Journal of Primeasia
Integrative Disciplinary Research | Online ISSN 3064-9870 | Print ISSN 3069-4353
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RESEARCH ARTICLE (Open Access)
Behavioral Determinants of Treatment Decision-Making in Precision Medicine for Gastric Cancer in Bangladesh
Mohammad Niamul Islam 1, Sneha Saha 2*, Dipa Barai 3, Mahedi Hasan 4
Journal of Primeasia 7 (1) 1-13 https://doi.org/10.25163/primeasia.7110754
Submitted: 04 August 2026 Revised: 12 October 2026 Accepted: 19 October 2026 Published: 21 October 2026
Abstract
Background: Gastric cancer remains a major global health burden, and although precision medicine advances treatment, decision-making is increasingly shaped by behavioral factors, with limited integrated evidence in LMICs like Bangladesh.Objective: This study systematically reviews global evidence on behavioral determinants influencing treatment decision-making in precision medicine for gastric cancer and contextualizes the findings within Bangladesh.Methods: A systematic literature review was conducted across PubMed, MedLine, PsycInfo, and Google Scholar, identifying 25,490 records, of which 65 studies met the inclusion criteria, guided by the PRISMA framework to examine psychosocial, biological, and treatment-related determinants in adult gastric cancer patients.Results: Treatment decision-making is shaped by multidimensional behavioral determinants, including biological, psychosocial, socioeconomic, treatment-related, and health system factors, where genetics, quality of life, inequalities, and healthcare access play key roles, with strong relevance to Bangladesh despite limited direct evidence.Conclusion: Treatment decisions in gastric cancer precision medicine are shaped by behavioral and structural factors, requiring integrated care and equitable access, especially in Bangladesh.
Keywords: Gastric cancer; precision medicine; behavioral determinants; treatment decision-making; psychosocial factors
References
An, J. Y., Youn, H. G., Choi, M. G., Noh, J. H., Sohn, T. S., & Kim, S. (2008). The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. American Journal of Surgery, 196(4), 587–591. https://doi.org/10.1016/j.amjsurg.2007.09.040
Arner, P., Henjes, F., Schwenk, J. M., et al. (2015). Circulating carnosine dipeptidase 1 associates with weight loss and poor prognosis in gastrointestinal cancer. PLoS ONE, 4(e0123566). https://doi.org/10.1371/journal.pone.0123566
Avery, K., Hughes, R., McNair, A., Alderson, D., Barham, P., & Blazeby, J. (2010). Health-related quality of life and survival in the 2 years after surgery for gastric cancer. European Journal of Surgical Oncology, 36(2), 148–154. https://doi.org/10.1016/j.ejso.2009.09.008
Bain, G. H., Collie-Duguid, E., Murray, G. I., Gilbert, F. J., Denison, A., McKiddie, F., ... & Stengel, A. (2016). Tumour expression of leptin is associated with chemotherapy resistance and therapy-independent prognosis in gastro-oesophageal adenocarcinomas. British Journal of Cancer, 114(e18). https://doi.org/10.1038/bjc.2016.139
Bartels, H., Pedersen, S. S., van der Laan, B. F., Staal, M. J., Albers, F. W., & Middel, B. (2010). The impact of the type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. Otology & Neurotology, 31(1), 11–18. https://doi.org/10.1097/MAO.0b013e3181bc3dd1
Baudry, A. S., Anota, A., Mariette, C., Bonnetain, F., Renaud, F., Piessen, G., ... & Stengel, A. (2019). The role of trait emotional intelligence in quality of life, anxiety and depression symptoms after surgery for oesophageal or gastric cancer: A French national database FREGAT. Psycho-Oncology, 28(4), 799–806. https://doi.org/10.1002/pon.5023
