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Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To examine changes in cancer-related knowledge, distress, and decisional conflict from pre- to post-genetic counseling (GC) in before (BDS) and after (ADS) definitive surgery breast cancer (BC) patients.

Methods

Sociodemographic and clinical characteristics were collected at baseline; primary outcome data were collected before (T1) and after (T2) pretest GC. Within group changes for cancer-related knowledge, distress, and decisional conflict over genetic testing were compared by Wilcoxon signed-rank tests.

Results

Of 103 BC patients, 87 were ADS and 16 were BDS. Analyses revealed that both groups reported significant increases in knowledge between T1 and T2 (median change 4.2, p = 0.004, and 2.7, p < 0.001, for BDS and ADS patients, respectively). Overall cancer-related distress showed a downward trend between T1 and T2 for both groups and was significant for BDS patients (p = 0.041). Reports of BDS patients trended toward overall and subscale-specific increases in decisional conflict, with the exception of the uncertainty which trended downward, but did not reach significance. Overall decisional conflict decreased in ADS patients, approaching marginal significance (p = 0.056), with significant improvements in informed decision making (median change −12.6, p < 0.001; i.e., pretest GC yielded improved knowledge of benefits, risks, and side effects of available options).

Conclusions

These pilot data suggest that pretest GC increases cancer-related knowledge for both BDS and ADS patients, decreases distress in BDS patients, and improves informed decision making in ADS patients. Future studies with larger sample sizes are needed to replicate these results.

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References

  1. Graeser MK, Engel C, Rhiem K, et al. Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2009;27:5887–92.

    Article  PubMed  Google Scholar 

  2. Malone KE, Begg CB, Haile RW, et al. Population-based study of the risk of second primary contralateral breast cancer associated with carrying a mutation in BRCA1 or BRCA2. J Clin Oncol. 2010;28:2404–10.

    Article  PubMed  CAS  Google Scholar 

  3. Metcalfe KA, Lynch HT, Ghadirian P, et al. The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol. 2005;96:222–6.

    Article  PubMed  CAS  Google Scholar 

  4. Chen Y, Thompson W, Semenciw R, Mao Y. Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomarkers Prev. 1999;8:855–61.

    PubMed  CAS  Google Scholar 

  5. Brekelmans CT, Tilanus-Linthorst MM, Seynaeve C, et al. Tumour characteristics, survival and prognostic factors of hereditary breast cancer from BRCA2-, BRCA1- and non-BRCA1/2 families as compared to sporadic breast cancer cases. Eur J Cancer. 2007;43:867–76.

    Article  PubMed  CAS  Google Scholar 

  6. Daly M, Axilbund JE, Bryant E, et al. The NCCN genetic/familial high-risk assessment: breast and ovarian clinical practice guideline, version 1.2006. http://www.nccn.org/. Accessed 1 Oct 2006.

  7. Boughey JC, Hoskin TL, Degnim AC, et al. Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer. Ann Surg Oncol. 2010;17:2702–9.

    Article  PubMed  Google Scholar 

  8. Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. J Am Med Assoc. 2010;304:967–75.

    Article  CAS  Google Scholar 

  9. Finch A, Beiner M, Lubinski J, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. J Am Med Assoc. 2006;296:185–92.

    Article  CAS  Google Scholar 

  10. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol. 2004;22:1055–62.

    Article  PubMed  Google Scholar 

  11. Rebbeck TR, Levin AM, Eisen A, et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst. 1999;91:1475–9.

    Article  PubMed  CAS  Google Scholar 

  12. Gronwald J, Tung N, Foulkes WD, et al. Tamoxifen and contralateral breast cancer in BRCA1 and BRCA2 carriers: an update. Int J Cancer. 2006;118:2281–4.

    Article  PubMed  CAS  Google Scholar 

  13. King MC, Wieand S, Hale K, et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: national surgical adjuvant breast and bowel project (NSABP-P1) breast cancer prevention trial. J Am Med Assoc. 2001;286:2251–6.

    Article  PubMed  CAS  Google Scholar 

  14. Narod SA, Brunet JS, Ghadirian P, et al. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Hereditary breast cancer clinical study group. Lancet. 2000;356:1876–81.

    Article  PubMed  CAS  Google Scholar 

  15. Daly M, Axilbund JE, Bryant E, et al. The NCCN genetic/familial high-risk assessment: breast and ovarian clinical practice guideline, version 1.2009. http://www.nccn.org/. Accessed 3 Dec 2009.

  16. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol. 2006;24:5112–6.

    Article  PubMed  Google Scholar 

  17. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press, 2005.

    Google Scholar 

  18. American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol. 2003;21:2397–406.

    Google Scholar 

  19. Robson ME, Storm CD, Weitzel J, et al. American society of clinical oncology policy statement update: genetic and genomic testing for cancer susceptibility. J Clin Oncol. 2010;28:893–901.

