Permanence of the information given during oncogenetic counseling to persons at familial risk of breast/ovarian and/or colon cancer

BRACAVENIR: an observational study of expectations and coping in young women with high hereditary risk of breast and ovarian cancer

Background

In families with high risk of hereditary breast/ovarian cancer (HBOC), women before age 30 do not yet undergo clinical screening, but they are exposed to contradictory information from diverse sources. They may be presented with surgical prevention options at a key moment of their identity construction, the start of a marital relationship and/or at the onset of procreation projects. We tested an original psychoeducational intervention to help these women better cope with these difficult issues.

Methods

Seven young female counselees (26.4 ± 2.9 years [23–30]) from the Oncogenetics Department at Jean Perrin Comprehensive Cancer Center were enrolled. A weekend group workshop composed of short conferences, group sharing and role playing activities was supervised by a psychotherapist. A longitudinal analysis of questionnaires over one year of follow-up was performed. The Herth Hope Inventory was evaluated, as well as self-esteem, anxiety, perceived control, coping, and quality of life. Participants’ comments were collected by a genetic counselor throughout the workshop.

Results

All participants were BRCA mutation carriers and six had lived with a close relative affected by breast/ovarian cancer. Hope, self-esteem and quality of life increased during the year after the workshop (p = 0.0003). Coping by focus on the problem increased in the first 6 months (p = 0.011) and returned to baseline values at one year, while coping by focus on emotions decreased steadily (p = 0.021). Debriefing from the workshop highlighted the new medical opportunities proposed and the challenges these young women face, such as whether to have prophylactic surgery, and if so before or after having children, and how surgery might affect their relationship with their partner.

Conclusion

A tailored two-day psychoeducational workshop may be sufficient to improve the way young women with BRCA mutations deal with the implications of HBOC risk.

Trial registration

BRACAVENIR was registered in ClinicalTrials.gov with no NCT02705924.

Electronic supplementary material

The online version of this article (10.1186/s13053-019-0107-7) contains supplementary material, which is available to authorized users.

Patients' Awareness Of The Prevention And Treatment Of Colorectal Cancer

The aim of the study was to assess patients' awareness of the prevention and treatment of colorectal cancer.

MATERIAL AND METHODS

Patients diagnosed with colorectal cancer, hospitalised at the Department of General and Colorectal Surgery of the Medical University in Łódź during the period from January 2015 to April 2015, were asked to complete a questionnaire concerning their families' medical case record, factors predisposing them to the development of colorectal cancer, the tests applied in diagnostics, and the treatment process. The questionnaire comprised 42 closed-ended questions with one correct answer. A statistical analysis of all answers was carried out.

RESULTS

The study group consisted of 30 men and 20 women aged 27-94 years old. A strong, statistically significant negative correlation between a patient's age and his/her awareness of the prevention and treatment of colorectal cancer was noted (p<0.001; r= -0.51). The study demonstrated a statistically significant relationship between the occurrence of neoplasms in a patient's family (p=0.009) or, more specifically, the occurrence of colorectal cancer (p=0.008), and the awareness of the prevention programme. The women's group was characterised by statistically significantly greater awareness of colonoscopy as a screening examination (p=0.004).

CONCLUSIONS

Patients need more information on colorectal cancer, its risk factors, prevention, the treatment process, and postoperative care. Lack of awareness of the colorectal cancer issue can be one of the major factors contributing to the high incidence of this disease.

BRACAVENIR - impact of a psychoeducational intervention on expectations and coping in young women (aged 18-30 years) exposed to a high familial breast/ovarian cancer risk: study protocol for a randomized controlled trial

Background

Young women exposed to a high hereditary breast and ovarian cancer (HBOC) risk are particularly vulnerable. They are ignored by health prevention measures but exposed to a stream of contradictory information (medicine, media, Internet). They may feel concerned about surgical prevention issues at a key moment of their identity construction (self, relationship, sexuality). We designed a special psychoeducational intervention to help these women cope better with these difficulties.

Methods/design

The BRACAVENIR study consists of a prospective, randomized superiority phase II trial with a wait list control group. Participants are childless young female counselees (aged 18–30 years) seen at the oncogenetics department of the Centre Jean Perrin and belonging to HBOC families either with or without BRCA mutations. They will be invited to attend a weekend group session at a spa resort and to participate in short expert conferences and focus group activities (group sharing, Moreno role game) supervised by a psychotherapist. Two sessions separated by a 6-month delay (wait list) will enable us to evaluate the intervention’s effect by comparing questionnaire scores between the 6-month time points. The main endpoint is an increase of the Herth Hope Index by at least 1 SD. Secondary endpoints are self-esteem, anxiety trait, anxiety state, coping, and quality of life. With a one-sided α = 0.05 and β = 0.20, 12 participants will be needed by group, plus an additional 2 in anticipation of dropouts. Participants will be randomized 1:1 to the first or the second session so that the groups will be comparable.

Discussion

The intent of this trial is to bridge the gap on a psychosocial level in these young women with HBOC. A particularity of the design is the use of a waiting list, which should allow for avoiding major bias. The intervention consists of a short session that could be proposed to other young counselees if successful. The results may bring complementary information to facilitate the intervention and also influence the contents of the oncogenetic consultation.

Trial registration

Ethics committee CPP SUD-EST-6: IRB00008526. Registered on 18 March 2016.

ClinicalTrials.gov identifier: NCT02705924. Registered on 2 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1642-4) contains supplementary material, which is available to authorized users.

[Informing the family: emotions and attitudes of oncogenetic counselees for familial breast/ovarian and/or colon cancer risk]

BACKGROUND

Transmission of oncogenetic information (TOI) by probands to their families is of major importance to organize medical prevention in his family. Little is known about the difficulties that the proband faces when he tries to endorse his "duty to warn".

METHODS

To characterize the barriers to TOI, a survey was performed, previously to the bioethic law of 2011, on a representative sample of 337 counselees seen in the last 10 years at the Centre Jean-Perrin Oncogenetics Department. A questionnaire comprising 97 items was prepared by experts and validated by a group of patients and health professionals. Nineteen Lickert-scale questions specially concerned TOI.

RESULTS

Analysis found two dimensions, one of emotions and one concerning communication attitudes. Both dimensions were negatively correlated (r=-0.34, P<10(-7)): high emotional levels limited communication attitudes. The probands' history of cancer was the main factor impacting TOI. TOI was more difficult for cancer patients than for healthy counselees (P=0.025). Delay since consultation and type of cancer risk had no bearing on TOI.

CONCLUSION

Cancer and its treatments seem to deeply affect patient's relatives and limit his capacity to involve his family into the oncogenetic inquiry. Measures are suggested to help ex-patients improve TOI.