Ben-Ezra, M., Shrira, A., Abrahami, Y., Hodedi, E., Haber, Y., & Wolf, J. (2011). The association between previous psychological trauma and mental health among gastric cancer patients. European Journal of Psychiatry, 25(3), 122–133. https://doi.org/10.4321/S0213-61632011000300002
Bilgin, S., & Gozum, S. (2018). Effect of nursing care given at home on the quality of life of patients with stomach cancer and their family caregivers’ nursing care. European Journal of Cancer Care, 27(e12567). https://doi.org/10.1111/ecc.12567
Borth, W. (1992). Alpha-2-macroglobulin, a multifunctional binding protein with targeting characteristics. FASEB Journal, 6(15), 3343. https://doi.org/10.1096/fasebj.6.15.1281457
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492
Calabrese, F., Molteni, R., Racagni, G., & Riva, M. A. (2009). Neuronal plasticity: A link between stress and mood disorders. Psychoneuroendocrinology, 34(Suppl 1), 208–216. https://doi.org/10.1016/j.psyneuen.2009.05.014
Calman, K. C. (1984). Quality of life in cancer patients—a hypothesis. Journal of Medical Ethics, 10(3), 124–127. https://doi.org/10.1136/jme.10.3.124
Cao, X., Wang, X., Li, P., & Ju, W. (2019). Psychological effects of advanced care on patients received endoscopic gastric cancer resection. Medicine, 98(39), e17497. https://doi.org/10.1097/MD.0000000000017497
Coburn, N., Cosby, R., Klein, L., Knight, G., Malthaner, R., Mamazza, J., ... & Stengel, A. (2018). Staging and surgical approaches in gastric cancer: A systematic review. Cancer Treatment Reviews, 63, 104–115. https://doi.org/10.1016/j.ctrv.2017.12.006
Conroy, T., Marchal, F., & Blazeby, J. (2006). Quality of life in patients with oesophageal and gastric cancer: An overview. Oncology, 70(6), 391–402. https://doi.org/10.1159/000099034
Correia, M., Cravo, M., Marques-Vidal, P., Grimble, R., Dias-Pereira, A., Faias, S., ... & Stengel, A. (2007). Serum concentrations of TNF-alpha as a surrogate marker for malnutrition and worse quality of life in patients with gastric cancer. Clinical Nutrition, 26(6), 728–735. https://doi.org/10.1016/j.clnu.2007.08.014
Davies, J., Johnston, D., Sue-Ling, H., Young, S., May, J., & Griffith, J. (1998). Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World Journal of Surgery, 22(10), 1048–1055. https://doi.org/10.1007/s002689900515
Dincheva, I., Glatt, C. E., & Lee, F. S. (2012). Impact of the BDNF Val66Met polymorphism on cognition: Implications for behavioral genetics. Neuroscientist, 18(5), 439–451. https://doi.org/10.1177/1073858411431646
Egan, M. F., Kojima, M., Callicott, J. H., Goldberg, T. E., Kolachana, B. S., Bertolino, A., ... & Stengel, A. (2003). The BDNF Val66Met polymorphism affects activity-dependent secretion of BDNF and human memory and hippocampal function. Cell, 112(2), 257–269. https://doi.org/10.1016/S0092-8674(03)00035-7
Fayers, P., & Hays, R. (Eds.). (2005). Assessing Quality of Life in Clinical Trials: Methods and Practice. Oxford University Press.
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., ... & Stengel, A. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), e359–e386. https://doi.org/10.1002/ijc.29210
Fujita, J., Takahashi, M., Urushihara, T., Tanabe, K., Kodera, Y., Yumiba, T., ... & Stengel, A. (2016). Assessment of postoperative quality of life following pyloruspreserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: Results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer, 19(1), 302–311. https://doi.org/10.1007/s10120-015-0460-9
Fujita, T., Nagayama, A., & Anazawa, S. (2003). Circulating alpha-2-macroglobulin levels and depression scores in patients who underwent abdominal cancer surgery. Journal of Surgical Research, 114(1), 90–94. https://doi.org/10.1016/S0022-4804(03)00194-X
