1
|
Toss A, Quarello P, Mascarin M, Banna GL, Zecca M, Cinieri S, Peccatori FA, Ferrari A. Cancer Predisposition Genes in Adolescents and Young Adults (AYAs): a Review Paper from the Italian AYA Working Group. Curr Oncol Rep 2022; 24:843-860. [PMID: 35320498 PMCID: PMC9170630 DOI: 10.1007/s11912-022-01213-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The present narrative systematic review summarizes current knowledge on germline gene mutations predisposing to solid tumors in adolescents and young adults (AYAs). RECENT FINDINGS AYAs with cancer represent a particular group of patients with specific challenging characteristics and yet unmet needs. A significant percentage of AYA patients carry pathogenic or likely pathogenic variants (PV/LPVs) in cancer predisposition genes. Nevertheless, knowledge on spectrum, frequency, and clinical implications of germline variants in AYAs with solid tumors is limited. The identification of PV/LPV in AYA is especially critical given the need for appropriate communicative strategies, risk of second primary cancers, need for personalized long-term surveillance, potential reproductive implications, and cascade testing of at-risk family members. Moreover, these gene alterations may potentially provide novel biomarkers and therapeutic targets that are lacking in AYA patients. Among young adults with early-onset phenotypes of malignancies typically presenting at later ages, the increased prevalence of germline PV/LPVs supports a role for genetic counseling and testing irrespective of tumor type.
Collapse
Affiliation(s)
- Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Quarello
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Giuseppe Luigi Banna
- Candiolo Cancer Institute, FPO-IRCCS, SP142, km 3.95, 10060, Candiolo, Turin, Italy.
| | - Marco Zecca
- Department of Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Saverio Cinieri
- Medical Oncology Unit and Breast Unit Ospedale Perrino ASL, Brindisi, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| |
Collapse
|
2
|
van Engelen K, Barrera M, Wasserman JD, Armel SR, Chitayat D, Druker H, Gallinger B, Malkin D, Villani A. Tumor surveillance for children and adolescents with cancer predisposition syndromes: The psychosocial impact reported by adolescents and caregivers. Pediatr Blood Cancer 2021; 68:e29021. [PMID: 33788392 DOI: 10.1002/pbc.29021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Individuals with cancer predisposition syndromes (CPS) are often followed in cancer screening programs, which aim to detect early stage tumors. While cancer surveillance has the potential to improve patient outcomes, its psychosocial impact is uncharacterized in the pediatric population. We examined the cancer surveillance experience from the perspectives of adolescents and parents of children at risk of developing cancer. PATIENTS AND METHODS Using grounded theory and thematic analysis qualitative methodology, we conducted semi-structured interviews with parents and adolescents, separately. Interviews were transcribed verbatim and coded separately to derive overlapping and unique themes. RESULTS We completed 20 semi-structured interviews (11 parents and nine adolescents). Positive experiences were related to feelings of reassurance and taking a proactive approach. Both adolescents and parents experienced worry, related to practical aspects of screening, and related to the reminder of cancer risk that manifests with surveillance appointments. This worry was cyclical, associated with appointments, and generally waned over time. Participants felt that the benefits of surveillance outweighed perceived challenges. Open communication with health care providers, and equipping parents/adolescents with vocabulary to discuss their diagnosis and care with others, were felt to be important for mitigating worries associated with cancer risk and surveillance. CONCLUSION Parents and adolescents experience worry associated with surveillance for CPS, which may warrant regular psychosocial support, particularly during the first year following CPS diagnosis. Enhancing communication with the health care team and among and beyond immediate family members represents an additional important strategy to mitigate adverse experiences and perceptions.
