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Campacci N, Grasel RS, Galvão HDCR, Garcia LF, Ribeiro PC, Pereira KFDJDS, Goldim JR, Ashton-Prolla P, Palmero EI. The history of families at-risk for hereditary breast and ovarian cancer: what are the impacts of genetic counseling and testing? Front Psychol 2024; 15:1306388. [PMID: 38500651 PMCID: PMC10946339 DOI: 10.3389/fpsyg.2024.1306388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Cancer Genetic Counseling (CGC) and genetic testing (GT) assume a paramount role for hereditary cancer predisposition syndrome families. We assessed the effects of CGC and GT on women affected by cancer who are at risk for hereditary breast and ovarian cancer predisposition syndrome (HBOC). Methods This study encompasses four time points: before the CGC session, after the CGC session when blood is drawn for GT, after disclosure of GT results, and six months following disclosure of GT results. The impacts of CGC and GT were assessed using psychosocial questionnaires. Additionally, a pedigree, genogram, and ecomap were constructed through a semistructured interview. Results A total of sixty women were included in the study. Most participants considered their perception of cancer risk to be equivalent to that of the general population, even among those with pathogenic variants. An increased perception of breast and ovarian cancer risks was associated with a heightened inclination toward religious engagement as a coping mechanism. Patients carrying variants of uncertain significance expressed greater concerns about developing another cancer compared to those who had BRCA1 and BRCA2 wild type or pathogenic variants. Qualitative analysis of the genograms and ecomaps demonstrated that the CGC/GT processes facilitate communication within families. The genogram analyses revealed the impact of CGC and GT processes on families at risk for hereditary cancer. Changes in some family relationships were observed, and an improvement in communication was noted following the GT process. Discussion These findings can assist healthcare professionals considering a personalized approaches in clinical practice.
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Affiliation(s)
- Natalia Campacci
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Genomic Medicine Service, Hospital A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rebeca Silveira Grasel
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Department of Genetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | - Edenir Inêz Palmero
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Department of Genetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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2
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Howard Sharp KM, Li C, Lu Z, Clark ME, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton KV, McGee RB, Nuccio R, Hines-Dowell S, Gattuso JS, Pritchard M, Mandrell BN, Tercyak KP, Nichols KE, Johnson LM. Parent Quality of Life After Disclosure of Pediatric Oncology Germline Sequencing Results. JCO Precis Oncol 2023; 7:e2300159. [PMID: 37944075 DOI: 10.1200/po.23.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To characterize parents' quality of life (QoL) after germline genomic sequencing for their children with cancer. METHODS Participants were n = 104 parents of children with cancer enrolled in a prospective study of clinical tumor and germline genomic sequencing. Parents completed surveys at study consent (T0), before disclosure of their child's germline results (T1), and again ≥5 weeks after results disclosure (T2). Bivariate associations with QoL were examined, followed by a multivariable regression model predicting parents' psychological distress. RESULTS At T2, parental distress significantly differed by their children's germline result type (positive, uncertain, negative; P = .038), parent relationship status (P = .04), predisclosure genetics knowledge (P = .006), and predisclosure worry about sequencing (P < .001). Specifically, parents of children with positive (ie, pathogenic or likely pathogenic) results experienced greater distress than those of children with negative results (P = .029), as did parents who were single, more knowledgeable about genetics, and with greater worry. In the adjusted regression model, a positive germline result remained significantly associated with parents' lower QoL at T2 follow-up (F [4,92] = 9.95; P < .001; R2 = .30; β = .19; P = .031). CONCLUSION Germline genomic sequencing for children with cancer is associated with distress among parents when revealing an underlying cancer predisposition among their affected children. Genetic education and counseling before and after germline sequencing may help attenuate this impact on QoL by addressing parents' concerns about test results and their health implications. Assessing parents' worry early in the testing process may also aid in identifying those most likely in need of psychosocial support.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Egan Clark
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Kayla V Hamilton
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Rose B McGee
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Jami S Gattuso
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Belinda N Mandrell
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kim E Nichols
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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Giunta EF, Arrichiello G, Pappalardo A, Federico P, Petrillo A. Transversal Perspectives of Integrative Oncology Care in Gastric and Lobular Breast Cancer. Cancer Treat Res 2023; 188:89-104. [PMID: 38175343 DOI: 10.1007/978-3-031-33602-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The occurrence of gastric cancer has been associated with an increased risk of lobular breast tumors in a subset of patients harboring selected germline mutations. Among all, the germline alteration of the gene coding for E-Cadherin (CDH1) was associated with an increased risk of gastric cancer diffuse-histotype and lobular breast cancer. However, the risk assessment of breast neoplasms and the role of multiple prophylactic procedures in these patients has never been systematically addressed. In addition, the performance of the common screening procedures for lobular breast cancer like mammography is suboptimal. Therefore, recalling the need for a better articulation of the patient-centered strategies of surveillance for individuals with germline CDH1 and other similar alterations, to offer comprehensive approaches for prevention, early diagnosis, and treatment. Accordingly, this chapter aims to discuss the value and the role of integrated oncological care in the era of oncology sub-specializations. Additionally, it sheds light on how the harmonization across the health providers can enhance patient care in this setting.
