following search terms: "total gastrectomy", "CDH1", "CTNNA1", "guidelines", "psychological", "psychiatric", "mental health", "quality of life", and "longitudinal". Articles that address psychological and QOL implications and outcomes for PTG or total gastrectomy (TG) patients were included. Articles that mentioned "psychosocial factors" generally, without specific details, were excluded.

37 articles met inclusion criteria. Seven of the most frequently mentioned psychosocial domains in the published literature include quality of life (n = 22), social relationships (n = 12), depression and anxiety (n = 8), decision-making (n = 7), employment and finances (n = 4), body image (n = 5), and substance abuse (n = 3).

Considering the known psychological impact of a genetic cancer predisposition diagnosis and the significant postoperative lifestyle adjustment, this review identifies a need for standardized integration of mental health care along the PTG surgical continuum. The combination of the diagnosis of a hereditary cancer syndrome and the life-altering nature of prophylactic total gastrectomy (PTG) presents a psychosocial vulnerability for CDH1 (P/LP) variant carriers.