Fukui, S., Ogawa, K., & Yamagishi, A. (2011). Effectiveness of communication skills training of nurses on the quality of life and satisfaction with healthcare professionals among newly diagnosed cancer patients. Psycho-Oncology, 20(12), 1285–1291. https://doi.org/10.1002/pon.1840
Fukui, S., Ogawa, K., Ohtsuka, M., & Fukui, N. (2008). A randomized study assessing the efficacy of communication skill training on patients’ psychologic distress and coping. Cancer, 113(6), 1462–1470. https://doi.org/10.1002/cncr.23710
Gockel, I., Pietzka, S., & Junginger, T. H. (2005). Quality of life after subtotal resection and gastrectomy for gastric cancer. Der Chirurg, 76(3), 250–257. https://doi.org/10.1007/s00104-004-0950-5
Goh, Y. M., Gillespie, C., Couper, G., & Paterson-Brown, S. (2015). Quality of life after total and subtotal gastrectomy for gastric carcinoma. The Surgeon, 13(5), 267–270. https://doi.org/10.1016/j.surge.2014.07.002
Hafizi, M., Kalanaky, S., Moaiery, H., Khayamzadeh, M., Noorian, S., Kaveh, V., ... & Stengel, A. (2019). A randomized, double-blind, placebo-controlled investigation of BCc1 nanomedicine effect on survival and quality of life in metastatic and non-metastatic gastric cancer patients. Journal of Nanobiotechnology, 17, 52–71. https://doi.org/10.1186/s12951-019-0484-0
He, X., & Cao, Z. (2020). Effect of high-quality nursing intervention on the psychological disorder in patients with gastric cancer during perioperative period: A protocol of systematic review and meta-analysis. Medicine, 99(23), e20381. https://doi.org/10.1097/MD.0000000000020381
Huang, T., Zhou, F., Yuan, X., Yang, T., Liang, X., Wang, Y., ... & Stengel, A. (2019). Reactive oxygen species are involved in the development of gastric cancer and gastric cancer-related depression through abl1-mediated inflammation signaling pathway. Oxidative Medicine and Cellular Longevity, 2019(e5813985). https://doi.org/10.1155/2019/5813985
icddr,b. (2025, April 22). icddr,b launches advanced genome sequencing based cancer diagnostics in Bangladesh. https://www.icddrb.org/press-releases/icddrb-launches-advanced-genome-sequencing-based-cancer-diagnostics-in-bangladesh-23-04-2025
Ikeguchi, M., Kuroda, H., Saito, H., Tatebe, S., & Wakatsuki, T. (2011). A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer. Langenbeck's Archives of Surgery, 396(6), 777–781. https://doi.org/10.1007/s00423-011-0779-6
International Agency for Research on Cancer. (2024). Bangladesh fact sheet: Globocan 2022. Global Cancer Observatory.
Islam, M. R., Siddiqua, S. M., Mina, S., Ayub, S. B. A., Islam, R., Saha, B., Rahman, M. H., Khatun, N., Craver, A., & Ahsan, H. (2025). Cancer care in Bangladesh: An urgent need for comprehensive reform. Discover Health Systems, 4, Article 96. https://doi.org/10.1007/s44250-025-00283-x
Jeong, A., & An, J. Y. (2017). The moderating role of social support on depression and anxiety for gastric cancer patients and their family caregivers. PLoS ONE, 12(e0189808). https://doi.org/10.1371/journal.pone.0189808
Kang, J. I., Chung, H. C., Jeung, H. C., Kim, S. J., An, S. K., & Namkoong, K. (2012). FKBP5 polymorphisms as vulnerability to anxiety and depression in patients with advanced gastric cancer. Psychoneuroendocrinology, 37(10), 1569–1576. https://doi.org/10.1016/j.psyneuen.2012.02.017
Kern, K., & Norton, J. (1988). Cancer cachexia. Journal of Parenteral and Enteral Nutrition, 12(3), 286–298. https://doi.org/10.1177/0148607188012003286