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Affiliation(s)
- Emilio Francesco Giunta
- Department of Precision Medicine, School of Medicine, University of Study of Campania, 80131, Naples, Italy
| | - Gianluca Arrichiello
- Department of Precision Medicine, School of Medicine, University of Study of Campania, 80131, Naples, Italy
| | | | - Piera Federico
- Medical Oncology Unit, Ospedale del Mare, Via E. Russo, 80147, Naples, Italy
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, Via E. Russo, 80147, Naples, Italy.
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4
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Brédart A, De Pauw A, Tüchler A, Lakeman IMM, Anota A, Rhiem K, Schmutzler R, van Asperen CJ, Devilee P, Stoppa-Lyonnet D, Kop JL, Dolbeault S. Genetic clinicians' confidence in BOADICEA comprehensive breast cancer risk estimates and counselees' psychosocial outcomes: a prospective study. Clin Genet 2022; 102:30-39. [PMID: 35508697 PMCID: PMC9322298 DOI: 10.1111/cge.14147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
Abstract
Counseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non‐genetic risk factors (NGRF) and polygenic risk scores (PRS). We examined genetic clinicians' confidence in counseling and counselees' psychosocial outcomes, using the BOADICEA risk prediction tool with different categories of risk factors as input. A prospective observational study in Dutch, French and German genetic clinics was performed including 22 clinicians, and 406 of 460 (88.3%) eligible cancer‐unaffected women at high breast cancer risk assessed at pre‐test and 350 (76.1%) at post‐test. We performed multilevel analyses accounting for the clinician, and counselees' characteristics. Overall, risk estimates category by GENE versus GENE+ NGRF, or GENE+NGRF+PRS differed in 11% and 25% of counselees, respectively. In multilevel analyses, clinicians felt less confident in counseling when the full model provided lower breast cancer risks than GENE (i.e., in 8% of cases). Older counselees expressed higher breast cancer risk perception and worries about the hereditary predisposition when the full model provided higher breast cancer risks than GENE only. Genetic clinicians appear confident with breast cancer risk comprehensive models, which seem only to affect perceptions of older counselees.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,University of Paris, 71 avenue Edouard Vaillant, Boulogne-Billancourt, France
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Anja Tüchler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Inge M M Lakeman
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Amélie Anota
- Centre Léon Bérard, Department of Clinical Research and Innovation& Human and Social Sciences Department, 28 rue Laennec, 69373, Lyon; French National Platform Quality of Life and Cancer, Lyon, France
| | - Kerstin Rhiem
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Rita Schmutzler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - C J van Asperen
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 place Godefroy de Bouillon, 54 015 Nancy Cedex, Nancy, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, Villejuif cedex, France
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5
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Matsukawa M, Torishima M, Satoh C, Honda S, Kosugi S. Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling. J Genet Couns 2021; 31:497-509. [PMID: 34661949 DOI: 10.1002/jgc4.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.
