Date: 06 Jul 2012
Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
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).
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.
Chen Y, Thompson W, Semenciw R, Mao Y. Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomarkers Prev. 1999;8:855–61.PubMed
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.
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.CrossRef
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.CrossRef
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.
Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press, 2005.
American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol. 2003;21:2397–406.
Fraser FC. Genetic counseling. Am J Hum Genet. 1974;26:636–61.PubMed
Vadaparampil ST, Miree CA, Wilson C, Jacobsen PB. Psychosocial and behavioral impact of genetic counseling and testing. Breast Dis. 2007;27:97–108.
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.CrossRef
Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.PubMed
O’Connor AM. User manual—decisional conflict scale. Ottawa: Ottawa Hospital Research Institute, 1993, updated 2010.
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.
- Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients
Annals of Surgical Oncology
Volume 19, Issue 13 , pp 4003-4011
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center, Tampa, FL, USA
- 2. Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, FL, USA
- 3. Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA
- 4. Lifetime Cancer Screening and Prevention Center, Moffitt Cancer Center, Tampa, FL, USA