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Urichuk M, Zrinyi A, Keijzer R, Lum Min SA. Prevalence of Mental Health Disorders in Individuals With Gastrointestinal Congenital Surgical Anomalies: A Systematic Review and Meta-analysis. J Pediatr Surg 2024; 59:924-929. [PMID: 38388285 DOI: 10.1016/j.jpedsurg.2024.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Studies examining functional outcomes and health-related quality of life for patients with congenital surgical anomalies (CSA) are increasingly common. However, the prevalence of mental health disorders in this population has not been determined. The purpose of this review is to summarize the reported prevalence of mental health disorders in children born with gastrointestinal CSA. METHODS A systematic review of the literature was conducted on Medline (OVID), EMBASE (OVID), CINAHL (EbscoHost), and Scopus to identify studies reporting mental health diagnoses in children with a gastrointestinal CSA. A meta-analysis of the prevalence of anxiety disorders and depressive disorders was completed. RESULTS Of 2546 manuscripts, seven met the inclusion criteria. All included manuscripts looked at patients with anorectal malformation (ARM) and/or Hirschsprung disease (HD). No studies assessed other gastrointestinal CSAs. A total of 183 psychiatric diagnoses were reported in 1167 patients. A pooled analysis of ARM patients revealed a 14.0% prevalence of anxiety disorders (N = 208; CI95 = 4.4-23.4%) and an 18.75% prevalence of depressive disorders (N = 48; CI95 = 7.7-29.8%). A pooled analysis of HD patients revealed a 15.8% prevalence of anxiety disorders (N = 19; CI95 = 0.6-32.2%) and a 4.75% prevalence of depressive disorders (N = 758; CI95 = 3.23-6.26%). CONCLUSIONS There is a paucity of evidence on mental health outcomes of individuals born with gastrointestinal CSA. However, the available evidence suggested a high prevalence of mental health diagnoses in individuals born with ARM or HD with 1 in 7 having an anxiety disorder. Additionally, 1 in 5 ARM patients and 1 in 20 HD patients were diagnosed with a depressive disorder. TYPE OF STUDY Systematic review and meta-analysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Karstensen JG, Wullum L, Andersen KK, Beck SH, Bülow S, Højen H, Jelsig AM, Jespersen N, Wewer MD, Pommergaard HC, Burisch J. Psychiatric and Educational Aspects of Familial Adenomatous Polyposis: A Nationwide Danish Cohort Study With Matched Nonexposed Individuals. Am J Gastroenterol 2024; 119:957-964. [PMID: 38032076 DOI: 10.14309/ajg.0000000000002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Familial adenomatous polyposis (FAP) is an autosomal, dominantly inherited disorder that predisposes to colorectal cancer. An increased risk of cancer may affect mental health, but the magnitude of this effect remains unknown. We assessed the psychosocial functioning, including the educational level attained and risk of psychiatric comorbidity, of patients with FAP by comparing them with matched nonexposed individuals. METHODS All Danish patients with FAP diagnosed before April 2021 were identified in the Danish Polyposis Register and paired with 4 matched nonexposed individuals. Educational history, psychiatric contacts or diagnoses ( International Classification of Disease, 10th Revision ), and treatment with antidepressants, anxiolytics, or antipsychotics were compared between patients with FAP and nonexposed individuals. RESULTS The analysis included 445 patients with FAP and 1,538 nonexposed individuals. The highest educational level reached was significantly lower for patients with FAP ( P < 0.001). When comparing patients with FAP and nonexposed and adjusting for a cancer diagnosis, an increased risk was observed for a psychiatric contact (1.69, 95% confidence interval [CI] 1.25-2.29, P < 0.001), any psychiatric prescription (1.39, 95% CI 1.17-1.66, P < 0.001), a psychiatric diagnosis (1.64, 95% CI 1.19-2.26, P = 0.002), and experiencing any psychiatric event (hazard ratio 1.42, 95% CI 1.20-1.68, P < 0.001). An increased risk was specifically seen for mood (affective) disorders (1.76, 95% CI 1.09-2.83, P = 0.02) and behavioral and emotional disorders (2.01, 95% CI 1.10-3.69, P = 0.02) and the need for antidepressants (1.59, 95% CI 1.24-2.03, P < 0.001) and antipsychotics (1.85, 95% CI 1.26-2.70, P = 0.002). DISCUSSION Compared with nonexposed individuals, patients with had significantly less education and an increased risk of developing mood and behavioral disorders, with an increased likelihood of needing antidepressants and antipsychotics.
