Healthcare Policy and Outcomes

Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4003-4011

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

  • Juliette ChristieAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center
  • , Gwendolyn P. QuinnAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer CenterDepartment of Oncologic Science, College of Medicine, University of South Florida
  • , Teri MaloAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center
  • , Ji-Hyun LeeAffiliated withDepartment of Oncologic Science, College of Medicine, University of South FloridaDepartment of Biostatistics, Moffitt Cancer Center
  • , Xiuhua ZhaoAffiliated withDepartment of Biostatistics, Moffitt Cancer Center
  • , Jessica McIntyreAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center
  • , Jennifer BrzosowiczAffiliated withLifetime Cancer Screening and Prevention Center, Moffitt Cancer Center
  • , Paul B. JacobsenAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer CenterDepartment of Oncologic Science, College of Medicine, University of South Florida
  • , Susan T. VadaparampilAffiliated withDepartment of Health Outcomes and Behavior, Population Science, Moffitt Cancer CenterDepartment of Oncologic Science, College of Medicine, University of South Florida Email author 

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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.