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Peipins LA, Dasari S, Viox MH, Rodriguez JL. Information needs persist after genetic counseling and testing for BRCA1/2 and Lynch Syndrome. Breast Cancer Res Treat 2024:10.1007/s10549-024-07377-9. [PMID: 39046629 DOI: 10.1007/s10549-024-07377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Research has shown that cancer genetic risk is often not well understood by patients undergoing genetic testing and counseling. We describe the barriers to understanding genetic risk and the needs of high-risk persons and cancer survivors who have undergone genetic testing. METHODS Using data from an internet survey of adults living in the USA who responded 'yes' to having ever had a genetic test to determine cancer risk (N = 696), we conducted bivariate analyses and multivariable logistic regression models to evaluate associations between demographic, clinical, and communication-related variables by our key outcome of having vs. not having enough information about genetics and cancer to speak with family. Percentages for yes and no responses to queries about unmet informational needs were calculated. Patient satisfaction with counseling and percentage disclosure of genetic risk status to family were also calculated. RESULTS We found that a lack of resources provided by provider to inform family members and a lack of materials provided along with genetic test results were strongly associated with not having enough information about genetics and cancer (OR 4.54 95% CI 2.40-8.59 and OR 2.19 95% CI 1.16-4.14 respectively). Among participants undergoing genetic counseling, almost half reported needing more information on what genetic risk means for them and their family and how genetic testing results might impact future screening. CONCLUSION High levels of satisfaction with genetic counseling may not give a full picture of the patient-provider interaction and may miss potential unmet needs of the patient. Accessible resources and ongoing opportunities for updating family history information could reinforce knowledge about genetic risk.
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Affiliation(s)
- Lucy A Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Centers for Disease Control and Prevention, NCCDPHP/DCPC, 4770 Buford Hwy., NE, Mailstop S107-4, Chamblee, GA, USA.
| | | | | | - Juan L Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Ustun Yilmaz S, Agaoglu NB, Manto K, Muftuoglu M, Özbek U. Cosmic Whirl: Navigating the Comet Trail in DNA: H2AX Phosphorylation and the Enigma of Uncertain Significance Variants. Genes (Basel) 2024; 15:724. [PMID: 38927659 PMCID: PMC11202575 DOI: 10.3390/genes15060724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Pathogenic variations in the BRCA2 gene have been detected with the development of next-generation sequencing (NGS)-based hereditary cancer panel testing technology. It also reveals an increasing number of variants of uncertain significance (VUSs). Well-established functional tests are crucial to accurately reclassifying VUSs for effective diagnosis and treatment. We retrospectively analyzed the multi-gene cancer panel results of 922 individuals and performed in silico analysis following ClinVar classification. Then, we selected five breast cancer-diagnosed patients' missense BRCA2 VUSs (T1011R, T1104P/M1168K, R2027K, G2044A, and D2819) for reclassification. The effects of VUSs on BRCA2 function were analyzed using comet and H2AX phosphorylation (γH2AX) assays before and after the treatment of peripheral blood mononuclear cells (PBMCs) of subjects with the double-strand break (DSB) agent doxorubicin (Dox). Before and after Dox-induction, the amount of DNA in the comet tails was similar in VUS carriers; however, notable variations in γH2AX were observed, and according to combined computational and functional analyses, we reclassified T1001R as VUS-intermediate, T1104P/M1168K and D2819V as VUS (+), and R2027K and G2044A as likely benign. These findings highlight the importance of the variability of VUSs in response to DNA damage before and after Dox-induction and suggest that further investigation is needed to understand the underlying mechanisms.
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Affiliation(s)
- Sevdican Ustun Yilmaz
- Department of Medical Biotechnology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye; (S.U.Y.); (M.M.)
| | - Nihat Bugra Agaoglu
- Department of Medical Genetics, Umraniye Training and Research Hospital, University of Health Sciences, 34764 Istanbul, Türkiye;
- IKF-The Frankfurt Institute of Clinical Cancer Research, 60488 Frankfurt am Main, Germany
| | - Karin Manto
- Department of Genome Studies, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye;
| | - Meltem Muftuoglu
- Department of Medical Biotechnology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye; (S.U.Y.); (M.M.)
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye
| | - Ugur Özbek
- Department of Medical Biotechnology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye; (S.U.Y.); (M.M.)
- Department of Genome Studies, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye;
- Izmir Biomedicine and Genome Center (IBG), 35340 Izmir, Türkiye
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3
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Nääs C, von Salomé J, Rosén A. Patients' perceptions and practices of informing relatives: a qualitative study within a randomised trial on healthcare-assisted risk disclosure. Eur J Hum Genet 2024; 32:448-455. [PMID: 38308085 PMCID: PMC10999412 DOI: 10.1038/s41431-024-01544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
In a multicentre randomised controlled trial (DIRECT), we evaluate whether an intervention of providing direct letters from healthcare professionals to at-risk relatives (ARRs) affects the proportion of ARRs contacting a cancer genetics clinic, compared with patient-mediated disclosure alone (control). With the aim to explore how the patients included in the trial perceived and performed risk communication with their ARRs we analysed 17 semi-structured interviews with reflexive thematic analysis. All patients described that they disclosed risk information to all close relatives themselves. No integrity-related issues were reported by patients offered the intervention, and all of them accepted direct letters to all their ARRs. Patients' approaches to informing distant relatives were unpredictable and varied from contacting all distant ARRs, sharing the burden with the family, utilising the offer of sending direct letters, vaguely relying on others to inform, or postponing disclosure. Most patients limited their responsibility to the disclosure, although others wanted relatives to get genetic counselling or felt a need to provide additional information to the ARRs before ending their mission. We also identified confusion about the implication of test results, who needed risk information, and who was responsible for informing ARRs. These misunderstandings possibly also affected risk disclosure. This study revealed that despite accepting the direct letters to be sent to all relatives, the patients also contributed to risk disclosure in other ways. It was only in some situations to distant relatives that the healthcare-assisted letter was the only means of communication to the ARRs.
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Affiliation(s)
- Charlotta Nääs
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Jenny von Salomé
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Anna Rosén
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden.
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4
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Martin SC, Scott AM, Stone AM. Women's Metaphors About BRCA Gene Testing and How They Can Inform Health Communication Theory and Practice. HEALTH COMMUNICATION 2024; 39:603-615. [PMID: 36775863 DOI: 10.1080/10410236.2023.2178051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman's risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women's experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora's box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women's experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk.
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Affiliation(s)
- Summer C Martin
- Department of Human Communication Studies, California State University, Fullerton
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5
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Wellman ML, Holton AE, Kaphingst KA. "Where do I go? Who do I go to?": BRCA Previvors, genetic counselors and family planning. PEC INNOVATION 2023; 2:100157. [PMID: 37214521 PMCID: PMC10194322 DOI: 10.1016/j.pecinn.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Objective We sought to understand BRCA previvors' perceptions of communication with genetic counselors and other healthcare providers. Methods We conducted 16 qualitative interviews and utilized thematic analysis to develop patterns present in the narratives of previvors. Results Interviews with previvors suggest genetic counselors and other providers often make assumptions about previvors' family planning and treatment needs based on perceived gender, age, and sexual orientation. Conclusion BRCA patients require individualized attention when planning for their future and making healthcare decisions and we argue that implementing patient-centered care practices into the communication process can provide a higher quality of care. Innovation This study offers an innovative lens through which scholars and healthcare providers may examine the experiences of BRCA previvors as they seek adequate care. Asking previvors to explain their perceptions of conversations with genetic counselors and healthcare providers offers insight into the communicative process of seeking care rather than the health outcomes of the care itself. Our findings suggest biases among providers related to gender, age, and sexual orientation are concerning elements of family planning communication that potentially interrupt previvors' abilities to express their care needs in a safe environment. We argue for an increased awareness of, and advocacy for, more inclusive conversations regarding treatment and family planning decisions.
