Reflex BRCA1 and BRCA2 tumour genetic testing for high-grade serous ovarian cancer: streamlined for clinicians but what do patients think?

Abstract

Background Reflex (automatic) BRCA1 and BRCA2 (BRCA1/2) genetic testing of tumour tissue is being completed for all newly diagnosed high-grade serous ovarian cancer (HGSOC) in the province of Ontario, Canada. The objective of this study was to measure the psychological impact of tumour genetic testing among individuals with a new diagnosis of HGSOC. Methods Participants had a new diagnosis of HGSOC and received reflex BRCA1/2 tumour genetic testing as a component of their care. Eligible individuals were recruited from two oncology centres in Toronto, Canada. One week after disclosure of tumour genetic test results, consenting participants were asked to complete a questionnaire that measured cancer-related distress, dispositional optimism, knowledge of hereditary breast/ovarian cancer, recall of tumour genetic test results, satisfaction, and the psychological impact of receiving tumour genetic test results. The Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire was used to measure the psychological impact of tumour genetic testing. Results 76 individuals completed the study survey; 13 said they did not receive their tumour test results. Of the remaining 63 participants, the average MICRA score was 26.8 (SD = 16.3). Higher total MICRA scores were seen among those with children (p = 0.02), who received treatment with primary surgery (p = 0.02), and had higher reported cancer-related distress (p < 0.001). Higher dispositional optimism (p < 0.001) and increasing age (p = 0.03) were associated with lower total MICRA scores. Most (83.5%) participants reported being satisfied/highly satisfied with having tumour testing completed; however, 40.8% could not accurately recall their tumor test results. Conclusions This study is the first to assess psychological outcomes following reflex BRCA1/2 tumour genetic testing in women newly diagnosed with HGSOC. Increased dispositional optimism provided a protective effect, while increased cancer-related distress increased the psychological impact of tumour genetic testing. Educational resources are needed to help increase patient understanding and recall of tumour results, particularly when tumour genetic testing includes analysis of genes that may have implications for hereditary cancer risk. Additional research is required to better understand the patient experience of reflex tumour genetic testing.

What happens in the long term: Uptake of cancer surveillance and prevention strategies among at‐risk relatives with pathogenic variants detected via cascade testing

“…32 The finding of overall high levels of satisfaction with genetic testing and an improved experience among older individuals is consistent with the prior literature on cancer genetic assessment. [32][33][34][35] Interestingly, although several prior studies have demonstrated that females are more likely to complete cascade testing than males, we found no difference in rates of testing by sex in our cohort 11,[36][37][38][39] ;…”

Patient‐reported outcomes associated with reflex BRCA1/2 tumor and subsequent germline panel genetic testing for high‐grade serous ovarian cancer

“…Additional qualitative studies to glean participant perspectives may provide more context to the relatively high MICRA scores seen in our cohort; however, they may be related to consistently high levels of cancer-related distress, as cancer-related distress has been associated with genetic testing-related distress (McCuaig et al, 2022). (Bjornslett et al, 2015;Pozzar et al, 2022;Richardson et al, 2020).…”

“…This is an exploratory secondary analysis of a prospective cohort study of newly diagnosed HGSOC patients seen at one of two academic centers in Toronto, Canada (McCuaig et al, 2022)…”

“…This is an exploratory secondary analysis of a prospective cohort study of newly diagnosed HGSOC patients seen at one of two academic centers in Toronto, Canada (McCuaig et al, 2022). Eligible participants were recruited from the University Health Network (UHN) from December 2019 to August 2021 and from Sunnybrook Health Sciences Centre (Sunnybrook) from December 2020 to August 2021.…”

“…Importantly, this genetic testing model was implemented prior to the availability of patient-reported outcomes. Our group recently reported on the experience of 76 individuals with a new diagnosis of HGSOC following receipt of reflex BRCA1/2 tumor genetic test results (McCuaig et al, 2022). While most were satisfied with having tumor genetic testing, almost half could not recall their test results and the level of genetic testing-related distress reported was relatively high when compared to other published cohorts of ovarian cancer patients.…”