O70 Psychological well-being of people living with a colorectal cancer predisposition syndrome: evidence from a systematic review

Introduction

About 5–10% of newly diagnosed colorectal cancers have a genetic cause. Early detection is key to facilitate effective treatments and prevent future cancers. When an inherited colorectal cancer is diagnosed, predictive genetic testing can be cascaded to first degree relatives. Genetic and genomic health information increasingly informs routine clinical care. Some health care professionals have concerns about the potential for genetic information to inflict psychological harm on patients. Therefore, it was decided to explore this area in depth within the scope of inherited colorectal cancer.

Methods

A systematic review was carried out using PRISMA guidelines. Six relevant databases were searched systematically, using MeSH and other search terms. Inclusion criteria followed those in our Prospero-published protocol (CRD42021257585): peer-reviewed quantitative and qualitative studies on the psychological well-being of adult asymptomatic individuals living with colorectal cancer.

Results

The search strategy yielded 1590 studies of which 33 were eligible. Eight studies were qualitative interviews of probands and families, and 25 were quantitative. Psychological distress, anxiety, depression, cancer worry, risk perception, quality of life, resilience, coping, and hopelessness were assessed using psychometric scales. Quantitative studies showed that there is a transient increase in anxiety, worry, and depression following genetic results which drop back to baseline level one year after the genetic results are given. Baseline is defined as immediately prior to genetic testing, when related worries may already be present. Overall, important factors that influence individuals' psychological well-being are decision making, risk perception, cancer worry, family relationships and coping mechanisms. Related positive outcomes are hopefulness, optimism, good communication within the family, and positive attitude.

Conclusions

Risk factors, such as experience of nursing a relative through colorectal cancer, significant family history, lack of close family connections, poor family dynamics, and 'feeling' alone in the genetic diagnosis, can help clinicians to identify patients that are more likely to need additional support when they receive a genetic diagnosis. We recommend further research using uniform, standardized tools to assess essential domains and positive outcomes across different cultures, incorporating wider determinants for meaningful interpretations and clinical applicability.