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Affiliation(s)
- John Gásdal Karstensen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Søren Hammershøj Beck
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Steffen Bülow
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Højen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Marie Jelsig
- Department of Clinical Genetics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Jespersen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Damsgaard Wewer
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Hans Christian Pommergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery and Transplantation, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johan Burisch
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Jelsig AM, Karstensen JG, Overeem Hansen TV. Progress report: Peutz-Jeghers syndrome. Fam Cancer 2024:10.1007/s10689-024-00362-7. [PMID: 38493229 DOI: 10.1007/s10689-024-00362-7] [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: 10/25/2023] [Accepted: 02/04/2024] [Indexed: 03/18/2024]
Abstract
Peutz-Jeghers syndrome is a rare, autosomal dominant polyposis syndrome. Presenting with a remarkable phenotype including development of characteristic gastrointestinal polyps, mucocutaneous pigmentations, and an increased risk of cancer, the syndrome has been subject to many studies concerning the natural course of disease. In most patients, pathogenic germline variants are detected in the STK11 gene including cases of mosaicism and structural variants. Yet, studies assessing the effect of surveillance, understanding of cancer development, as well as clinical studies evaluating chemoprevention are lacking. In addition, the impact of Peutz-Jeghers syndrome on mental health, education, and family planning are insufficiently addressed. In this progress report, we describe current knowledge, clinical phenotype, surveillance strategies, and future areas of research.
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Affiliation(s)
- Anne Marie Jelsig
- Department of Clinical Genetics, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - John Gásdal Karstensen
- The Danish Polyposis Register, Gastro Unit and Department of Clinical Medicine, Amager and Hvidovre, Copenhagen University Hospital and University of Copenhagen-, Copenhagen, Denmark
| | - Thomas V Overeem Hansen
- Department of Clinical Genetics and Department of Clinical Medicine, University Hospital of Copenhagen, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
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Altered neural networks and cognition in a hereditary colon cancer. IBRO Neurosci Rep 2021; 11:137-143. [PMID: 34693396 PMCID: PMC8517154 DOI: 10.1016/j.ibneur.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Familial Adenomatous Polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene presenting with numerous colorectal adenomatous polyps and a near 100% risk of colon cancer. Preliminary research findings from our group indicate that FAP patients experience significant deficits across many cognitive domains. In the current study, fMRI brain metrics in a FAP population and matched controls were used to further the mechanistic understanding of reported cognitive deficits. This research identified and characterized any possible differences in resting brain networks and associations between neural network changes and cognition from 34 participants (18 FAP patients, 16 healthy controls). Functional connectivity analysis was performed using FSL with independent component analysis (ICA) to identify functional networks. Significant differences between cases and controls were observed in 8 well-established resting state networks. With the addition of an aggregate cognitive measure as a covariate, these differences were virtually non-existent, indicating a strong correlation between cognition and brain activity at the network level. The data indicate robust and pervasive effects on functional neural network activity among FAP patients and these effects are likely involved in cognitive deficits associated with this disease.
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ACG Clinical Report and Recommendations on Transition of Care in Children and Adolescents With Hereditary Polyposis Syndromes. Am J Gastroenterol 2021; 116:638-646. [PMID: 33982929 DOI: 10.14309/ajg.0000000000001140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transition of care (TOC) in adolescents and young adults (AYAs) with chronic gastrointestinal disorders has received increased attention, especially in those with inflammatory bowel disease. AYAs with hereditary polyposis syndromes are a heterogeneous group of patients with overlapping and complex medical needs. These patients are particularly vulnerable because of the risk of loss of continuity of care and subsequent poor disease outcomes. The Pediatric Committee of the American College of Gastroenterology commissioned a report with recommendations on TOC in AYAs with hereditary polyposis syndromes. This report aims at achieving best practice by both pediatric and adult gastroenterologists despite the paucity of published evidence in this population reflected in the included PRISMA report. Therefore, the group extrapolated findings from the literature related to other chronic gastrointestinal disorders, and a high degree of expert consensus was scored for all recommendations. The report addresses TOC through identifying shared domains followed by specific recommendations in disease management, including models of care, providers and patient and socioeconomic factors relevant to TOC. Areas of strong emphasis include the need for early planning, flexibility in the transition process to maintain continuity during major surgical procedures, patient and family psychological readiness, liaison among team members addressing transition, and changing insurance coverage in this population.