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Affiliation(s)
- Mariah L. Wellman
- Department of Communication, University of Illinois Chicago, 1007 W. Harrison St., Chicago, IL, 60607, United States of America
| | - Avery E. Holton
- Department of Communication, University of Utah, United States of America
| | - Kimberly A. Kaphingst
- Department of Communication, Huntsman Cancer Institute, University of Utah, United States of America
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6
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Sweet K, Reiter PL, Schnell PM, Senter L, Shane-Carson KP, Aeilts A, Cooper J, Spears C, Brown J, Toland AE, Agnese DM, Katz ML. Genetic counseling and testing for females at elevated risk for breast cancer: Protocol for the randomized controlled trial of the Know Your Risk intervention. Contemp Clin Trials 2023; 133:107323. [PMID: 37661005 PMCID: PMC10591709 DOI: 10.1016/j.cct.2023.107323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Genetic counseling and testing have an important role in the care of patients at elevated risk for breast cancer. However, conventional pre- and post-test genetic counseling is labor and time intensive, less accessible for patients living outside major urban centers, and impractical on a large scale. A patient-driven approach to genetic counseling and testing may increase access, improve patients' experiences, affect efficiency of clinical practice, and help meet workforce demand. The objective of this 2-arm randomized controlled trial is to determine the efficacy of Know Your Risk (KYR), a genetic counseling patient preference intervention. METHODS Females (n = 1000) at elevated risk (>20% lifetime) for breast cancer will be randomized to the KYR intervention or conventional genetic counseling. The study will provide comprehensive assessment of breast cancer risk by multigene panel testing and validated polygenic risk score. Primary outcome is adherence to National Comprehensive Cancer Network guidelines for a clinical encounter every 6-12 months and an annual mammogram (breast MRI if recommended) determined by medical record review. Secondary outcomes include adherence to other recommended cancer screening tests determined by medical record review and changes in breast cancer knowledge, perception of risk, post-test/counseling distress, and satisfaction with counseling by completion of three surveys during the study. Study aims will be evaluated for non-inferiority of the KYR intervention compared to conventional genetic counseling. CONCLUSION If efficacious, the KYR intervention has the potential to improve patients' experience and may change how genetic counseling is delivered, inform best practices, and reduce workforce burden. TRIAL REGISTRATION ClinicalTrials.govNCT05325151.
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Affiliation(s)
- Kevin Sweet
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Paul L Reiter
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Patrick M Schnell
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kate P Shane-Carson
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amber Aeilts
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Julia Cooper
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Christina Spears
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Jordan Brown
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Bioethics, Department of Biomedical Education and Anatomy, The Ohio State University, Columbus, OH, USA
| | - Amanda E Toland
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Doreen M Agnese
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
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7
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Abdel-Razeq H, Abbasi S, Abdeen G, Abdulelah H, Debs J, Al Masri S, Aljadayeh MH, Awidi A. Management of breast cancer patients with BRCA gene mutations in Jordan: perspectives and challenges. Hosp Pract (1995) 2023; 51:184-191. [PMID: 37927299 DOI: 10.1080/21548331.2023.2266019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND This paper explores and discusses local challenges oncologists face for diagnosing and managing breast cancer patients with BRCA gene mutations in Jordan. METHODS A task force involving key opinion leaders, experts in the management of breast cancer, and stakeholders in healthcare systems where genetic testing is available in Jordan discussed current evidence and local real-life practice. The task force then formulated recommendations to achieve better patient outcomes and satisfaction based on evidence-based medicine and their clinical experience in BRCA-mutated breast cancer management. RESULTS AND CONCLUSION Eligibility of patients for genetic testing, physician acceptance and willingness to integrate genetic testing into routine practice is encouraging but remains restricted by testing availability and financial coverage. Until more data is available, genetic testing should be targeted for breast cancer patients based on tumor subtypes, as well as family and personal history of cancer, as per international guidelines. Whenever possible, genetic testing should aim to detect all actionable genes through a multigene panel including BRCA1/2. Major challenges faced in clinical practice in Jordan include fear of genetic discrimination and social stigmatization, as well as hesitancy toward risk-reducing surgery. Pre-testing counseling is therefore critical to promote acceptance of genetic testing. Since geneticists are in short supply in Jordan, genetic counseling can be offered through a specially trained genetic counselor or through a hybrid system that includes oncologist-based counselling. In addition to cancer prevention, germline genetic testing may assist in the selection of specific anti-cancer therapy, such as PARP inhibitors, in patients with BRCA1/2 mutation. Nationwide initiatives are also needed to ensure access to PARP inhibition therapy and provide financial coverage for genetic screening, mastectomies and reconstructive surgery across Jordan.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Deputy Director General, Chief Medical Officer, King Hussein Cancer Center, Amman, Jordan
| | - Salah Abbasi
- Hematology and Medical Oncology; Associate Professor of Medicine, Hematology & Oncology, Private Sector, Jordan University, Amman, Jordan
| | - Ghadeer Abdeen
- Consultant Internal Medicine and Medical Oncologist, King Hussein Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Consultant Internal Medicine and Medical Oncologist, King Hussein Cancer Center, Amman, Jordan
| | - Jamil Debs
- Medical Affairs, Pfizer Inc., Beirut, Lebanon
| | | | - Majdi H Aljadayeh
- Head of Medical Oncology, Hematology and Stem Cell Transplant Unit, Military Cancer Center, Royal Medical Services, Amman, Jordan
| | - Abdalla Awidi
- Professor of Medicine, Hematology & Oncology, Director of cell therapy center, Chief of Hematology & Oncology, Cell Therapy center, The University of Jordan, Amman, Jordan
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8
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Shi XP, Dychangco MEA, Yang XM, Olivar JJR. Development and Validation of the Missed Nursing Care Tool for Pre-Operative Patients with Lung Cancer in China. Patient Prefer Adherence 2023; 17:1451-1465. [PMID: 37350778 PMCID: PMC10284153 DOI: 10.2147/ppa.s413585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Current research suggests that missed nursing care is widespread in preoperative lung cancer patients in China, and preoperative airway management nursing care for lung cancer patients is not standardized. Missed nursing care for preoperative lung cancer patients, on the other hand, is rarely investigated, particularly from the patient's perspective. This study aimed to develop and validate the MISSCARE Survey for pre-operative patients with lung cancer in China. Methods This study generated the preliminary draft of the MISSCARE Survey - Lung Cancer Patient (MS-LCP) and tested its reliability and stability through three rounds of lung cancer resection (494, 50, and 309 cases, respectively). 20 patients and 6 experts determined the face and content validity. EFA and CFA assessed construct and convergent validity. Internal consistency, including Cronbach's alpha, Spearman-Brown reliability, and re-test reliability, was also examined. Results The scale contained 15 items, including specific care, communicative care, timely care, and basic care. KMO was 0.932 (> 0.6), and Bartlett's Test of Sphericity showed P = 0.000 (<0.05). The attribution factor's item loads ranged from 0.765 to 0.853, accounting for 82.20% of the variation. The scale's Cronbach's alpha, Spearman-Brown, and retest reliability were 0.945, 0.879, and 0.824. CFA showed goodness of fit (RMSEA = 0.021, χ2/df = 1.138, GFI = 0.900, AGFI = 0.945, CFI = 0.996, NFI = 0.967, IFI = 0.996). For each dimension, AVE ranged from 0.555 to 0.717 (>0.50) and CR from 0.861 to 0.904 (>0.70). Conclusion The MS-LCP was reliable and valid in this study, making it appropriate for the Chinese lung cancer patient population. This tool is more objective in its presentation of missed nursing care, assisting nursing staff in optimizing nursing procedures before surgery, increasing the implementation of higher-quality tumor care, and promoting the recovery of lung cancer surgery patients.