Collapse
Affiliation(s)
- Kalene van Engelen
- Department of Clinical and Metabolic Genetics, The Hospital for Sick Children, Department of Molecular Genetics, University of Toronto, Toronto, Canada.,Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Canada
| | - Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Jonathan D Wasserman
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Susan Randall Armel
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Harriet Druker
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Bailey Gallinger
- Department of Clinical and Metabolic Genetics, The Hospital for Sick Children, Department of Molecular Genetics, University of Toronto, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - David Malkin
- Department of Pediatrics, Division of Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anita Villani
- Department of Pediatrics, Division of Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
van der Meer LB, van Duijn E, Giltay EJ, Tibben A. Do Attachment Style and Emotion Regulation Strategies Indicate Distress in Predictive Testing? J Genet Couns 2015; 24:862-71. [PMID: 25641254 PMCID: PMC4564439 DOI: 10.1007/s10897-015-9822-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 01/07/2015] [Indexed: 12/15/2022]
Abstract
Predictive genetic testing for a neurogenetic disorder evokes strong emotions, and may lead to distress. The aim of this study is to investigate whether attachment style and emotion regulation strategies are associated with distress in persons who present for predictive testing for a neurogenetic disorder, and whether these psychological traits predict distress after receiving test results. Self-report scales were used to assess attachment insecurity (anxiety and avoidance) and maladaptive emotion regulation strategies (self-blame, rumination, catastrophizing) in adults at 50 % risk for Huntington's Disease (HD), Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), and Hereditary Cerebral Hemorrhage With Amyloidosis - Dutch type (HCHWA-D), when they presented for predictive testing. Distress was measured before testing and twice (within 2 months and between 6 and 8 months) after receiving test results. Pearson correlations and linear regression were used to analyze whether attachment style and emotion regulation strategies indicated distress. In 98 persons at risk for HD, CADASIL, or HCHWA-D, attachment anxiety and catastrophizing were associated with distress before predictive testing. Attachment anxiety predicted distress up to 2 months after testing. Clinicians may consider looking for signs of attachment anxiety and catastrophizing in persons who present for predictive testing, to see who may be vulnerable for distress during and after testing.
Collapse
Affiliation(s)
- Lucienne B van der Meer
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands.
| | - Erik van Duijn
- Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands.,Center for Mental Health Care Delfland, Delft, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Cappelli M, Esplen MJ, Wilson BJ, Dorval M, Bottorff JL, Ly M, Carroll JC, Allanson J, Humphreys E, Rayson D. Identifying mental health services in clinical genetic settings. Clin Genet 2009; 76:326-31. [DOI: 10.1111/j.1399-0004.2009.01250.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Hoedemaekers E, Jaspers JPC, Van Tintelen JP. The influence of coping styles and perceived control on emotional distress in persons at risk for a hereditary heart disease. Am J Med Genet A 2007; 143A:1997-2005. [PMID: 17676600 DOI: 10.1002/ajmg.a.31871] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This prospective study investigates the influence of two coping styles (monitoring and blunting) and perceived control (health locus of control and mastery) on emotional distress in persons at risk of a hereditary cardiac disease. Emotional distress in people at risk for a hereditary cardiac disease does not differ from the normal population, neither before nor after disclosure of the DNA-or clinical test results. Less monitoring reflects less emotional distress before the results of the DNA-test or clinical investigations are known, while a stronger feeling of mastery reflects less emotional distress both before and after the results of the tests are known. These results indicate that the negative effect of monitoring is temporary. Mastery is a more powerful predictor than health locus of control in this situation.
Collapse
Affiliation(s)
- Elly Hoedemaekers
- Psychosocial Counseling Service, University Medical Center Groningen UMCG, University of Groningen, Groningen, The Netherlands
| | | | | |
Collapse
|
6
|
Martin W, Degner L. Perception of risk and surveillance practices of women with a family history of breast cancer. Cancer Nurs 2006; 29:227-35. [PMID: 16783123 DOI: 10.1097/00002820-200605000-00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A retrospective study was designed to examine the relationship between perception of risk and surveillance activities (mammography and clinical breast examination) in women with a family history of breast cancer. The Revised Susceptibility, Benefits, and Barriers Scale for Mammography Screening, the Centre for Epidemiology Studies--Depression Scale (CES-D), and a demographic form were administered to a convenience sample of 56 women. There were no significant relationships between perceived risk and screening activities. No significant correlations were found between age or depressive symptoms with either perceived risk or screening behaviors. Women with postsecondary qualifications were more likely to obtain regular mammograms. A substantial portion (34.5%) of participants reported depressive symptoms at a level associated with clinically significant levels of depression (>or=16 on the CES-D). Women over age 50 reported significantly more depressive symptoms than younger women. Perceived risk was not associated with screening; however, depression should be considered closely when dealing with women with higher-than-average risk of breast cancer.
Collapse
Affiliation(s)
- Wanda Martin
- Centre on Aging, University of Victoria, Victoria, BC, Canada.
| | | |
Collapse
|
7
|
Stemerding D, Nelis A. Cancer genetics and its "different faces of autonomy". NEW GENETICS AND SOCIETY 2006; 25:1-19. [PMID: 17312627 DOI: 10.1080/14636770600603329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this article we discuss the development of a practice of screening, preventive treatment, and presymptomatic testing for individuals at risk of Familial Adenomatous Polyposis (FAP), a specific hereditary predisposition for colon cancer. We describe this development as a process of co-evolution, showing how this practice has been gradually taking shape in a new network of actors, routines, rules, institutions and technologies. We further argue that, looking at the emergence and transformation of this practice, we can distinguish two different regimes: a regime of prevention and a regime of self-determination. In each of these regimes the autonomy of patients and individuals at risk is shaped in a different way, that is, through a different complex of ideals, procedures, institutions, technologies, and routines. In our view, the interference between these two regimes is an important characteristic of the emergent new genetics and is reflected in the growing debate about non-directivity in genetic counselling. However, as our argument implies, when facing the challenges of the new genetics we should not restrict the debate to the quality and ethics of counselling, but extend our view to the whole complex of elements and activities which shapes individual autonomy in the context of different regimes.