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Cali RJ, Nephew BC, Moore CM, Chumachenko S, Sala AC, Cintron B, Luciano C, King JA, Hooper SR, Giardiello FM, Cruz-Correa M. Altered Resting State Brain Networks and Cognition in Familial Adenomatous Polyposis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33173924 DOI: 10.1101/2020.11.02.20224477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Familial Adenomatous Polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene presenting with numerous colorectal adenomatous polyps and a near 100% risk of colon cancer. Preliminary research findings from our group indicate that FAP patients experience significant deficits across many cognitive domains. In the current study, fMRI brain metrics in a FAP population and matched controls were used to further the mechanistic understanding of reported cognitive deficits. This research identified and characterized any possible differences in resting brain networks and associations between neural network changes and cognition from 34 participants (18 FAP patients, 16 healthy controls). Functional connectivity analysis was performed using FSL with independent component analysis (ICA) to identify functional networks. Significant differences between cases and controls were observed in 8 well-established resting state networks. With the addition of an aggregate cognitive measure as a covariate, these differences were virtually non-existent, indicating a strong correlation between cognition and brain activity at the network level. The data indicate robust and pervasive effects on functional neural network activity among FAP patients and these effects are likely involved in cognitive deficits associated with this disease.
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Yang J, Gurudu SR, Koptiuch C, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Wani SB, Samadder NJ. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc 2020; 91:963-982.e2. [PMID: 32169282 DOI: 10.1016/j.gie.2020.01.028] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 02/08/2023]
Abstract
Familial adenomatous polyposis (FAP) syndrome is a complex entity, which includes FAP, attenuated FAP, and MUTYH-associated polyposis. These patients are at significant risk for colorectal cancer and carry additional risks for extracolonic malignancies. In this guideline, we reviewed the most recent literature to formulate recommendations on the role of endoscopy in this patient population. Relevant clinical questions were how to identify high-risk individuals warranting genetic testing, when to start screening examinations, what are appropriate surveillance intervals, how to identify endoscopically high-risk features, and what is the role of chemoprevention. A systematic literature search from 2005 to 2018 was performed, in addition to the inclusion of seminal historical studies. Most studies were from worldwide registries, which have compiled years of data regarding the natural history and cancer risks in this cohort. Given that most studies were retrospective, recommendations were based on epidemiologic data and expert opinion. Management of colorectal polyps in FAP has not changed much in recent years, as colectomy in FAP is the standard of care. What is new, however, is the developing body of literature on the role of endoscopy in managing upper GI and small-bowel polyposis, as patients are living longer and improved endoscopic technologies have emerged.