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Affiliation(s)
- Xin-ping Shi
- The Nursing Department, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Ma Encarnacion A Dychangco
- Paulinian Leadership Academy, University Research Council, St Paul University Manila, Manila, Philippine
| | - Xu-ming Yang
- Operating Room, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Brugioni E, Cathcart-Rake E, Metsker J, Gustafson E, Douglass L, Pluard TJ. Germline BRCA-Mutated HER2-Negative Advanced Breast Cancer: Overcoming Challenges in Genetic Testing and Clinical Considerations When Using Talazoparib. Clin Breast Cancer 2023:S1526-8209(23)00091-5. [PMID: 37246120 DOI: 10.1016/j.clbc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/30/2023]
Abstract
Genetic testing is essential to the diagnosis and management of patients with breast cancer. For example, women who carry mutations in BRCA1/2 genes have an increased lifetime risk of breast cancer and the presence of these mutations may sensitize the patient to treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. Two PARP inhibitors are approved by the US Food and Drug Administration for patients with germline BRCA-mutated advanced breast cancer (olaparib and talazoparib). The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer (Version 2.2023) recommend that all patients with recurrent or metastatic breast cancer (mBC) be assessed for the presence of germline BRCA1/2 mutations. However, many women eligible for genetic testing do not receive it. Here, we provide our perspectives on both the importance of genetic testing and the challenges patients and community clinicians may face when trying to access genetic testing. We also present a hypothetical case study involving a female patient with germline BRCA-mutated human epidermal growth factor receptor 2 (HER2)-negative mBC to highlight potential clinical considerations on the use of talazoparib, including the decision to initiate therapy, dosing considerations, potential drug-drug interactions, and managing side effects. This case illustrates the benefits of a multidisciplinary approach to managing patients with mBC and involving the patient in the decision-making process. This patient case is fictional and does not represent events or a response from an actual patient; this fictional case is for educational purposes only.
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Affiliation(s)
| | | | | | | | | | - Timothy J Pluard
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO
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10
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Katz ML, Senter L, Reiter PL, Emerson B, Ennis AC, Shane-Carson KP, Aeilts A, Cassingham HR, Schnell PM, Agnese DM, Toland AE, Sweet K. Development of a web-based, theory-guided narrative intervention for women at elevated risk for breast cancer. PATIENT EDUCATION AND COUNSELING 2023; 106:163-169. [PMID: 36333195 PMCID: PMC10395484 DOI: 10.1016/j.pec.2022.10.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the development of a web-based, theory-guided narrative intervention that replaces conventional pre-test genetic counseling for women at elevated breast cancer risk. METHODS We used an iterative process that was guided by health behavior theory and feedback from multiple stakeholder groups including: 1) content input from genetic experts; 2) study team input; 3) review of video storyboards, video example, study logo, recruitment materials, post-test patient preference counseling survey, and additional study surveys; 4) video series development; and 5) intervention review and finalization of study-related materials. RESULTS The intervention is patient-centered providing convenience and an opportunity for an individual's preferences for post-test counseling delivery. The intervention's efficacy is being determined in a randomized controlled trial compared to conventional genetic counseling for adherence to recommended guidelines and changes in knowledge, perception of breast cancer risk, breast cancer-specific worry, and satisfaction with counseling. CONCLUSION If efficacious, the intervention may improve the delivery of the genetic testing and counseling process, inform best practices, and reduce the genetic counseling workforce burden. PRACTICE IMPLICATIONS The developed intervention has the potential to improve the genetic testing and counseling experience for women at elevated risk for breast cancer, inform best practices, and reduce genetic counseling workforce burden.
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Affiliation(s)
- Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alysha C Ennis
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kate P Shane-Carson
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amber Aeilts
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Hayley R Cassingham
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Doreen M Agnese
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amanda E Toland
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA; Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kevin Sweet
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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11
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Krauss E, Macher J, Capasso J, Bernhardt B, Ali-KhanCatts Z, Levin A, Brandt R. Experiences of genetic testing among individuals with retinitis pigmentosa. Ophthalmic Genet 2022; 43:633-640. [PMID: 35796432 DOI: 10.1080/13816810.2022.2096243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Retinitis pigmentosa (RP) is a genetically heterogeneous retinal dystrophy which results in progressive vision loss. There is scant literature on the experiences of genetic testing in patients with RP. MATERIALS AND METHODS Patients with a clinical diagnosis of RP who received genetic testing at the Wills Eye Ocular Genetics clinic between 2016 and 2020 were recruited. Telephone interviews were conducted using a semi-structured guide designed to elicit participant experiences with genetic testing. A thematic analysis was performed to describe patterns in participant responses. RESULTS Twelve patients participated. Seven participants identified as female and five as male, with ages ranging from 22 to 70. Ten patients had positive genetic test results, while two had negative genetic testing. Reported motivations for genetic testing included qualification for clinical trials (58% of total participants), determination of etiology or usal gene (50%), reproductive concerns (50%), and prognostic outlook (50%). Most participants (75%) expressed satisfaction about their decision to pursue genetic testing. Participants with both positive and negative genetic testing reported persistent uncertainty regarding their prognosis for visual decline (50%). Genetic confirmation of disease leads to initiation of safety and vision-protecting health behaviors (42%). CONCLUSION Patients with RP are generally satisfied with their testing experience, despite approaching testing with a wide range of motivations and expectations. Future research can leverage this methodology to identify targets for improvement in pre- and post-test education and counselling.