Collapse
Affiliation(s)
- Dirk Stemerding
- Department of Science, Technology, Health and Policy Studies, University of Twente, BBT-STeHPS, PO Box 217, 7500 AE Enschede, The Netherlands.
| | | |
Collapse
|
8
|
Rimes KA, Salkovskis PM, Jones L, Lucassen AM. Applying a cognitive behavioral model of health anxiety in a cancer genetics service. Health Psychol 2006; 25:171-80. [PMID: 16569108 DOI: 10.1037/0278-6133.25.2.171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A cognitive-behavioral model of health anxiety was used to investigate reactions to genetic counseling for cancer. Participants (N = 218) were asked to complete a questionnaire beforehand and 6 months later. There was an overall decrease in levels of cancer-related anxiety, although 24% of participants showed increased cancer-related anxiety at follow-up. People who had a general tendency to worry about their health reported more cancer-related anxiety than those who did not at both time points. This health-anxious group also showed a postcounseling anxiety reduction, whereas the others showed no significant change. Participants with breast or ovarian cancer in their family were more anxious than participants with colon cancer in their family. Preexisting beliefs were significant predictors of anxiety, consistent with a cognitive-behavioral approach.
Collapse
Affiliation(s)
- Katharine A Rimes
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.
| | | | | | | |
Collapse
|
9
|
Griffith GL, Tudor-Edwards R, Gray J, Butler R, Wilkinson C, Turner J, France B, Bennett P. A micro costing of NHS cancer genetic services. Br J Cancer 2005; 92:60-71. [PMID: 15583691 PMCID: PMC2361743 DOI: 10.1038/sj.bjc.6602270] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper presents the first full micro costing of a commonly used cancer genetic counselling and testing protocol used in the UK. Costs were estimated for the Cardiff clinic of the Cancer Genetics Service in Wales by issuing a questionnaire to all staff, conducting an audit of clinic rooms and equipment and obtaining gross unit costs from the finance department. A total of 22 distinct event pathways were identified for patients at risk of developing breast, ovarian, breast and ovarian or colorectal cancer. The mean cost per patient were pound sterling 97- pound sterling 151 for patients at moderate risk, pound sterling 975- pound sterling 3072 for patients at high risk of developing colorectal cancer and pound sterling 675- pound sterling 2909 for patients at high risk of developing breast or ovarian cancer. The most expensive element of cancer genetic services was labour. Labour costs were dependent upon the amount of labour, staff grade, number of counsellors used and the proportion of staff time devoted to indirect patient contact. With the growing demand for cancer genetic services and the growing number of national and regional cancer genetic centers, there is a need for the different protocols being used to be thoroughly evaluated in terms of costs and outcomes.
Collapse
Affiliation(s)
- G L Griffith
- Centre for the Economics of Health, Institute of Medical and Social Care Research, Wheldon Building, University of Wales, Bangor LL57 2UW, UK.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Hendriks KSWH, Grosfeld FJM, Wilde AAM, van den Bout J, van Langen IM, van Tintelen JP, ten Kroode HFJ. High Distress in Parents Whose Children Undergo Predictive Testing for Long QT Syndrome. ACTA ACUST UNITED AC 2005; 8:103-13. [PMID: 15925886 DOI: 10.1159/000084778] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the psychological effect of predictive testing in parents of children at risk for long QT syndrome (LQTS) in a prospective study. METHODS After their child was clinically screened by electrocardiography and blood was taken for DNA analysis, and shortly after delivery of the DNA test result, 36 parents completed measures of psychological distress. RESULTS 24 parents were informed that at least one of their children is a mutation carrier. Up to 50% of the parents of carrier children showed clinically relevant high levels of distress. Parents who were familiar with the disease for a longer time, who had more experiences with the disease in their family and who received positive test results for all their children were most distressed. CONCLUSIONS Predictive ECG testing together with DNA testing has a profound impact on parents whose minors undergo predictive testing for LQTS.
Collapse
Affiliation(s)
- Karin S W H Hendriks
- Department of Medical Psychology, University Medical Center Utrecht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|