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Affiliation(s)
- Julie Yang
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Suryakanth R Gurudu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Cathryn Koptiuch
- Department of Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deepak Agrawal
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Syed M Abbas Fehmi
- Department of Gastroenterology, University of California, San Diego, California, USA
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA
| | - Terry L Jue
- Department of Gastroenterology, The Permanente Medical Group, San Francisco, California, USA
| | - Joanna K Law
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Mariam Naveed
- Advent Health Medical Group, Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, University of Florida, Gainsville, Florida, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Sachin B Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
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Abstract
BACKGROUND Almost all patients with familial adenomatous polyposis undergo abdominal surgery with a risk of disease and surgery-related complications. This, the familial nature of the syndrome, and its wide-ranging manifestations make patients prone to mental health symptoms. If this is true, patients need appropriate evaluation and treatment. OBJECTIVE The purpose of this study was to record the experience of mental health symptoms in a group of unselected patients with FAP. DESIGN We conducted an observational study using an anonymized mental health symptom survey for patients affected with familial adenomatous polyposis. SETTINGS The study was conducted using the Hereditary Colorectal Cancer Registry in a tertiary referral center. PATIENTS Patients affected with familial adenomatous polyposis were included. MAIN OUTCOME MEASURES Results of the mental health survey were measured. RESULTS Seventy nine of 100 patients completed the survey; 57 endorsed ≥1 psychosocial symptom (72.2%). with a mean of 4 per patient. Nine patients (11.4%) met all 4 of the American Psychiatric Association diagnostic criteria for posttraumatic stress disorder, and 8 (10.1%) endorsed partial posttraumatic stress disorder criteria (3/4 symptoms). Patients who met all of the criteria for posttraumatic stress disorder had an average of 9.3 psychosocial symptoms each compared with 8.3 for those who met 3 of 4 and 2.2 for those who met <3. Six patients endorsed suicidal thoughts, all of whom met 3 or 4 of the criteria for posttraumatic stress disorder. LIMITATIONS The study was limited by its referral bias toward severe cases and relatively small number of patients. Because of the limitations of an anonymous self-administered screening, no mental health diagnoses have been given. CONCLUSIONS Patients with familial adenomatous polyposis are at risk for mental health symptoms, which can be multiple and severe. Some patients need professional counseling. A correlation between familial adenomatous polyposis patients with posttraumatic stress disorder and suicidal ideation is important. See Video Abstract at http://links.lww.com/DCR/A995. SÍNTOMAS PSICOPATOLÓGICOS EN PACIENTES CON PÓLIPOSIS ADENOMATOSO FAMILIAR: UN ESTUDIO OBSERVACIONAL: Un mayoría de pacientes con póliposis adenomatoso familiar (PAF) se someten a cirugía abdominal con los riesgos de enfermedad propria y complicaciones relacionadas a cirugía. Estos factores, la relación familiar del síndrome y sus manifestaciones altamente variables hacen que los pacientes sean propensos a psicopatologías. Si estas consideraciones son validas, los pacientes requieren evaluación y tratamiento adecuado. OBJETIVO Documentar la experiencia de los síntomas psicopatológicos en un grupo de pacientes no seleccionados con PAF. DISEÑO:: Estudio observacional utilizando una encuesta anónima de síntomas psicopatológicos en pacientes afectados con póliposis adenomatoso familiar. AMBIENTE CLINICO Registro de cáncer colorrectal hereditario en un centro de referencia de tercer nivel. PACIENTES Individuos afectados con póliposis adenomatoso familiar. OBJETIVOS PRINCIPALES A VALORACIÓN:: Resultados de la encuesta de salud mental. RESULTADOS Setenta y nueve de 100 pacientes completaron la encuesta; 57 afirmaron uno o más síntomas psicosociales (72,2%) con un promedio de 4 por paciente. 9 (11,4%) pacientes cumplieron con los 4 criterios de diagnóstico de la Asociación Estadounidense de Psiquiatría para el trastorno por estrés postraumático, y 8 (10,1%) llenaron los criterios del trastorno de estrés postraumático parcial (3/4 síntomas). Los pacientes que cumplieron con todos los criterios para el trastorno por estrés postraumático tuvieron un promedio de 9.3 síntomas psicosociales cada uno, en comparación con 8.3 para los que cumplieron con 3/4 y 2.2 para los que cumplieron con <3. 6 pacientes afirmaron pensamientos de suicidio, todos los cuales cumplieron con 3 o 4 de los criterios para el trastorno por estrés postraumático. LIMITACIONES Sesgo de referencia hacia casos graves, y un número relativamente pequeño de pacientes. Debido a las limitaciones de un examen anónimo auto administrado, no se confirmaron diagnósticos de psicopatología. CONCLUSIONES Los pacientes con póliposis adenomatoso familiar tienen riesgo de síntomas de salud mental alterada que pueden ser múltiples y graves. Algunos pacientes necesitan asesoramiento profesional. La correlación entre los pacientes con póliposis adenomatoso familiar con trastorno por estrés postraumático y ideación suicida es importante. Vea el Resumen del Video en http://links.lww.com/DCR/A995.
