Do premalignant conditions impact health and wellbeing? A mixed methods systematic review

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Aims

Premalignant conditions, such as colorectal polyps and Barrett’s oesophagus (BO) may impact on the health and wellbeing of patients however, no comprehensive assessment has been undertaken. We sought to systematically review the literature on the effects of precancerous conditions, including gastrointestinal disorders, on health and wellbeing.

Methods

Databases PubMed, PsycInfo, Web of Science, EMBASE and Medline were searched from inception through to September 2016 to identify studies measuring quality of life (QoL) and/or the psychosocial impact of premalignant conditions. Studies were included if they included both patients with a confirmed premalignant condition, and a patient-/selfreported measure or qualitative assessment of QoL/psychosocial health. Meta-analytic procedures were undertaken to combine findings from quantitative questionnaires.

Results

In total, 93 articles, comprising of 14,465 patients (BO n=16 articles; Polyps n=8 articles; n=4782 patients) met the inclusion criteria. Preliminary analysis of generic and disease specific questionnaires suggests having a premalignant diagnosis may negatively impact a patients’ QoL and psychological wellbeing. The qualitative data indicates that information seeking and uncertainty are key QoL/psychosocial concerns for patients. For BO and Polyps, the role of surveillance and changing of behaviours were key issues.

Conclusion

Clinicians should be aware of the potential psychosocial impact of premalignant conditions. This is especially relevant in gastroenterology, as many patients with BO or polyps are on long-term care pathways, requiring continued support from their healthcare team.