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

Christie, Juliette; Quinn, Gwendolyn P.; Malo, Teri L.; Lee, Ji‐Hyun; Zhao, Xiuhua; McIntyre, Jessica; Brzosowicz, Jennifer; Jacobsen, Paul B.; Vadaparampil, Susan T.

doi:10.1245/s10434-012-2460-x

Cited by 31 publications

(27 citation statements)

References 55 publications

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“…21,22 By contrast, qualitative data indicate that women with breast cancer have a positive attitude toward RGCT, 23 and results of a pilot study have suggested that genetic counseling before definitive surgery does not increase distress levels. 24 The results of our trial provide additional evidence in this regard. However, we emphasize the need to confirm our results in future studies.…”

Section: Discussionmentioning

confidence: 58%

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

Wevers

Ausems

Verhoef

et al. 2016

Genetics in Medicine

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Original research article IntroductIonFemale breast cancer patients who carry a BRCA1 or BRCA2 gene mutation have an increased risk of 20-55% for developing a second primary breast cancer 1 and are at increased risk for ovarian cancer. The risk of contralateral breast cancer is highest for carriers who were diagnosed with their first breast cancer at a young age. 1 Between 18 and 29% of carriers with a favorable prognosis opt for immediate or, more often, delayed contralateral prophylactic mastectomy (CPM) to reduce their risk of a second breast cancer. [2][3][4] Several studies have shown that a CPM leads to a large reduction (up to 95%) in the risk of contralateral breast cancer, with increasing evidence of improved breast cancer-specific survival. 5,6 Advances in the technology and logistics of genetic testing of the BRCA1 and BRCA2 genes have made it possible to offer high-risk breast cancer patients the opportunity to undergo rapid genetic counseling and testing (RGCT) during the time period between diagnosis and primary surgery. Women who Purpose: Female breast cancer patients carrying a BRCA1/2 mutation have an increased risk of second primary breast cancer. Rapid genetic counseling and testing (RGCT) before surgery may influence choice of primary surgical treatment. In this article, we report on the psychosocial impact of RGCT. Methods:Newly diagnosed breast cancer patients at risk for carrying a BRCA1/2 mutation were randomized to an intervention group (offer of RGCT) or a usual care control group (ratio 2:1). Psychosocial impact and quality of life were assessed with the Impact of Events Scale, Hospital Anxiety and Depression Scale, Cancer Worry Scale, and the EORTC QLQ-C30 and QLQ-BR23. Assessments took place at study entry and at 6-and 12-month follow-up visits.results: Between 2008 and 2010, 265 patients were recruited into the study. Completeness of follow-up data was more than 90%. Of the 178 women in the intervention group, 177 had genetic counseling, of whom 71 (40%) had rapid DNA testing and 59 (33%) received test results before surgery. Intention-to-treat and per-protocol analyses showed no statistically significant differences between groups over time in any of the psychosocial outcomes. conclusions:In this study, RGCT in newly diagnosed breast cancer patients did not have any measurable adverse psychosocial effects.

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Section: Discussionmentioning

confidence: 58%

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

Wevers

Ausems

Verhoef

et al. 2016

Genetics in Medicine

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“…13,26 Better outcomes when genetic counseling is performed by a GC compared with nongenetics physicians are not unexpected, given that nongenetics physicians often self-report little or no genetics training and low competence in genetics. [27][28][29] Compounding factors include increasing demands on physician time, shorter encounters with patients, and limited mechanisms for clinician training in genetics.…”

Section: Use and Outcomes Of Brca Testing And Counseling In Insured Wmentioning

confidence: 99%

Utilization and Outcomes ofBRCAGenetic Testing and Counseling in a National Commercially Insured Population

et al. 2015

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Despite improved patient knowledge, understanding, and satisfaction among patients who receive genetic counseling provided by a genetics clinician, as well as multiple guidelines emphasizing the importance of genetic counseling, most US women undergoing BRCA genetic testing do not receive this clinical service. Lack of physician recommendation is the most commonly reported reason. These findings demonstrate important gaps in clinical genetics services. Recently mandated coverage of genetic counseling services as a preventive service without patient cost sharing should contribute to improving clinical genetics services and associated outcomes in the future.

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“…Furthermore, results from this sample reported in an earlier manuscript found no changes in cancer distress or decisional conflict about genetic testing following the pre-test genetic counseling session [26]. However, it is unclear what aspects of genetic counseling caused these positive changes.…”

Section: Discussionmentioning

confidence: 71%

“…The methods used for the study are reported in greater detail in previous reports [26,27] and are briefly summarized below.…”

Section: Methodsmentioning

confidence: 99%

“…As part of a longitudinal study exploring the impact of genetic counseling and testing on cognitive and psychological outcomes, an earlier paper reported results from the first two time points, before and after the pre-test genetic counseling session. The paper reported differences in outcomes related to knowledge, cancer-related distress, and decisional conflict between patients who attended pretest genetic counseling prior to, versus those who attended after definitive surgical treatment [26]. A second paper reported on communication of test results to family members and providers among a subset of BC survivors who pursued genetic testing [27].…”

Section: Introductionmentioning

confidence: 99%

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Breast Cancer Survivors' Knowledge of Hereditary Breast and Ovarian Cancer following Genetic Counseling: An Exploration of General and Survivor-Specific Knowledge Items

Scherr

Christie

Vadaparampil

2015

Public Health Genomics

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Background: Previous studies found genetic counseling increased participants' knowledge about hereditary breast and ovarian cancer (HBOC). However, most explored knowledge gain in unaffected women and the scale most commonly used does not include items that may be more pertinent to breast cancer (BC) survivors. Aims: To explore whether genetic counseling impacts BC survivors' knowledge about HBOC and BC survivor-specific information. Methods: The National Center for Human Genome Research Knowledge Scale and 5 additional items specific to BC survivors were tested among BC survivors; before genetic counseling (time 1), 2-3 weeks after genetic counseling (time 2), and 6 months following genetic counseling (time 3). Results: A statistically significant change in knowledge over time was found. Post hoc analyses revealed statistically significant increases in knowledge between time 1 (median = 7.00) and time 2 (median = 10.00; p < 0.005), and between time 1 and time 3 (median = 9.00; p < 0.005). Conclusion: Knowledge increased following genetic counseling, but the highest total average score at any time was <70% out of 100%. Additional analyses revealed items with low rates of correct response at all three time points, raising several concerns and the consideration of alternative approaches to measuring knowledge.

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

Cited by 31 publications

References 55 publications

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

Utilization and Outcomes ofBRCAGenetic Testing and Counseling in a National Commercially Insured Population

Breast Cancer Survivors' Knowledge of Hereditary Breast and Ovarian Cancer following Genetic Counseling: An Exploration of General and Survivor-Specific Knowledge Items

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