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Affiliation(s)
- Emily Krauss
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jared Macher
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Jenina Capasso
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Rochester, New York, USA.,Pediatric Genetics, Golisano Children's Hospital, Rochester, New York, USA
| | - Barbara Bernhardt
- Human Genetics and Genetic Counseling, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zohra Ali-KhanCatts
- Human Genetics and Genetic Counseling, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alex Levin
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Rochester, New York, USA.,Pediatric Genetics, Golisano Children's Hospital, Rochester, New York, USA
| | - Rachael Brandt
- Human Genetics and Genetic Counseling, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Lankenau Medical Center, Main Line Health Hospitals, Wynnewood, Pennsylvania, USA.,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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12
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Brédart A, Kop JL, Tüchler A, De Pauw A, Cano A, Dick J, Rhiem K, Devilee P, Schmutzler R, Stoppa-Lyonnet D, Dolbeault S. Assessment of psychosocial difficulties by genetic clinicians and distress in women at high risk of breast cancer: a prospective study. Eur J Hum Genet 2022; 30:1067-1075. [PMID: 35399119 PMCID: PMC9437045 DOI: 10.1038/s41431-022-01096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
We examined how often genetic clinicians correctly identify psychosocial difficulties in women at high breast cancer risk and explored effects of this assessment and the genetic test result on counselees’ distress. A prospective observational study of counselee–clinician dyads was performed in three French, German and Spanish genetic clinics, involving 709 counselees (participation rate, 83.4%) and 31 clinicians (participation rate, 100%). Counselee–clinician agreement in perceived psychosocial difficulties was measured after the pre-test genetic consultation. Multivariate mixed linear models accounting for clinicians were tested. Predicted distress levels were assessed after the pre- (T1) and post-test result disclosure consultations (T2). Depending on the difficulty domain, clinicians adequately assessed the presence or absence of difficulties in 51% (“familial issues”) to 59% (“emotions”) of counselees. When counselees’ and clinicians’ perceptions disagreed, difficulties were generally underestimated by clinicians. Counselees’ distress levels remained stable from T1 to T2, irrespective of clinicians’ appraisal adequacy, and the genetic test result disclosure. Psychological referral need were found in 20–42% of counselees, more frequently observed for difficulties in the “emotions” domain. Our findings suggest that the genetic test result is a suboptimal indicator for psychological referral. Instead, clinicians should focus on emotions expressed by counselees to appraise their needs for psychological support.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France. .,Psychopathology and Health Process Laboratory UR4057, Psychology Institute, Paris University, 71 Avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Anja Tüchler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Antoine De Pauw
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Alejandra Cano
- University Autónoma of Barcelona, Clinical and Health Psychology Department, Barcelona, Spain
| | - Julia Dick
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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13
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Agaoglu NB, Unal B, Akgun Dogan O, Kanev MO, Zolfagharian P, Ozemri Sag S, Temel SG, Doganay L. Consistency of variant interpretations among bioinformaticians and clinical geneticists in hereditary cancer panels. Eur J Hum Genet 2022; 30:378-383. [PMID: 35132179 PMCID: PMC8904571 DOI: 10.1038/s41431-022-01060-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/19/2021] [Accepted: 01/28/2022] [Indexed: 01/12/2023] Open
Abstract
Next-generation sequencing (NGS) is used increasingly in hereditary cancer patients' (HCP) management. While enabling evaluation of multiple genes simultaneously, the technology brings to light the dilemma of variant interpretation. Here, we aimed to reveal the underlying reasons for the discrepancy in the evidence titles used during variant classification according to ACMG guidelines by two different bioinformatic specialists (BIs) and two different clinical geneticists (CGs). We evaluated final reports of 1920 cancer patients and 189 different variants from 285 HCP were enrolled to the study. A total of 173 of these variants were classified as pathogenic (n = 132) and likely pathogenic (n = 41) by the BI and an additional 16 variants, that were classified as VUS by at least one interpreter and their classification would change the clinical management, were compared for their evidence titles between different specialists. The attributed evidence titles and the final classification of the variants among BIs and CGs were compared. The discrepancy between P/LP final reports was 22.5%. The discordance between CGs was 30% whereas the discordance between two BIs was almost 75%. The use of PVS1, PS3, PP3, PP5, PM1, PM2, BP1, BP4 criteria markedly varied from one expert to another. This difference was particularly noticeable in PP3, PP5, and PM1 evidence and mostly in the variants affecting splice sites like BRCA1(NM_007294.4) c.4096 + 1 G > A and CHEK2(NM_007194.4) c.592 + 3 A > T. With recent advancements in precision medicine, the importance of variant interpretations is emerging. Our study shows that variant interpretation is subjective process that is in need of concrete definitions for accurate and standard interpretation.
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Affiliation(s)
- Nihat Bugra Agaoglu
- Department of Medical Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Busra Unal
- Department of Medical Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Akgun Dogan
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Martin Orlinov Kanev
- Department of Biotechnology and Genetic, Institute of Science, Trakya University, Edirne, Turkey
| | - Payam Zolfagharian
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sebnem Ozemri Sag
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Sehime Gulsun Temel
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Histology and Embryology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Translational Medicine, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
- Department of Medical Genetics PhD. Program, Institute of Health Sciences, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Levent Doganay
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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14
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Zhang Y, Yi S, Trace CB, Williams-Brown MY. Understanding the Information Needs of Patients With Ovarian Cancer Regarding Genetic Testing to Inform Intervention Design: Interview Study. JMIR Cancer 2022; 8:e31263. [PMID: 35133282 PMCID: PMC8864522 DOI: 10.2196/31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Experts in gynecological cancer care recommend that all patients with invasive or high-grade ovarian cancer (OC) undergo genetic testing. However, even patients who intend to take or have taken genetic tests have many unaddressed information needs regarding genetic testing. Existing genetic counseling falls short of adequately addressing this challenge. Objective This study aims to investigate the genetic testing–related information needs of patients with OC to inform the design of interactive technology-based interventions that can enhance communication of genetic testing information to patients. Methods We interviewed 20 patients with OC who had taken genetic tests and gathered genetic testing–related messages from an active OC web-based community. The interview transcripts and web-based community messages were analyzed using the qualitative content analysis method. Results Data analyses produced a comprehensive taxonomy of the genetic testing–related information needs of patients with OC, which included five major topic clusters: knowledge of genetic testing as a medical test, genetic testing process, genetic testing implications for patients, implications for family members, and medical terminology. Findings indicated that patients wanted to receive information that was relevant, understandable, concise, usable, appropriate, sympathetic, and available when needed. They also preferred various channels to receive information, including internet-based technologies, print, and conversations with health care providers. Conclusions Patients with OC need a range of information to address the uncertainties and challenges that they encounter while taking genetic tests. Their preferences for channels to receive information vary widely. A multichannel information delivery solution that combines both provider-led and peer-to-peer education models is needed to supplement existing genetic counseling to effectively meet the genetic testing–related information needs of patients with OC.
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Affiliation(s)
- Yan Zhang
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Siqi Yi
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Ciaran B Trace
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Marian Yvette Williams-Brown
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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15
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Stracke C, Lemmen C, Rhiem K, Schmutzler R, Kautz-Freimuth S, Stock S. Medical knowledge and information needs among women with pathogenic variants in moderate-risk genes for hereditary breast cancer attending genetic counseling at an academic hospital in Germany-A qualitative approach. J Genet Couns 2021; 31:698-712. [PMID: 34837291 DOI: 10.1002/jgc4.1536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022]
Abstract
With 69,000 newly diagnosed cases every year, breast cancer (BC) is the most frequent cancer disease among women in Germany. Familial clustering is seen in about 30% of newly diagnosed cases. Besides the high-risk genes BRCA1/2, there are also moderate-risk BC genes (MBCG) that are associated with a 20%-50% risk of BC, such as CHEK2, ATM, and PALB2. In Germany, carriers of pathogenic variants in MBCG receive specific information on their test results, individual risks, and preventive options during genetic counseling for the disclosure of the results in a specialized center. Little is known about the medical knowledge that women have after attending counseling. This study aims to identify the medical knowledge, further information needs, and the possible impact of a lack of information on dealing with everyday life for women with pathogenic variants in MBCG who have attended genetic counseling at an academic hospital in Germany. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview guide was developed based on the methods of the problem-centered interview according to Witzel. The interview analysis was based on Mayring's qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Several medical uncertainties and information needs emerged from the data, concerning (a) medical terms, (b) risk perception, (c) BC therapy for hereditary BC, (d) lifestyle advice and risk factors, and (e) family planning and risk-reducing mastectomy. Women with pathogenic variants in MBCG might develop their own conceptions regarding the onset of disease and inheritance. In order to meet the need for information and address the uncertainties that may still exist after genetic counseling, structured, evidence-based and comprehensible written information in German should be developed for this group.