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Christian S, Somerville M, Huculak C, Atallah J. Practice Variation among an International Group of Genetic Counselors on when to Offer Predictive Genetic Testing to Children at Risk of an Inherited Arrhythmia or Cardiomyopathy. J Genet Couns 2018; 28:10.1007/s10897-018-0293-x. [PMID: 30132189 DOI: 10.1007/s10897-018-0293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022]
Abstract
Cascade predictive genetic testing is available for many families as a means to identify individuals at risk of long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). The general issue of offering predictive genetic testing to minors has been an area of ethical debate among genetic counselors and other healthcare professionals for many years. An online questionnaire was circulated to four international genetic counseling associations to assess the views of cardiac genetic counselors regarding when to offer predictive genetic testing to children at risk of LQTS, CPVT, HCM, and ARVC. Analysis was both quantitative and qualitative. The study sample comprised 98 respondents. The majority reported that they offer predictive genetic testing before 5 years of age to children at risk of LQTS (83%) and CVPT (75%) and before 10 years of age to children at risk of HCM (66%) or ARVC (70%). Influencing factors included country of practice, clinical setting, and years of experience. The rationale provided for when to offer predictive genetic testing is encompassed by the ethical principles of beneficence, non-maleficence, autonomy, and informed consent. In conclusion, significant practice variation exists among cardiac genetic counselors regarding predictive genetic testing for children at risk of an inherited cardiomyopathy. These variations call for more research in the area to assist with the development of evidence-based guidelines.
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Affiliation(s)
- S Christian
- Department of Medical Genetic, University of Alberta, 826 Medical Sciences Building, Edmonton, AB, T6G 2H7, Canada.
| | - M Somerville
- Department of Medical Genetic, University of Alberta, 826 Medical Sciences Building, Edmonton, AB, T6G 2H7, Canada
| | - C Huculak
- Department of Medical Genetics, Alberta Health Services, Calgary, AB, Canada
| | - J Atallah
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Achatz MI, Porter CC, Brugières L, Druker H, Frebourg T, Foulkes WD, Kratz CP, Kuiper RP, Hansford JR, Hernandez HS, Nathanson KL, Kohlmann WK, Doros L, Onel K, Schneider KW, Scollon SR, Tabori U, Tomlinson GE, Evans DGR, Plon SE. Cancer Screening Recommendations and Clinical Management of Inherited Gastrointestinal Cancer Syndromes in Childhood. Clin Cancer Res 2018; 23:e107-e114. [PMID: 28674119 DOI: 10.1158/1078-0432.ccr-17-0790] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
Hereditary gastrointestinal cancer predisposition syndromes have been well characterized, but management strategies and surveillance remain a major challenge, especially in childhood. In October 2016, the American Association for Cancer Research organized the AACR Childhood Cancer Predisposition Workshop in which international experts in care of children with a hereditary risk of cancer met to define surveillance strategies and management of children with cancer predisposition syndromes. In this article, we review the current literature in polyposis syndromes that can be diagnosed in childhood and may be associated with an increased incidence of gastrointestinal neoplasms and other cancer types. These disorders include adenomatous polyposis syndromes (APC and MUTYH), juvenile polyposis coli (BMPR1A and SMAD4), Peutz-Jeghers Syndrome (STK11/LKB1), and PTEN hamartoma tumor syndrome (PHTS; PTEN), which can present with a more limited juvenile polyposis phenotype. Herein, the panel of experts provides recommendations for clinical diagnosis, approach to genetic testing, and focus on cancer surveillance recommendations when appropriate during the pediatric period. We also review current controversies on genetic evaluation of patients with hepatoblastoma and indications for surveillance for this tumor. Childhood cancer risks and surveillance associated with disorders involving the mismatch repair genes, including Lynch syndrome and constitutional mismatch repair deficiency (CMMRD), are discussed elsewhere in this series. Clin Cancer Res; 23(13); e107-e14. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Maria Isabel Achatz
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
| | | | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Harriet Druker
- Division of Hematology/Oncology, Department of Genetic Counselling, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Thierry Frebourg
- Department of Genetics, Rouen University Hospital, Rouen, France
| | - William D Foulkes