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Affiliation(s)
- Manami Matsukawa
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Torishima
- Department of Genomic Medicine, Kyoto University School of Public Health, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Chika Satoh
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Sayaka Honda
- Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
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6
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A Comparison of Patient-Reported Outcomes Following Consent for Genetic Testing Using an Oncologist- or Genetic Counselor-Mediated Model of Care. ACTA ACUST UNITED AC 2021; 28:1459-1471. [PMID: 33917963 PMCID: PMC8167594 DOI: 10.3390/curroncol28020138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Genetic testing for hereditary cancer risk is usually arranged by a genetic counselor after talking about possible risks and benefits. To increase access to genetic testing, oncologists have started to order genetic testing. This survey study compared patient outcomes following genetic testing ordered by a genetic counselor or an oncologist. Genetic counselor-mediated genetic testing was associated with higher patient knowledge, as well as higher experience and understanding of genetic testing. Differences were noted in the type of psychological concerns reported, with individuals having genetic counselor-mediated testing being more likely to express concerns about having a hereditary cancer predisposition and those having oncologist-mediated testing more likely to express concerns regarding general emotions. Overall, oncologist-mediated genetic testing appears to provide a streamlined alternative to genetic testing; however, all individuals may benefit from post-test genetic counseling to address any knowledge gaps and provide additional psychological support. Abstract This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results.
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7
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Yoon SY, Wong SW, Lim J, Ahmad S, Mariapun S, Padmanabhan H, Hassan NT, Lau SY, Ch'ng GS, Haniffa M, Ong WP, Rethanavelu K, Moey LH, Keng WT, Omar J, Mohd Abas MN, Yong CM, Ramasamy V, Md Noor MR, Aliyas I, Lim MCK, Suberamaniam A, Mat Adenan NA, Ahmad ZA, Ho GF, Abdul Malik R, Subramaniam S, Khoo BP, Raja A, Chin YS, Sim WW, Teh BH, Kho SK, Ong ESE, Voon PJ, Ismail G, Lee CL, Abdullah BZ, Loo KS, Lim CS, Lee SJ, Lim KJL, Shafiee MN, Ismail F, Latiff ZA, Ismail MP, Mohamed Jamli MF, Kumarasamy S, Leong KW, Low J, Md Yusof M, Ahmad Mustafa AM, Mat Ali NH, Makanjang M, Tayib S, Cheah N, Lim BK, Fong CK, Foo YC, Mellor Abdullah M, Tan TS, Chow DSY, Ho KF, Raman R, Radzi A, Deniel A, Teoh DCY, Ang SF, Joseph JK, Ng PHO, Tho LM, Ahmad AR, Muin I, Bleiker E, George A, Thong MK, Woo YL, Teo SH. Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes. J Med Genet 2021; 59:220-229. [PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming. METHODS The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer. RESULTS Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms. CONCLUSION The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.
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Affiliation(s)
- Sook-Yee Yoon
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Joanna Lim
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Syuhada Ahmad
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shivaani Mariapun
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | | | - Nur Tiara Hassan
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shao Yan Lau
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Gaik-Siew Ch'ng
- Genetics, Penang Hospital, Penang, Penang, Malaysia.,Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Muzhirah Haniffa
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Winnie P Ong
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Kavitha Rethanavelu
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lip Hen Moey
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wee Teik Keng
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jamil Omar
- Gynaeoncology, Institut Kanser Negara, Putrajaya, Wilayah Persekutuan Putra, Malaysia
| | | | | | | | - Mohd Rushdan Md Noor
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Ismail Aliyas
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Michael C K Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Anuradha Suberamaniam
- Gynaeoncology, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Noor Azmi Mat Adenan
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zatul Akmar Ahmad
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Suguna Subramaniam
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Boom Ping Khoo
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Arivendran Raja
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Yeung Sing Chin
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Wee Wee Sim