Kim, J. W., Kim, J. G., Kang, B. W., Chung, I. J., Hong, Y. S., Kim, T. Y., ... & Stengel, A. (2019). Treatment patterns and changes in quality of life during first-line palliative chemotherapy in korean patients with advanced gastric cancer. Cancer Research and Treatment, 51(1), 223–239. https://doi.org/10.4143/crt.2018.073
Kim, K. C., Yook, J. H., Eisenbraun, J., Kim, B. S., & Huber, R. (2012). Quality of life, immunomodulation and safety of adjuvant mistletoe treatment in patients with gastric carcinoma – a randomized, controlled pilot study. BMC Complementary and Alternative Medicine, 12, 172. https://doi.org/10.1186/1472-6882-12-172
Kim, S. M., Cho, J., Kang, D., Oh, S. J., Kim, A. R., Sohn, T. S., ... & Stengel, A. (2016). A randomized controlled trial of vagus nerve-preserving distal gastrectomy versus conventional distal gastrectomy. Annals of Surgery, 263(6), 1079–1084. https://doi.org/10.1097/SLA.0000000000001565
Kim, Y. W., Baik, Y. H., Yun, Y. H., Nam, B. H., Kim, D. H., Choi, I. J., ... & Stengel, A. (2008). Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer. Annals of Surgery, 248(5), 721–727. https://doi.org/10.1097/SLA.0b013e318185e62e
Koh, M. J., Jeung, H. C., Namkoong, K., Chung, H. C., & Kang, J. I. (2014). Influence of the BDNF Val66Met polymorphism on coping response to stress in patients with advanced gastric cancer. Journal of Psychosomatic Research, 77(1), 76–80. https://doi.org/10.1016/j.jpsychores.2014.04.008
Lee, K., & Lim, K. (2019). Mediation effect of adaption on the quality of life in patients with gastric cancer undergoing gastrectomy. Asian Nursing Research, 13(1), 38–46. https://doi.org/10.1016/j.anr.2019.01.001
Lee, S. S., Ryu, S. W., Kim, I. H., & Sohn, S. S. (2012). Quality of life beyond the early postoperative period after laparoscopy-assisted distal gastrectomy: The level of patient expectation as the essence of quality of life. Gastric Cancer, 15(3), 299–304. https://doi.org/10.1007/s10120-011-0113-6
Lehnert, T., & Buhl, K. (2004). Techniques of reconstruction after total gastrectomy or cancer. British Journal of Surgery, 91(5), 528–539. https://doi.org/10.1002/bjs.4512
Lekman, M., Laje, G., Charney, D., Rush, A. J., Wilson, A. F., Sorant, A. J., ... & Stengel, A. (2008). The FKBP5-gene in depression and treatment response. Biological Psychiatry, 63(12), 1103–1110. https://doi.org/10.1016/j.biopsych.2007.10.026
Misawa, K., Fujiwara, M., Ando, M., Ito, S., Mochizuki, Y., Ito, Y., ... & Stengel, A. (2015). Long-term quality of life after laparoscopic distal gastrectomy for early gastric cancer. Gastric Cancer, 18(2), 417–425. https://doi.org/10.1007/s10120-014-0374-y
Mitchell, A., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., ... & Stengel, A. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncology, 12(2), 160–174. https://doi.org/10.1016/S1470-2045(11)70002-X
National Institute of Cancer Research and Hospital. (2026). About us.
Naus, M. J., Ishler, M. D., Parrott, C. E., & Kovacs, S. A. (2009). Cancer survivor adaptation model: Conceptualizing cancer as a chronic illness. Journal of Clinical Psychology, 65(12), 1350–1359. https://doi.org/10.1002/jclp.20622
Necula, L., Matei, L., Dragu, D., Neagu, A. I., Mambet, C., Nedeianu, S., ... & Stengel, A. (2019). Recent advances in gastric cancer early diagnosis. World Journal of Gastroenterology, 25(17), 2029–2044. https://doi.org/10.3748/wjg.v25.i17.2029
Nordin, K., Berglund, G., Glimelius, B., & Sjöden, P. O. (2001). Predicting anxiety and depression among cancer patients. European Journal of Cancer, 37(3), 376–384. https://doi.org/10.1016/S0959-8049(00)00398-1
Ogden, J. (2000). Health Psychology: A Textbook. (2nd ed.). Open University Press.