    Article  PubMed  Google Scholar 

  20. Berliner JL, Fay AM. Risk assessment and genetic counseling for hereditary breast and ovarian cancer: recommendations of the national society of genetic counselors. J Genet Couns. 2007;16:241–60.

    Article  PubMed  Google Scholar 

  21. Fraser FC. Genetic counseling. Am J Hum Genet. 1974;26:636–61.

    PubMed  CAS  Google Scholar 

  22. Bernhardt BA, Biesecker BB, Mastromarino CL. Goals, benefits, and outcomes of genetic counseling: client and genetic counselor assessment. Am J Med Genet. 2000;94:189–97.

    Article  PubMed  CAS  Google Scholar 

  23. Shiloh S, Avdor O, Goodman RM. Satisfaction with genetic counseling: dimensions and measurement. Am J Med Genet. 1990;37:522–9.

    Article  PubMed  CAS  Google Scholar 

  24. Pilnick A, Dingwall R. Research directions in genetic counselling: a review of the literature. Patient Educ Couns. 2001;44:95–105.

    Article  PubMed  CAS  Google Scholar 

  25. Braithwaite D, Emery J, Walter F, et al. Psychological impact of genetic counseling for familial cancer: a systematic review and meta-analysis. J Natl Cancer Inst. 2004;96:122–33.

    Article  PubMed  Google Scholar 

  26. Lerman C, Croyle RT, Tercyak KP, Hamann H. Genetic testing: psychological aspects and implications. J Consult Clin Psychol. 2002;70:784–97.

    Article  PubMed  Google Scholar 

  27. Meiser B. Psychological impact of genetic testing for cancer susceptibility: an update of the literature. Psychooncology. 2005;14:1060–74.

    Article  PubMed  Google Scholar 

  28. Hamann HA, Somers TJ, Smith AW, et al. Posttraumatic stress associated with cancer history and BRCA1/2 genetic testing. Psychosom Med. 2005;67:766–72.

    Article  PubMed  Google Scholar 

  29. Vadaparampil ST, Miree CA, Wilson C, Jacobsen PB. Psychosocial and behavioral impact of genetic counseling and testing. Breast Dis. 2007;27:97–108.

    Google Scholar 

  30. Schlich-Bakker KJ, Warlam-Rodenhuis CC, van Echtelt J, et al. Short term psychological distress in patients actively approached for genetic counselling after diagnosis of breast cancer. Eur J Cancer. 2006;42:2722–8.

    Article  PubMed  Google Scholar 

  31. Vadaparampil ST, Quinn GP, Brzosowicz J, Miree CA. Experiences of genetic counseling for BRCA1/2 among recently diagnosed breast cancer patients: a qualitative inquiry. J Psychosoc Oncol. 2008;26:33–52.

    Article  PubMed  Google Scholar 

  32. Geer KP, Ropka ME, Cohn WF, et al. Factors influencing patients’ decisions to decline cancer genetic counseling services. J Genet Couns. 2001;10:25–40.

    Article  PubMed  CAS  Google Scholar 

  33. Nusbaum RH, Peshkin BN, DeMarco TA, Goodenberger M. BRCA 1/2 testing in patients with newly diagnosed breast cancer. Commun Oncol. 2009;6:367–71.

    Article  Google Scholar 

  34. Lerman C, Schwartz MD, Lin TH, et al. The influence of psychological distress on use of genetic testing for cancer risk. J Consult Clin Psychol. 1997;65:414–20.

    Article  PubMed  CAS  Google Scholar 

  35. Lerman C, Narod S, Schulman K, et al. BRCA1 testing in families with hereditary breast–ovarian cancer. A prospective study of patient decision making and outcomes. J Am Med Assoc. 1996;275:1885–92.

    Article  PubMed  CAS  Google Scholar 

  36. Lerman C, Biesecker B, Benkendorf JL, et al. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst. 1997;89:148–57.

    Article  PubMed  CAS  Google Scholar 

  37. Hopwood P, Shenton A, Lalloo F, et al. Risk perception and cancer worry: an exploratory study of the impact of genetic risk counselling in women with a family history of breast cancer. J Med Genet. 2001;38:139.

    Article  PubMed  CAS  Google Scholar 

  38. Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.

    PubMed  CAS  Google Scholar 

  39. Vadaparampil ST, Ropka ME, Stefanek ME. Measurement of psychological factors associated with genetic testing for hereditary breast, ovarian and colon cancers. Fam Cancer. 2005;4:195–206.

    Article  PubMed  Google Scholar 

  40. Wevers MR, Ausems MG, Verhoef S, et al. Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: design of a multicenter randomized clinical trial. BMC Cancer. 2011;11:6.

    Article  PubMed  Google Scholar 

  41. Thewes B, Meiser B, Hickie IB. Psychometric properties of the Impact of Event Scale amongst women at increased risk for hereditary breast cancer. Psychooncology. 2001;10:459–68.