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Beng Hock Teh
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Swee Kiong Kho
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Eunice S E Ong
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Ghazali Ismail
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chui Ling Lee
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Kwong Sheng Loo
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chun Sen Lim
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Saw Joo Lee
- Gynaeoncology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Mohamad Nasir Shafiee
- Gynaeoncology, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Fuad Ismail
- Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zarina Abdul Latiff
- Clinical Genetics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mohd Pazudin Ismail
- Gynaeoncology, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | | | | | - Kin Wah Leong
- Oncology, Gleneagles Penang, Penang, Penang, Malaysia
| | - John Low
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mastura Md Yusof
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Nor Huda Mat Ali
- Gynaeoncology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mary Makanjang
- Gynaeoncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shahila Tayib
- Gynaeoncology, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
| | - Nellie Cheah
- Oncology, Loh Guan Lye Specialist Centre, Penang, Malaysia
| | - Boon Kiong Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chee Kin Fong
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Yoke Ching Foo
- Oncology, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | | | - Teck Sin Tan
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Doris S Y Chow
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Kean Fatt Ho
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Rakesh Raman
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Ahmad Radzi
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Azura Deniel
- Oncology, KPJ Ampang Puteri Specialist Hospital, Ampang, Kuala Lumpur, Malaysia
| | - Daren C Y Teoh
- Oncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Soo Fan Ang
- Oncology, Penang Adventist Hospital, Penang, Penang, Malaysia
| | - Joseph K Joseph
- Oncology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Paul Hock Oon Ng
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lye-Mun Tho
- Oncology, Beacon Hospital Sdn Bhd, Petaling Jaya, Malaysia
| | | | - Ileena Muin
- Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Eveline Bleiker
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Angela George
- Oncology, Royal Marsden Hospital Chelsea, London, London, UK
| | - Meow-Keong Thong
- Genetic Medicine Unit, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yin Ling Woo
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Soo Hwang Teo
- Cancer Prevention and Population Science, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.,University Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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8
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Oliveira FFB, de Barros Silva PG, de Sant'Ana RO, de Albuquerque CGP, Bezerra MJB, Wong DVT, da Silveira Bitencourt F, de Lima Silva-Fernandes IJ, Lima MVA. How does genetic testing influence anxiety, depression, and quality of life? A hereditary breast and ovarian cancer syndrome suspects trial. Support Care Cancer 2020; 29:3521-3530. [PMID: 33155091 DOI: 10.1007/s00520-020-05867-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emotional distress associated with genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) is reported to interfere with adherence to treatment and prophylactic measures and compromise quality of life. OBJECTIVES To determine levels of anxiety, depression, and quality of life in patients tested for pathogenic BRCA1/2 mutations and identify risk factors for the development of adverse psycho-emotional effects. METHODS Cross-sectional observational trial involving 178 breast or ovarian cancer patients from a referral cancer hospital in Northeastern Brazil. Information was collected with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization (WHO) Quality of Life (QoL) questionnaire (WHOQOL-BREF). RESULTS Patients suspected of HBOC had higher levels of anxiety than depression. The presence of (probably) pathogenic BRCA1/2 mutations did not affect levels of anxiety and depression. High schooling, history of psychiatric disease, and use of psychotropic drugs were directly associated with high anxiety. High schooling was too inversely associated with QoL as such a breast tumor. Anxiety and depression were directly correlated and both reduced significantly QoL. CONCLUSION Our results highlight the importance of psychological support and screening of risk factors for anxiety and depression and low QoL in HBOC patients at the time of testing.