Oliveira Miranda, D., Soares de Lima, T. A., Ribeiro Azevedo, L., Feres, O., Ribeiro da Rocha, J. J., & Pereira-da-Silva, G. (2014). Proinflammatory cytokines correlate with depression and anxiety in colorectal cancer patients. Biomed Research International, 2014(e739650). https://doi.org/10.1155/2014/739650
Pan, Y., Zhou, F., He, C., Hui, L., Huang, T., & Wei, Y. (2017). Leptin-LepRb expressed in gastric cancer patients and related to cancer-related depression. Biomed Research International, 2017(e6482842). https://doi.org/10.1155/2017/6482842
Rupp, S. K., & Stengel, A. (2021). Influencing factors and effects of treatment on quality of life in patients with gastric cancer—A systematic review. Frontiers in Psychiatry, 12(656929). https://doi.org/10.3389/fpsyt.2021.656929
Sarker, A. R., Islam, R., & Tran-Duy, A. (2025). Out-of-pocket cost and financial catastrophe of patients with cancer: the alarming cost-of-illness in Bangladesh. International journal for equity in health, 24(1), 186. https://doi.org/10.1186/s12939-025-02421-6
Shimada, H., Takiguchi, N., & Kainuma, O. (2010). High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer, 13(3), 170–176. https://doi.org/10.1007/s10120-010-0554-3
Sun, D. Z., Jiao, J. P., Zhang, X., Xu, J. Y., Ye, M., Xiu, L. J., ... & Stengel, A. (2015). Therapeutic effect of jinlongshe granule (?????) on quality of life of stage IV gastric cancer patients using EORTC QLQ-C30. Chinese Journal of Integrative Medicine, 8(8), 579–586. https://doi.org/10.1007/s11655-014-1950-z
Takahashi, T., Hondo, M., Nishimura, K., Kitani, A., Yamano, T., Yanagita, H., ... & Stengel, A. (2008). Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy. Radiation Medicine, 26(7), 396–401. https://doi.org/10.1007/s11604-008-0248-5
Takase, M., Sumiyama, Y., & Nagao, J. (2003). Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: Digestion and absorption test with stable isotope 13C-labeled lipid compound. Gastric Cancer, 6(3), 134–141. https://doi.org/10.1007/s10120-003-0238-3
Thomas, C., Medden, F., & Jehu, D. (1987). Psychological effects of stomas: II. factor influencing outcomes. Journal of Psychosomatic Research, 31(3), 317–323. https://doi.org/10.1016/0022-3999(87)90051-1
Tian, J., Chen, Z. C., Wu, B., & Meng, X. (2004). Comparison of quality of life between urban and rural gastric cancer patients and analysis of influencing factors. World Journal of Gastroenterology, 10(20), 2940–2943. https://doi.org/10.3748/wjg.v10.i20.2940
Venerito, M., Vasapolli, R., Rokkas, T., & Malfertheiner, P. (2018). Gastric cancer: Epidemiology, prevention, and therapy. Helicobacter, 23(e12518). https://doi.org/10.1111/hel.12518
Wang, Y., Wang, Y. H., Yin, G. H., Tian, H. Z., & Wang, D. (2010). The quality of life of chinese middle-aged male patients with gastric carcinoma after total gastrectomy and nursing intervention. Clinical Oncology Research, 7(3), 151–156. https://doi.org/10.1007/s11805-010-0511-2
Wei, Y. C., Zhou, F. L., He, D. L., Bai, J. R., Ding, H., Wang, X. Y., ... & Stengel, A. (2009). Oxidative stress in depressive patients with gastric adenocarcinoma. International Journal of Neuropsychopharmacology, 12(8), 1089–1096. https://doi.org/10.1017/S1461145709000091
World Bank. (2025). Out of pocket expenditure (% of current health expenditure): Bangladesh. https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=BD
Xu, L., Pan, Q., & Lin, R. (2016). Prevalence rate and influencing factors of preoperative anxiety and depression in gastric cancer patients in china. Journal of International Medical Research, 44(2), 377–388. https://doi.org/10.1177/0300060515616722
Yamaoka, K. S., Ogoshi, K., Haruyama, K., Watanabe, M., Hayashi, F., & Hayashi, C. (1998). Health-related quality of life varies with personality types. Quality of Life Research, 7(6), 535–544. https://doi.org/10.1023/A:1008830509237
Zhan, Y. P., Huang, X. E., Cao, J., Lu, Y. Y., Wu, X. Y., Liu, J., ... & Stengel, A. (2012). Clinical study on safety and efficacy of Qinin R© (Cantharidin Sodium) injection combined with chemotherapy in treating patients with gastric cancer. Asian Pacific Journal of Cancer Prevention, 13(9), 4773–4776. https://doi.org/10.7314/APJCP.2012.13.9.4773
Zhang, J. K., Fang, L. L., Zhang, D. W., Jin, Q., Wu, X. M., Liu, J. C., ... & Stengel, A. (2016). Type D personality in gastric cancer survivors: Association with poor quality of life, overall survival, and mental health. Journal of Pain and Symptom Management, 52(1), 81–91. https://doi.org/10.1016/j.jpainsymman.2015.12.342
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