    Article  PubMed  CAS  Google Scholar 

  42. Schwartz MD, Lerman C, Brogan B, et al. Impact of BRCA1/BRCA2 counseling and testing on newly diagnosed breast cancer patients. J Clin Oncol. 2004;22:1823–9.

    Article  PubMed  Google Scholar 

  43. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15:25–30.

    Article  PubMed  Google Scholar 

  44. O’Connor AM. User manual—decisional conflict scale. Ottawa: Ottawa Hospital Research Institute, 1993, updated 2010.

    Google Scholar 

  45. Cranney A, O’Connor AM, Jacobsen MJ, et al. Development and pilot testing of a decision aid for postmenopausal women with osteoporosis. Patient Educ Couns. 2002;47:245–55.

    Article  PubMed  Google Scholar 

  46. Man-Son-Hing M, Laupacis A, O’Connor AM, et al. A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. J Am Med Assoc. 1999;282:737–43.

    Article  PubMed  CAS  Google Scholar 

  47. Stacey D, DeGrasse C, Johnston L. Addressing the support needs of women at high risk for breast cancer: evidence-based care by advanced practice nurses. Oncol Nurs Forum. 2002;29:E77–84.

    Article  PubMed  Google Scholar 

  48. Sawka CA, Goel V, Mahut CA, et al. Development of a patient decision aid for choice of surgical treatment for breast cancer. Health Expect. 1998;1:23–36.

    Article  PubMed  Google Scholar 

  49. O’Connor AM, Tugwell P, Wells GA, et al. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33:267–79.

    Article  PubMed  Google Scholar 

  50. O’Connor AM, Tugwell P, Wells GA, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy. Med Decis Making. 1998;18:295–303.

    Article  PubMed  Google Scholar 

  51. Trivers KF, Baldwin LM, Miller JW, et al. Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians: a vignette-based study. Cancer. 2011;117:5334–43.

    Article  PubMed  Google Scholar 

  52. Meyer LA, Anderson ME, Lacour RA, et al. Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: missed opportunities. Obstet Gynecol. 2010;115:945–52.

    Article  PubMed  Google Scholar 

  53. Vadaparampil ST, Quinn GP, Miree CA, et al. Recall of and reactions to a surgeon referral letter for BRCA genetic counseling among high-risk breast cancer patients. Ann Surg Oncol. 2009;16:1973–81.

    Article  PubMed  Google Scholar 

  54. O’Neill SM, Peters JA, Vogel VG, et al. Referral to cancer genetic counseling: are there stages of readiness? Am J Med Genet C Semin Med Genet. 2006;142C:221–31.

    Article  PubMed  Google Scholar 

  55. Levy DE, Byfield SD, Comstock CB, et al. Underutilization of BRCA1/2 testing to guide breast cancer treatment: black and Hispanic women particularly at risk. Genet Med. 2011;13:349–55.

    Article  PubMed  Google Scholar 

  56. Clarke A, Parsons E, Williams A. Outcomes and process in genetic counselling. Clin Genet. 1996;50:462–9.

    Article  PubMed  CAS  Google Scholar 

  57. Bowen DJ, Burke W, McTiernan A, et al. Breast cancer risk counseling improves women’s functioning. Patient Educ Couns. 2004;53:79–86.

    Article  PubMed  Google Scholar 

  58. Meiser B, Halliday JL. What is the impact of genetic counselling in women at increased risk of developing hereditary breast cancer? A meta-analytic review. Soc Sci Med. 2002;54:1463–70.

    Google Scholar 

  59. Bellcross CA, Kolor K, Goddard KA, et al. Awareness and utilization of BRCA1/2 testing among U.S. primary care physicians. Am J Prev Med. 2011;40:61–6.

    Article  PubMed  Google Scholar 

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Acknowledgment

Supported in part by the American Cancer Society (MRSG CPPB-111062) and the Survey Methods Core Facility at Moffitt Cancer Center.

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Authors and Affiliations

  1. Department of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center, Tampa, FL, USA

    Juliette Christie PhD, Gwendolyn P. Quinn PhD, Teri Malo PhD, Jessica McIntyre BA, Paul B. Jacobsen PhD & Susan T. Vadaparampil PhD

  2. Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, FL, USA

    Gwendolyn P. Quinn PhD, Ji-Hyun Lee PhD, Paul B. Jacobsen PhD & Susan T. Vadaparampil PhD

  3. Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA

    Ji-Hyun Lee PhD & Xiuhua Zhao MPH

  4. Lifetime Cancer Screening and Prevention Center, Moffitt Cancer Center, Tampa, FL, USA

    Jennifer Brzosowicz MS, CGC

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  1. Juliette Christie PhD
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  2. Gwendolyn P. Quinn PhD
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Correspondence to Susan T. Vadaparampil PhD.

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Christie, J., Quinn, G.P., Malo, T. et al. Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients. Ann Surg Oncol 19, 4003–4011 (2012). https://doi.org/10.1245/s10434-012-2460-x

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  • DOI: https://doi.org/10.1245/s10434-012-2460-x

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