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Affiliation(s)
- Francisca Fernanda Barbosa Oliveira
- Department of Psychology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil.,Laboratory of Genetics and Molecular Biology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil
| | | | - Rosane Oliveira de Sant'Ana
- Laboratory of Genetics and Molecular Biology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil.,Department of Clinical Oncology/Oncogenetics, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil.,Medical School, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | | | - Maria Júlia Barbosa Bezerra
- Laboratory of Genetics and Molecular Biology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil
| | - Deysi Viviana Tenazoa Wong
- Laboratory of Genetics and Molecular Biology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil
| | - Flávio da Silveira Bitencourt
- Department of Clinical Oncology/Oncogenetics, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil
| | | | - Marcos Venicio Alves Lima
- Laboratory of Genetics and Molecular Biology, Hospital Haroldo Juaçaba, the Ceará Cancer Institute, Fortaleza, Brazil
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9
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Žigman T, Lukša I, Mihaljević G, Žarković M, Kirac I, Vrdoljak DV, Šerman L. Defining health-related quality of life in localized and advanced stages of breast cancer - the first step towards hereditary cancer genetic counseling. Acta Clin Croat 2020; 59:209-215. [PMID: 33456106 PMCID: PMC7808234 DOI: 10.20471/acc.2020.59.02.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The important goal in breast cancer treatment is to improve patient quality of life. Due to the huge economic burden, it is necessary to estimate the health state utility values for different breast cancer stages accurately. A group of 114 women filled out the EuroQol-5D-3L questionnaire at two time points. The participants were divided into three groups, as follows: group 1 including healthy high-risk individuals; group 2 including patients with localized stage breast cancer; and group 3 including patients with advanced stage breast cancer. Results were expressed either as summary health state utility score or summary visual-analog score. The EuroQol utility index score and EuroQol visual-analog score were statistically significantly higher in the group of healthy high-risk individuals. The EuroQol visual-analog score was mostly correlated with the anxiety/depression and pain/discomfort quality of life dimensions. Health state utility values for different breast cancer stages are a necessary tool to perform economic analyses in breast cancer management decision making, due to its huge economic burden. Special attention should be paid to assessment of the psychosocial aspects of the disease, as well as pain management.
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Affiliation(s)
| | - Ivana Lukša
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Gloria Mihaljević
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Maša Žarković
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Iva Kirac
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Danko Velimir Vrdoljak
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ljiljana Šerman
- 1University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia
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10
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Cognitive and affective outcomes of genetic counselling in the Netherlands at group and individual level: a personalized approach seems necessary. Eur J Hum Genet 2020; 28:1187-1195. [PMID: 32341467 PMCID: PMC7608363 DOI: 10.1038/s41431-020-0629-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/13/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
We performed a large outcome study at group and individual level in which the goals of genetic counselling were operationalized into cognitive and affective outcomes: empowerment, perceived personal control and anxiety. We then examined which socio-demographic and clinical variables were associated with changes in these outcomes. Data came from 1479 counselees who completed questionnaires (GCOS-18, PPC and STAI) at three time points: before the start of genetic counselling, after the first consultation and after the results of genetic counselling were disclosed. Results showed that at group level empowerment, perceived personal control and anxiety improved significantly after the whole genetic counselling process. Effect-sizes were medium for empowerment and small for the other outcomes. At individual level, 48% of counselees improved in empowerment, 21% in perceived personal control and 17% in anxiety. Around 10% of counselees worsened on all outcomes. Only ‘reason for referral’ and ‘genetic test result’ were significantly associated with changes in outcomes. This study demonstrated improvements among counselees in cognitive and affective outcomes after genetic counselling at group level. However, our results also suggest that there are opportunities for improvement at individual level, as many counselees remained stable and some even worsened on all outcomes. Routine outcome monitoring could help to explore the needs of counselees and could help to identify counselees who worsen.
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11
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Campacci N, de Campos Reis Galvão H, Garcia LF, Ribeiro PC, Grasel RS, Goldim JR, Ashton-Prolla P, Palmero EI. Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome. Psychooncology 2020; 29:681-687. [PMID: 31984583 DOI: 10.1002/pon.5305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families' profiles and the challenges of the oncogenetics setting. METHODS This was a cross-sectional study in which interviews were conducted with 83 cancer-affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the "life course perspective" theory. RESULTS Individuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20-29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing. CONCLUSIONS This study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow-up and prevention strategies.