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Affiliation(s)
- Claudia Stracke
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Clarissa Lemmen
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Rita Schmutzler
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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16
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van der Giessen JAM, Ausems MGEM, van Riel E, de Jong A, Fransen MP, van Dulmen S. Development of a plain-language guide for discussing breast cancer genetic counseling and testing with patients with limited health literacy. Support Care Cancer 2021; 29:2895-2905. [PMID: 33001269 PMCID: PMC8062319 DOI: 10.1007/s00520-020-05800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Due to limited health literacy and resulting ineffective communication between healthcare professionals and patients, not all eligible patients are offered breast cancer genetic counseling and testing. We aimed to develop a plain-language guide to increase effective communication about genetic counseling and testing with breast cancer patients with limited health literacy. METHODS Together with oncological healthcare professionals, we drafted a list of jargon words frequently used during (breast) cancer genetic counseling. In a focus group interview with breast cancer counselees with limited health literacy, who had received genetic counseling before, we reformulated these words in plain language. Low-literate individuals, who are not familiar with breast cancer care or genetic counseling, reflected on the draft of the guide. Completeness, acceptability, and perceived usability were tested in an online questionnaire among healthcare professionals. RESULTS The result is a plain-language guide for genetic counseling and testing with 33 frequently used jargon words and a reformulation of these words in plain language. Acceptability and perceived usefulness of the guide among healthcare professionals (n = 58) were high. CONCLUSION The plain-language guide provides opportunities to facilitate communication about genetic counseling and testing with patients with limited health literacy and could enhance opportunities for patients to make informed decisions to participate in genetic testing. As the intention from healthcare professionals to use the plain-language guide is high, implementation of the guide in a real-life setting seems promising.
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Affiliation(s)
- J A M van der Giessen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E van Riel
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A de Jong
- Reading & Writing Foundation, Den Haag, The Netherlands
| | - M P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dulmen
- Research Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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17
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Amornsiripanitch N, Ameri SM, Goldberg RJ. Impact of Age, Race, and Socioeconomic Status on Women's Perceptions and Preferences Regarding Communication of Estimated Breast Cancer Risk. Acad Radiol 2021; 28:655-663. [PMID: 32376184 DOI: 10.1016/j.acra.2020.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/07/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Performing breast cancer risk assessment at the time of screening mammography has potential to increase high-risk identification, appropriate supplemental screening, and risk management. The study's goal is to investigate women's interest in risk assessment and preferred method of risk communication in a diverse patient population. MATERIALS AND METHODS Surveys in English and five non-English languages were distributed to women presenting for screening mammography at eight screening mammography facilities between February and May 2019 to assess their interest in risk assessment, preferred method, and level of detail of estimated risk communication in hypothetical scenarios where estimated risks are average and elevated. RESULTS Among 683 survey respondents, 592 (87%) expressed interest in learning about their estimated lifetime risk of breast cancer. Controlling for age, race/ethnicity, and education, women with higher income were more interested in risk assessment than comparison group (p<0.05). The most preferred method of average risk communication was by a mailed letter accompanying mammographic results (57%), but more women exclusively preferred face-to-face communications of elevated risk than of average risk estimate (191, 28% vs. 128, 19%, p<0.0001). Phone communication was more preferred by younger women, electronic communication was less preferred by older women and those with lower income, and non-Hispanic blacks and older women preferred less detailed communication (p<0.05). CONCLUSION Sociodemographic factors influence women's interest in risk assessment and preference in risk communication about breast cancer. Screening Mammogram facilities implementing risk assessment should consider risk communication strategies that are most effective for their patient population.
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Affiliation(s)
- N Amornsiripanitch
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655.
| | - S M Ameri
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655. Phone: (617) 894-2712.
| | - R J Goldberg
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655. Phone: (508) 856-8798. Fax (508) 856-8993.
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18
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Smit AK, Bartley N, Best MC, Napier CE, Butow P, Newson AJ, Tucker K, Ballinger ML, Thomas DM, Jacobs C, Meiser B, Goldstein D, Savard J, Juraskova I. Family communication about genomic sequencing: A qualitative study with cancer patients and relatives. PATIENT EDUCATION AND COUNSELING 2021; 104:944-952. [PMID: 33129629 DOI: 10.1016/j.pec.2020.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study explored family communication about undertaking genomic sequencing, and intentions to communicate pertinent heritable results to family members. METHODS Semi-structured interviews were conducted with cancer patients (n = 53) and their relatives (n = 20) who underwent germline genome sequencing or molecular tumor testing. Interviews were audio-recorded, transcribed and analyzed using thematic analysis. RESULTS Key themes relevant to family communication about undertaking sequencing included: perceiving family member interest, delaying discussion until results were received, having shared capacity to understand and cope, and having open communication in the family. Intended communication subsequent to receiving results was affected by: disease severity, risk management options, degree of closeness in the family, sense of responsibility, and potential adverse impacts on family. Resource and support needs varied based on the complexity of test results, health professionals' availability, and disease severity. Unique subthemes were identified for specific subgroups. CONCLUSION Current findings support the need to assess the impact and resource needs specific to each clinical application of genomic sequencing. PRACTICE IMPLICATIONS Increasingly sophisticated and complex clinical genomic sequencing warrants development of family-centered interventions and resources to facilitate preference-sensitive communication about genomic sequencing, including disseminating relevant information to family members.
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Affiliation(s)
- Amelia K Smit
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, Sydney, Australia; The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia; The University of Sydney, Melanoma Institute Australia, Australia.
