Abstract
According to the Dutch Guideline on Hereditary Colorectal Cancer published in 2008, patients with recently diagnosed colorectal cancer (CRC) should undergo microsatellite instability (MSI) testing by a pathologist immediately after tumour resection if they are younger than 50 years, or if a second CRC has been diagnosed before the age of 70 years, owing to the high risk of Lynch syndrome (MIPA). The aim of the present MIPAPS study was to investigate general distress and cancer-specific distress following MSI testing. From March 2007 to September 2009, 400 patients who had been tested for MSI after newly diagnosed CRC were recruited from 30 Dutch hospitals. Levels of general distress (SCL-90) and cancer-specific distress (IES) were assessed immediately after MSI result disclosure (T1) and 6 months later (T2). Response rates were 23/77 (30%) in the MSI-positive patients and 58/323 (18%) in the MSI-negative patients. Levels of general distress and cancer-specific distress were moderate. In the MSI-positive group, 27% of the patients had high general distress at T1 versus 18% at T2 (p = 0.5), whereas in the MSI-negative group, these percentage were 14 and 18% (p = 0.6), respectively. At T1 and T2, cancer-specific distress rates in the MSI-positive group and MSI-negative group were 39 versus 27% (p = 0.3) and 38 versus 36% (p = 1.0), respectively. High levels of general distress were correlated with female gender, low social support and high perceived cancer risk. Moderate levels of distress were observed after MSI testing, similar to those found in other patients diagnosed with CRC. Immediately after result disclosure, high cancer-specific distress was observed in 40% of the MSI-positive patients.
Highlights
Each year, more than one million patients are diagnosed with colorectal cancer (CRC) worldwide and approximately 3% have Lynch syndrome [1]
The MIPA procedure greatly enhances the efficiency of genetic counselling, because there is an increased risk that microsatellite instability (MSI)-high CRC patients are carriers of the mismatch repair (MMR) gene mutation
This is in agreement with a previous study in which a shorter time interval between the cancer diagnosis and genetic pre-screening for Lynch syndrome was not related to higher psychological distress [40]
Summary
More than one million patients are diagnosed with colorectal cancer (CRC) worldwide and approximately 3% have Lynch syndrome [1]. In patients diagnosed with CRC at a relatively young age, a positive MSI test is strongly associated with genetic susceptibility [7] and can be used as an indicator for Lynch syndrome. A new cost-effective and efficient test (MSItesting-indicated-by-a-Pathologist (MIPA) procedure) [5, 14, 15] has enhanced the recognition of patients at risk for Lynch syndrome [5, 14, 15]. One year before the introduction of the MIPA procedure, only 30% of patients at risk for Lynch syndrome were recognized as such by the traditional method based on family history [18]. After the introduction of the MIPA procedure, performed by multidisciplinary teams that include surgeons and pathologists, the recognition of patients at risk for Lynch syndrome has increased substantially [15]
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