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Affiliation(s)
- Natalia Campacci
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Lucas F Garcia
- Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário Cesumar, Maringá, Brazil
| | - Paula C Ribeiro
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Rebeca S Grasel
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - José R Goldim
- Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Patrícia Ashton-Prolla
- Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Edenir I Palmero
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Sao Paolo, Brazil
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12
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Brédart A, Anota A, Dick J, Cano A, De Pauw A, Kop JL, Aaronson NK, Bleiker EM, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. The "Psychosocial Aspects in Hereditary Cancer" questionnaire in women attending breast cancer genetic clinics: Psychometric validation across French-, German- and Spanish-language versions. Eur J Cancer Care (Engl) 2019; 29:e13173. [PMID: 31571365 DOI: 10.1111/ecc.13173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/23/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We performed a comprehensive assessment of the psychometrics of the "Psychosocial Aspects in Hereditary Cancer" (PAHC) questionnaire in French, German and Spanish. METHODS Women consecutively approached in Cancer Genetic Clinics completed the PAHC, distress and satisfaction questionnaires at pre-testing (T1) and after test result disclosure (T2). In addition to standard psychometric attributes, we assessed the PAHC ability to respond to change (i.e. improvement or deterioration from T1 to T2) in perceived difficulties and computed minimal important differences (MID) in PAHC scores as compared with self-reported needs for additional counselling. RESULTS Of 738 eligible counselees, 214 (90%) in France (Paris), 301 (92%) in Germany (Cologne) and 133 (77%) in Spain (Barcelona) completed the PAHC. A six-factor revised PAHC model yielded acceptable CFA goodness-of-fit indexes and good all scales internal consistencies. PAHC scales demonstrated expected conceptual differences with distress and satisfaction with counselling. Different levels of psychosocial difficulties were evidenced between counselees' subgroups and over time (p-values < .05). MID estimates ranged from 8 to 15 for improvement and 9 to 21 for deterioration. CONCLUSION The PAHC French, German and Spanish versions are reliable and valid for evaluating the psychosocial difficulties of women at high BC risk attending genetic clinics.
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Affiliation(s)
- Anne Brédart
- Supportive Care Department, Psycho-oncology Unit, Psychopathology and Health Process Laboratory, EA 4047, Psychology Institute, Institut Curie, University Paris Descartes, Paris, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology unit (INSERM UMR 1098), University Hospital of Besançon and French National Platform Quality of Life and Cancer, Besançon, France
| | - Julia Dick
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Jean-Luc Kop
- Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eveline M Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joan Brunet
- Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Department of Human Genetics & Division of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, Paris and CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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13
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Brédart A, Kop JL, Dick J, Cano A, De Pauw A, Anota A, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study. BMJ Open 2019; 9:e029926. [PMID: 31551380 PMCID: PMC6773290 DOI: 10.1136/bmjopen-2019-029926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES AND SETTING Advances in multigene panel testing for cancer susceptibility has increased the complexity of counselling, requiring particular attention to counselees' psychosocial needs. Changes in psychosocial problems before and after genetic testing were prospectively compared between genetic test results in women tested for breast or ovarian cancer genetic susceptibility in French, German and Spanish clinics. PARTICIPANTS AND MEASURES Among 752 counselees consecutively approached, 646 (86%) were assessed after the initial genetic consultation (T1), including 510 (68%) affected with breast cancer, of which 460 (61%) were assessed again after receiving the test result (T2), using questionnaires addressing genetic-specific psychosocial problems (Psychosocial Aspects of Hereditary Cancer (PAHC)-six scales). Sociodemographic and clinical data were also collected. RESULTS Seventy-nine (17.2%), 19 (4.1%), 259 (56.3%), 44 (9.6%) and 59 (12.8%) women received a BRCA1/2, another high/moderate-risk pathogenic variant (PV), negative uninformative, true negative (TN) or variant of uncertain significance result (VUS), respectively. On multiple regression analyses, compared with women receiving another result, those with a VUS decreased more in psychosocial problems related to hereditary predisposition (eg, coping with the test result) (ß=-0.11, p<0.05) and familial/social issues (eg, risk communication) (ß=-0.13, p<0.05), almost independently from their problems before testing. Women with a PV presented no change in hereditary predisposition problems and, so as women with a TN result, a non-significant increase in familial/social issues. Other PAHC scales (ie, emotions, familial cancer, personal cancer and children-related issues) were not affected by genetic testing. CONCLUSIONS In women tested for breast or ovarian cancer genetic risk in European genetics clinics, psychosocial problems were mostly unaffected by genetic testing. Apart from women receiving a VUS result, those with another test result presented unchanged needs in counselling in particular about hereditary predisposition and familial/social issues.