| | - Nicci Bartley
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Megan C Best
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Christine E Napier
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Mandy L Ballinger
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - Chris Jacobs
- University of Technology Sydney, Graduate School of Health, Sydney, Australia; Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | | | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, Australia
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19
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Makhnoon S, Yu R, Cunningham SA, Peterson SK, Shete S. Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey. Public Health Genomics 2021; 24:160-170. [PMID: 33887738 DOI: 10.1159/000515465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/22/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors. METHODS A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population. RESULTS Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79). DISCUSSION The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert Yu
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Sonia A Cunningham
- Department of Epidemiology, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, Texas, USA.,Department of Epidemiology, UT MD Anderson Cancer Center, Houston, Texas, USA.,Division of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, Houston, Texas, USA
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20
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Di Pietro ML, Zaçe D, Orfino A, Di Raimo FR, Poscia A, de Matteis E, Turchetti D, Godino L, Bertonazzi B, Franiuk M, Bruzzone C, Varesco L, Lucci-Cordisco E, Genuardi M. Intrafamilial communication of hereditary breast and ovarian cancer genetic information in Italian women: towards a personalised approach. Eur J Hum Genet 2021; 29:250-261. [PMID: 32929237 PMCID: PMC7868365 DOI: 10.1038/s41431-020-00723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
Genomic testing expansion is accompanied by an increasing need for genetic counselling and intrafamilial communication. Genetic counselling can play an important role in facilitating intrafamilial communication and relationships. We conducted a cross-sectional, multicenter study including 252 Italian women, using a questionnaire divided in two sections, the first one to be filled after the pre-test counselling and the second after receiving BRCA test results. We assessed the factors influencing intrafamilial disclosure of genetic information for hereditary breast and ovarian cancer, family members with whom probands are more prone to share genetic information, and the perceived understanding of information received by counselees during genetic counselling. Women were accompanied to the counselling more often by their husband/partner. Among those with a positive BRCA test result, 49% intended to communicate it to their offspring and 27% to their husband/partner. Younger women, those living with their husband/partner, and those who described family communication as open/profound and spontaneous/sincere had a higher probability of being accompanied during genetic counselling and discuss about it with relatives. Spontaneous/sincere or open/profound family communication and joyful/happy familial relationships were associated with the decision to undergo genetic testing as a responsibility towards relatives. Women had a good understanding of counselling contents (mean score 9.27 in a scale 1-10). Genetic counselling providers should consider that genetic information disclosure does not depend only on the clarity of the information provided, but also on pre-existing intrafamilial communication and relationships, family structure and marital status, indicating the need for a personalised approach accounting for these factors.
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Affiliation(s)
- Maria Luisa Di Pietro
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Drieda Zaçe
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Alessia Orfino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Romana Di Raimo
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Poscia
- UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases-Department of Prevention-Local Health Authority (ASUR-AV2), Jesi, Italy
| | | | - Daniela Turchetti
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Lea Godino
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Benedetta Bertonazzi
- U.O. Genetica Medica, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Centro di Ricerca sui Tumori Ereditari, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Università di Bologna, Bologna, Italy
| | - Marzena Franiuk
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carla Bruzzone
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Liliana Varesco
- Hereditary Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuela Lucci-Cordisco
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genuardi
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Wedderburn S, McVeigh TP. Should All Individuals Be Screened for Genetic Predisposition to Cancer? Genet Res (Camb) 2021; 2021:6611963. [PMID: 33762893 PMCID: PMC7953527 DOI: 10.1155/2021/6611963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sarah Wedderburn
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital, Glasgow, UK
| | - Terri P. McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
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Stewart DR, Frone MN, Chanock SJ. Stomaching Multigene Panel Testing: What to Do About CDH1? J Natl Cancer Inst 2020; 112:325-326. [PMID: 31841165 DOI: 10.1093/jnci/djz230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Douglas R Stewart
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - Megan N Frone
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
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Medendorp NM, van Maarschalkerweerd PEA, Murugesu L, Daams JG, Smets EMA, Hillen MA. The impact of communicating uncertain test results in cancer genetic counseling: A systematic mixed studies review. PATIENT EDUCATION AND COUNSELING 2020; 103:1692-1708. [PMID: 32278626 DOI: 10.1016/j.pec.2020.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cancer genetic counseling increasingly involves discussing uncertain test results, for example because multiple genes are sequenced simultaneously. This review was performed to provide insight into how counselors' communication of uncertain test results during genetic counseling for cancer affects counselors and counselees. METHODS A systematic mixed studies review was undertaken to review research on the effects of communicating uncertain test results. Four databases were searched using a PICO search strategy. Study findings of articles meeting the inclusion criteria were synthesized narratively. RESULTS Twenty-four articles were included. Uncertain test results encompassed either an inconclusive test result or a variant of unknown significance (VUS). Counselees involved almost exclusively women at risk of hereditary breast and/or ovarian cancer. None of the articles reported effects on counselor outcomes. Counselee outcomes were categorized as cognitive, affective or behavioral. Interpretation of a VUS was overall reported as difficult, and counselees' distress and worry were repeatedly found to decrease over time after the discussion of any uncertain test result. For most other outcomes, findings were sparse and/or inconsistent. CONCLUSION Evidence on effects on counselee outcomes is scant and inconsistent. Future studies are warranted to provide insight into how counselees and counselors are affected. PRACTICE IMPLICATIONS Clinical practice could benefit from guidelines on how to address uncertain test results during pre- and posttest genetic consultations.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | | | - Laxsini Murugesu
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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Manchanda R, Lieberman S, Gaba F, Lahad A, Levy-Lahad E. Population Screening for Inherited Predisposition to Breast and Ovarian Cancer. Annu Rev Genomics Hum Genet 2020; 21:373-412. [DOI: 10.1146/annurev-genom-083118-015253] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The discovery of genes underlying inherited predisposition to breast and ovarian cancer has revolutionized the ability to identify women at high risk for these diseases before they become affected. Women who are carriers of deleterious variants in these genes can undertake surveillance and prevention measures that have been shown to reduce morbidity and mortality. However, under current strategies, the vast majority of women carriers remain undetected until they become affected. In this review, we show that universal testing, particularly of the BRCA1 and BRCA2 genes, fulfills classical disease screening criteria. This is especially true for BRCA1 and BRCA2 in Ashkenazi Jews but is translatable to all populations and may include additional genes. Utilizing genetic information for large-scale precision prevention requires a paradigmatic shift in health-care delivery. To address this need, we propose a direct-to-patient model, which is increasingly pertinent for fulfilling the promise of utilizing personal genomic information for disease prevention.
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Affiliation(s)
- Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom;,
- Department of Gynaecological Oncology, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Sari Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;,
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Faiza Gaba
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom;,
- Department of Gynaecological Oncology, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Amnon Lahad
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Clalit Health Services, Jerusalem 9548323, Israel
| | - Ephrat Levy-Lahad
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;,
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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25
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Underhill-Blazey M, Blonquist T, Chittenden A, Pozzar R, Nayak M, Lansang K, Hong F, Garber J, Stopfer JE. Informing models of cancer genetics care in the era of multigene panel testing with patient-led recommendations. J Genet Couns 2020; 30:268-282. [PMID: 32851753 DOI: 10.1002/jgc4.1317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The study describes patient-reported experiences and recommendations to improve the genetic counseling and multigene panel testing (MGPT) process. A descriptive mixed-method study with concurrently collected and integrated qualitative and quantitative data was conducted. Eligible participants were English-speaking adults with a breast or gynecologic cancer diagnosis who had received genetic counseling and testing with a MGPT from one Comprehensive Cancer Center. Satisfaction with the genetic counseling, genetic knowledge using a recently validated scale (KnowGene), the multidimensional impact of cancer risk assessment (MICRA), family communication, and the association with demographic factors were evaluated. To supplement the large quantitative data set, qualitative focus group responses and open-ended text items were collected. Univariate and multivariable associations between each outcome of interest and personal characteristics were assessed. Qualitative data were content-analyzed. 603 participants completed the survey (48% response rate) and 10 individuals participated in the focus groups. Participants were mostly Caucasian, educated with a college degree or more, and female with median age 58 (24-91), and 78% of participants had a breast cancer diagnosis. Of all individuals undergoing genetic testing using a MGPT, 13% had a pathogenic variant identified, and 30% had a variant of uncertain significance (VUS). Overall, participants reported satisfaction with the genetic counseling and testing process (mean 36.9 [SD 4.7]). On average, participants had 7 incorrect answers out of 19 on the genetic knowledge scale (mean 12.3 [SD 3.4]). MICRA scores showed overall low levels of distress and uncertainty, as well as positive experiences, with wide variability (median 17 [0-84]). Age, marital status, education level, type of cancer diagnosis, and genetic testing results were significantly associated with outcomes. Most participants communicated genetic testing results to mainly female first-degree relatives. A wide range of individual preferences affecting overall satisfaction, or suggestions for improvement were shared. As new models of streamlined cancer genetic services are being clinically implemented, approaches should continue to assess and tailor the process based on patients' informational and emotional needs.