- Department of Medicine, Oncology and Human Genetics, McGill University, Montreal, Canada
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Roland P Kuiper
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital; Murdoch Children's Research Institute; University of Melbourne, Melbourne, Australia
| | | | | | - Wendy K Kohlmann
- Population Health Sciences Department, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | - Kenan Onel
- Department of Pediatrics, Hofstra-Northwell School of Medicine and Cohen Children's Medical Center, Manhasset, New York
| | - Kami Wolfe Schneider
- Division of Hematology, Oncology, Bone Marrow Transplant, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah R Scollon
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
| | - Uri Tabori
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Tomlinson
- Department of Pediatric Hematology-Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - D Gareth R Evans
- Department of Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester, United Kingdom
| | - Sharon E Plon
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
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McGill B, Wakefield C, Vetsch J, Barlow‐Stewart K, Kasparian N, Patenaude A, Young M, Cohn R, Tucker K. Children and young people's understanding of inherited conditions and their attitudes towards genetic testing: A systematic review. Clin Genet 2018; 95:10-22. [DOI: 10.1111/cge.13253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 01/26/2023]
Affiliation(s)
- B.C. McGill
- Discipline of PaediatricsSchool of Women's and Children's Health UNSW Sydney Kensington Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer CentreSydney Children's Hospital Randwick Australia
| | - C.E. Wakefield
- Discipline of PaediatricsSchool of Women's and Children's Health UNSW Sydney Kensington Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer CentreSydney Children's Hospital Randwick Australia
| | - J. Vetsch
- Discipline of PaediatricsSchool of Women's and Children's Health UNSW Sydney Kensington Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer CentreSydney Children's Hospital Randwick Australia
| | - K. Barlow‐Stewart
- Discipline of Genetic Medicine, Sydney Medical School, University of Sydney at the Northern Clinical SchoolRoyal North Shore Hospital, St Leonards Australia
| | - N.A. Kasparian
- Discipline of PaediatricsSchool of Women's and Children's Health UNSW Sydney Kensington Australia
- Heart Centre for ChildrenThe Sydney Children's Hospitals Network (Westmead and Randwick) Sydney Australia
| | - A.F. Patenaude
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer Institute Boston Massachusetts USA
- Department of PsychiatryHarvard Medical School Boston Massachusetts USA
| | - M.‐A. Young
- Garvan Institute of Medical Research Darlinghurst Sydney Australia
| | - R.J. Cohn
- Discipline of PaediatricsSchool of Women's and Children's Health UNSW Sydney Kensington Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer CentreSydney Children's Hospital Randwick Australia
| | - K.M. Tucker
- Hereditary Cancer Clinic, Department of Medical OncologyPrince of Wales Hospital Randwick Australia
- Prince of Wales Clinical SchoolUNSW Sydney Sydney Australia
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12
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Should Genetic Testing be Offered for Children? The Perspectives of Adolescents and Emerging Adults in Families with Li-Fraumeni Syndrome. J Genet Couns 2017; 26:1106-1115. [DOI: 10.1007/s10897-017-0091-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
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13
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Georgiou G, Wakefield CE, McGill BC, Fardell JE, Signorelli C, Hanlon L, Tucker K, Patenaude AF, Cohn RJ. Genetic testing for the risk of developing late effects among survivors of childhood cancer: Consumer understanding, acceptance, and willingness to pay. Cancer 2016; 122:2876-85. [PMID: 27258553 DOI: 10.1002/cncr.30119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Genetic testing to determine cancer survivors' risk of developing late effects from their cancer treatment will be increasingly used in survivorship care. This 2-stage study with 64 survivors of childhood cancer and their parents investigated the preferences and acceptability of testing among those who may be at risk of developing late effects. METHODS The first stage (Stage 1) identified the most commonly perceived benefits and concerns regarding genetic testing for the risk of late effects among 24 participants. In Stage 2, during interviews, 20 survivors (55% of whom were female; mean age, 26.0 years [range, 18-39 years]; standard deviation [SD], 0.80) and 20 parents (55% of whom were male; mean age of child survivor, 14.2 years [range, 10-19 years]; SD, 0.79) rated the 7 most common benefits and