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Affiliation(s)
- Anne Brédart
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- Psychopathology and Health Process Laboratory, University Paris Descartes, Boulogne-Billancourt, Paris, France
| | - Jean-Luc Kop
- Département de Psychologie, Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Amélie Anota
- French National Quality of Life in Oncology Platform, and Methodology; Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Joan Brunet
- Medical Oncology Department, Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Division of Pathology; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Sylvie Dolbeault
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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14
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Patient-Centered Care in Breast Cancer Genetic Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020319. [PMID: 29439543 PMCID: PMC5858388 DOI: 10.3390/ijerph15020319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/30/2022]
Abstract
With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.
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15
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González-Ramírez LP, Martínez-Arriaga R, Camacho-Cárdenas E, Del Toro-Valero A, Oceguera-Villanueva A, Zagamé L, Silva-García AA, Daneri-Navarro A. Evaluation of psychosocial aspects in participants of cancer genetic counseling. Hered Cancer Clin Pract 2017; 15:13. [PMID: 28943989 PMCID: PMC5607594 DOI: 10.1186/s13053-017-0073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/10/2017] [Indexed: 01/02/2023] Open
Abstract
Background The instrument called “Hospital Anxiety and Depression Scale” (HADS) is frequently used to evaluate anxious and depressive symptomatology in patients who receive Cancer Genetic Counseling (CGC). However, this instrument cannot identify all of the psychosocial factors, such as the antecedents of the patients’ emotional states or their concerns. The objective of the present research was to compare cases detected with psychosocial alterations by means of HADS and a Psychological Health Interview (PHI). Methods A transversal analytical design was used. One hundred ten participants were included (97.3% females and 2.7% males). The average age was 45 years ±10 years. Results The PHI identified twice the amount of participants with psychosocial alterations than did HADS, which only detected 43% of these participants. Conclusions The results of our study suggest that the PHI should be applied in addition to HADS to identify participants who would require psychological support due to recurrent concerns.
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Affiliation(s)
- Leivy Patricia González-Ramírez
- Departamento de Ciencias de la Salud, Centro Universitario de Tonala, Universidad de Guadalajara, 555 Nuevo Periférico Av. Ejido San Jose Tatepozco, 45425 Guadalajara, Jalisco Mexico.,Programa de Asesoramiento Genético Oncológico, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico
| | - Reyna Martínez-Arriaga
- Departamento de Ciencias de la Salud, Centro Universitario de Tonala, Universidad de Guadalajara, 555 Nuevo Periférico Av. Ejido San Jose Tatepozco, 45425 Guadalajara, Jalisco Mexico.,Programa de Asesoramiento Genético Oncológico, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico
| | - Erendira Camacho-Cárdenas
- Programa de Asesoramiento Genético Oncológico, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico
| | - Azucena Del Toro-Valero
- Programa de Asesoramiento Genético Oncológico, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico.,Instituto Jalisciense de Cancerología, Secretaría de Salud Jalisco, 715 Coronel Calderón St., El Retiro, 44280 Guadalajara, Jalisco Mexico
| | - Antonio Oceguera-Villanueva
- Instituto Jalisciense de Cancerología, Secretaría de Salud Jalisco, 715 Coronel Calderón St., El Retiro, 44280 Guadalajara, Jalisco Mexico
| | - Livia Zagamé
- Instituto Jalisciense de Cancerología, Secretaría de Salud Jalisco, 715 Coronel Calderón St., El Retiro, 44280 Guadalajara, Jalisco Mexico
| | - Aída Araceli Silva-García
- O.P.D. Hospital Civil Nuevo de Guadalajara "Dr. Juan I. Menchaca", 876 Salvador Quevedo y Zubieta St., Independencia Oriente, 44340 Guadalajara, Jalisco Mexico
| | - Adrián Daneri-Navarro
- Programa de Asesoramiento Genético Oncológico, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico.,Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 950 Sierra Mojada St., Independencia, 44340 Guadalajara, Jalisco Mexico
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16
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Referrals to Mental Health Services: Exploring the Referral Process in Genetic Counseling. J Genet Couns 2017; 27:289-300. [DOI: 10.1007/s10897-017-0147-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
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