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Affiliation(s)
- Meghan Underhill-Blazey
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA.,School of Nursing, University of Rochester, Rochester, NY, USA
| | - Traci Blonquist
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anu Chittenden
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manan Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristina Lansang
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy Garber
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jill E Stopfer
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
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From Probands to Relatives: Communication of Genetic Risk for Hereditary Breast-Ovarian Cancer and Its Influence on Subsequent Testing. Cancer Nurs 2020; 45:E91-E98. [PMID: 32804756 DOI: 10.1097/ncc.0000000000000876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The genetic risk communication from proband to relatives varies from family to family, and patients often need support with the communication of genetic test results and making decisions to manage hereditary cancer risks. OBJECTIVE The aim of this study was to characterize the communication of BRCA1 or BRCA2 (BRCA1/2) genetic risk from proband to first-degree relatives (FDRs) using a social network framework. METHODS We characterized network and nonnetwork factors to explore their association with which FDRs were told about the genetic risk and whether or not relatives underwent genetic testing. Ninety-two female probands with hereditary breast and ovarian cancer who have confirmed BRCA1/2 mutations participated in the study. Communication of hereditary breast and ovarian cancer risk was assessed between 92 probands and their 417 FDRs. RESULTS Of 92 probands, 94.5% (n = 87) communicated their genetic test result to at least one of their FDRs. Of FDRs older than 18 years, 19.9% (n = 72) have genetic testing. Emotional closeness, educational level of the proband, and relative's age were significantly associated with communicating test results with FDRs. CONCLUSION Communication of genetic risk with the FDRs after having a BRCA1/2 gene-mutation-positive test result was high in this group of cancer patients. However, the rate of genetic testing among FDRs was low. IMPLICATIONS FOR PRACTICE Probands' educational level and age of relatives for cascade genetic screening should be considered during counseling. Interventions to support women with BRCA1/2 mutations during the communication process and their family members' engagement in testing and risk-reducing strategies are needed.
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Malhotra H, Kowtal P, Mehra N, Pramank R, Sarin R, Rajkumar T, Gupta S, Bapna A, Bhattacharyya GS, Gupta S, Maheshwari A, Mannan AU, Reddy Kundur R, Sekhon R, Singhal M, Smruti B, SP S, Suryavanshi M, Verma A. Genetic Counseling, Testing, and Management of HBOC in India: An Expert Consensus Document from Indian Society of Medical and Pediatric Oncology. JCO Glob Oncol 2020; 6:991-1008. [PMID: 32628584 PMCID: PMC7392772 DOI: 10.1200/jgo.19.00381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Hereditary breast and ovarian cancer (HBOC) syndrome is primarily characterized by mutations in the BRCA1/2 genes. There are several barriers to the implementation of genetic testing and counseling in India that may affect clinical decisions. These consensus recommendations were therefore convened as a collaborative effort to improve testing and management of HBOC in India. DESIGN Recommendations were developed by a multidisciplinary group of experts from the Indian Society of Medical and Pediatric Oncology and some invited experts on the basis of graded evidence from the literature and using a formal Delphi process to help reach consensus. PubMed and Google Scholar databases were searched to source relevant articles. RESULTS This consensus statement provides practical insight into identifying patients who should undergo genetic counseling and testing on the basis of assessments of family and ancestry and personal history of HBOC. It discusses the need and significance of genetic counselors and medical professionals who have the necessary expertise in genetic counseling and testing. Recommendations elucidate requirements of pretest counseling, including discussions on genetic variants of uncertain significance and risk reduction options. The group of experts recommended single-site mutation testing in families with a known mutation and next-generation sequencing coupled with multiplex ligation probe amplification for the detection of large genomic rearrangements for unknown mutations. Recommendations for surgical and lifestyle-related risk reduction approaches and management using poly (ADP-ribose) polymerase inhibitors are also detailed. CONCLUSION With rapid strides being made in the field of genetic testing/counseling in India, more oncologists are expected to include genetic testing/counseling as part of their clinical practice. These consensus recommendations are anticipated to help homogenize genetic testing and management of HBOC in India for improved patient care.
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Affiliation(s)
- Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, India
| | - Pradnya Kowtal
- Sarin Laboratory and OIC Sanger Sequencing Facility, Advanced Centre for Treatment Research, and Education in Cancer, Navi Mumbai, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | - Raja Pramank
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Sarin
- Radiation Oncology, Cancer Genetics Unit, Tata Memorial Centre and PI Sarin Laboratory, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai, India
| | | | - Sudeep Gupta
- Tata Memorial Centre Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Ajay Bapna
- Department of Medical Oncology, Bhagwan Mahavir Cancer Hospital Research Center, Jaipur, India
| | | | - Sabhyata Gupta
- Department of Gynae Oncology, Medanta-The Medicity, Gurgaon, India
| | - Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Centre, Mumbai, India
| | - Ashraf U. Mannan
- Clinical Diagnostics, Strand Center for Genomics and Personalized Medicine, Strand Life Sciences, Bangalore, India
| | | | - Rupinder Sekhon
- Gynae Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - B.K. Smruti
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Somashekhar SP
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Moushumi Suryavanshi
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Amit Verma
- Molecular Oncology and Cancer Genetics, Max Hospital, New Delhi, India
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Scott N, O'Sullivan J, Asgeirsson K, Macmillan D, Wilson E. Changing practice: moving to a specialist nurse-led service for BRCA gene testing. ACTA ACUST UNITED AC 2020; 29:S6-S13. [DOI: 10.12968/bjon.2020.29.10.s6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Some 5–10% of all breast cancers are associated with a pathogenic variant in a breast cancer-associated gene (BRCA1/BRCA2). Historically, with referral to the Nottingham University Hospitals NHS Trust's clinical genetics department for genetic testing, waiting times were on average 12–14 weeks for an initial appointment and 4–6 months to obtain results from the date of testing. A specialist, nurse-led mainstreaming cancer genetics (MCG) service was set up in the trust's Nottingham Breast Institute (NBI) to: reduce waiting times for the initial consultation, counselling, consent and obtaining results for BRCA1/BRCA2 gene testing; and to ensure appropriate patients with breast cancer were offered genetic testing. Two breast clinical nurse specialists were trained so they could counsel, consent and give results for the BRCA1/BRCA2 gene testing directly to patients. Average waiting times for results from the time of testing were reduced to 35.8 days under the nurse-led service, which enabled oncologists and patients to consider individual treatment options at an earlier time. The MCG service reduced waiting times, resulting in an improved, more streamlined service for patients undergoing genetic testing. The MCG service extended the scope of practice of the breast nurse clinical specialists, embedded an expert advanced nursing role in the breast multidisciplinary team and developed nurse mentoring opportunities.