concerns from those identified in Stage 1. Interviews were transcribed verbatim and analyzed. Decisional balance ratios were calculated by dividing the participants' average concerns scores with the average benefits scores. RESULTS Genetic testing for late effects was highly acceptable: 95% of participants leaned toward testing, and the majority (65.9%) would pay up to Australian $5000. The majority (97.2%) reported it was acceptable to wait for up to 6 months to receive results, and to be offered testing immediately after treatment or when the survivor reached adulthood (62.9%). Survivors and parents had a highly positive decisional balance (Mean (M), 0.5 [SD, 0.38] and M, 0.5 [SD, 0.39], respectively), indicating that perceived benefits outweighed concerns. CONCLUSIONS Although to our knowledge clinical efficacy has yet to be clearly demonstrated, survivors and parents described positive interest in genetic testing for the risk of developing late effects. Perceived benefits outweighed harms, and the majority of participants would be willing to pay, and wait, for testing. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2876-2885. © 2016 American Cancer Society.
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Affiliation(s)
- Gabrielle Georgiou
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Brittany C McGill
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Lucy Hanlon
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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14
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The psychological impact of genetic information on children: a systematic review. Genet Med 2016; 18:755-62. [DOI: 10.1038/gim.2015.181] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022] Open
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15
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Grubman J, Barzi A. We Don't Know What We Don't Know About Adolescent and Young Adult Patients with Familial Adenomatous Polyposis-Related Colorectal Cancer. J Adolesc Young Adult Oncol 2015; 4:105-7. [PMID: 26421219 DOI: 10.1089/jayao.2015.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Grubman
- Department of Obstetrics/Gynecology, University of Texas Southwestern Medical Center/Parkland Memorial Hospital , Dallas, TX
| | - Afsaneh Barzi
- Department of Hematology/Medical Oncology, Keck School of Medicine of the University of Southern California , Los Angeles, California
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16
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Gonzalez L, Alvarez J, Weinstein E, Korenis P. Familial adenomatous polyposis in an adolescent with coexisting schizophrenia: treatment strategies and implications. Mol Genet Genomic Med 2015; 3:391-5. [PMID: 26436104 PMCID: PMC4585446 DOI: 10.1002/mgg3.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022] Open
Abstract
Schizophrenia is associated with high mortality and morbidity. The etiology of schizophrenia remains unclear, studies implicate a multifactorial origin with genetic and environmental factors. The adenomatous polyposis coli (APC) gene has been associated with FAP (familial adenomatous polyposis), and studies have linked it to schizophrenia. However, there are few studies which examine the association between FAP and schizophrenia. Limited data exist regarding recommendations for genetic counseling of adolescents with comorbid psychiatric illness. A case of an adolescent with FAP who developed psychotic symptoms is presented. This case hopes to add to the literature about mental illness in those with FAP. A review of literature about the role of APC in schizophrenia as well as implications of genetic counseling on those who suffer with mental illness will be discussed.
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Affiliation(s)
- Luisa Gonzalez
- Bronx Lebanon Hospital Center, Albert Einstein College of MedicineBronx, New York
- Albert Einstein College of MedicineBronx, New York
| | - Jose Alvarez
- Bronx Lebanon Hospital Center, Albert Einstein College of MedicineBronx, New York
| | | | - Panagiota Korenis
- Bronx Lebanon Hospital Center, Albert Einstein College of MedicineBronx, New York
- Albert Einstein College of MedicineBronx, New York
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17
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Unique Genetic Counseling Considerations in the Pediatric Oncology Setting. CURRENT GENETIC MEDICINE REPORTS 2015. [DOI: 10.1007/s40142-015-0064-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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How harmful is genetic testing for familial adenomatous polyposis (FAP) in young children; the parents’ experience. Fam Cancer 2014; 13:391-9. [DOI: 10.1007/s10689-014-9724-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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