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Affiliation(s)
- Nicola Scott
- Breast Clinical Nurse Specialist and Specialist in Breast Family History, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Jackie O'Sullivan
- Breast Clinical Nurse Specialist and Specialist in Breast Family History, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Kristjan Asgeirsson
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Douglas Macmillan
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Emma Wilson
- Associate Professor in Public Health, University of Nottingham
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Ballatore Z, Bracci R, Maccaroni E, Svarca L, Bianchi F, Belvederesi L, Bruciati C, Pagliaretta S, Murrone A, Bini F, Pistelli M, Ricci G, Berardi R. Expectations and psychological issues before genetic counseling: analysis of distress determinant factors. Hered Cancer Clin Pract 2020; 18:10. [PMID: 32368313 PMCID: PMC7189592 DOI: 10.1186/s13053-020-00142-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Hereditary non-polyposis colorectal cancer (HNPCC) and Hereditary Breast and Ovarian Cancer Syndrome (HBOC) are the most common hereditary cancer syndromes in which a genetic test is available. Potential risks associated with testing include psychological harm, emotional distress and insurance problems. Methods The aim of the present study is to investigate determinants of distress in a sample of Italian subjects undergoing genetic counseling. Demographic information and psychological distress were assessed by using a self-reported questionnaire and the "Hospital Anxiety and Depression Scale" (HAD), before attending the first counseling session. Results Of the all subjects referred for the first time to our Center (January 2012-June 2013), a total of 227 were eligible (female/male = 174/53) for the survey, 134 (59%) were oncologic patients and of these, 116 received genetic test (36 for HNPCC and 80 for HBOC). The remaining 93 (41%) were healthy subjects referred for suspected familiar history and of this group, 65 subjects performed predictive test in a family with a known pathogenic mutation (53 for HBOC and 12 for HNPCC). Affected subjects had a significantly higher level of anxiety (p = 0.02) and HAD global score (p = 0.01) than healthy ones. There was no difference in HAD score between individuals testing for different syndromes (p = 0.3). In the affected subgroup, there was a significant linear correlation between the HAD anxiety score and how much subjects perceived their disease as hereditary (p = 0.01). Female and younger subjects had higher levels of anxiety (p = 0.05). Also healthy single subjects show more general distress (p = 0.02) than those with a partner. Conclusions Greater level of distress identified on females, single and younger subjects.
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Affiliation(s)
- Zelmira Ballatore
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Raffaella Bracci
- 2Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Santa Croce, Fano, Italy
| | - Elena Maccaroni
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Lucia Svarca
- 3Neuropsichiatria Infantile, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Francesca Bianchi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Laura Belvederesi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Cristiana Bruciati
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Alberto Murrone
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Federica Bini
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Mirco Pistelli
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giulia Ricci
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Rossana Berardi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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Points to consider for reporting of germline variation in patients undergoing tumor testing: a statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2020; 22:1142-1148. [PMID: 32321997 DOI: 10.1038/s41436-020-0783-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 02/08/2023] Open
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Menko FH, Jeanson KN, Bleiker EMA, van Tiggelen CWM, Hogervorst FBL, Ter Stege JA, Ait Moha D, van der Kolk LE. The uptake of predictive DNA testing in 40 families with a pathogenic BRCA1/BRCA2 variant. An evaluation of the proband-mediated procedure. Eur J Hum Genet 2020; 28:1020-1027. [PMID: 32300191 DOI: 10.1038/s41431-020-0618-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/14/2020] [Accepted: 03/15/2020] [Indexed: 11/09/2022] Open
Abstract
When hereditary breast and ovarian cancer (HBOC) due to a BRCA1/BRCA2 germline pathogenic variant is diagnosed, the proband will be asked to inform other at-risk family members. In the Netherlands, a guideline was introduced in 2012 which provided detailed recommendations regarding this proband-mediated procedure. We now evaluated the uptake of predictive BRCA1/BRCA2 testing in 40 consecutive HBOC families diagnosed in our centre in 2014. We performed a retrospective observational study of all 40 families in which a pathogenic BRCA1/BRCA2 germline variant was identified during 2014. We scored the uptake of predictive and confirmatory testing by the end of 2018 and explored factors associated with the level of uptake. Two families were excluded. In the remaining 38 families, among 239 family members ≥18 years at 50% risk of being a mutation carrier or at 25% risk if the family member at 50% risk was deceased, 102 (43%) were tested. Among 108 females 25-75 years of age at 50% risk, 59 (55%) underwent predictive or confirmatory testing, and among 43 males at 50% risk with daughters ≥18 years, 22 (51%) were tested. Factors which complicated cascade screening included family members living abroad, probands not wanting to share information and limited pedigree information. In conclusion, the standard proband-mediated procedure of informing relatives seems to be far from optimal. We suggest a tailored approach for each family, including the option of a direct approach to at-risk family members by the geneticist. In addition, we suggest detailed monitoring and follow-up of families.
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Affiliation(s)
- Fred H Menko
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Kiki N Jeanson
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Eveline M A Bleiker
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Carla W M van Tiggelen
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Frans B L Hogervorst
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacqueline A Ter Stege
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daoud Ait Moha
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Lizet E van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Hillyer GC, Schmitt KM, Reyes A, Cruz A, Lizardo M, Schwartz GK, Terry MB. Community education to enhance the more equitable use of precision medicine in Northern Manhattan. J Genet Couns 2020; 29:247-258. [PMID: 32157769 DOI: 10.1002/jgc4.1244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/30/2022]
Abstract
Focusing screening and treatment to those most likely to benefit is the promise of precision medicine but inequitable distribution of precision medicine innovations may exacerbate health disparities. We investigated whether complex genomic concepts can be successfully communicated to diverse populations. Incorporating principles of Community-based Participatory Research, we created a precision medicine curriculum tailored to the needs of our predominantly Hispanic community. We administered the curriculum over 26 months, assessed pre- and post-test comprehension of 8 genetics-related terms, and compared comprehension differences based on demography and health literacy. In total, 438 individuals completed pre-/post-test assessments. At pre-test, 45.6% scored ≥75% across eight major constructs; 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for 'mutation' (55% to 78%) and 'sporadic' (34% to 59%). Mean pre-test comprehension scores (≥75%) were lower for Spanish versus. English speakers; mean post-test scores were equivalent. No heterogeneity by demographics or health literacy was observed. We demonstrate that a brief community educational program can improve knowledge of complex genomic concepts. Interventions to increase understanding of genomic concepts underlying precision medicine are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.
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Affiliation(s)
- Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | - Andria Reyes
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Alejandro Cruz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
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Scott D, Friedman S, Telli ML, Kurian AW. Decision Making About Genetic Testing Among Women With a Personal and Family History of Breast Cancer. JCO Oncol Pract 2019; 16:e37-e55. [PMID: 31613719 DOI: 10.1200/jop.19.00221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To understand genetic testing use and decision making among patients with high genetic risk. MATERIALS AND METHODS A survey of breast cancer survivors was administered online by a hereditary cancer nonprofit organization, Facing Our Risk of Cancer Empowered, from October 2017 to March 2018. RESULTS Of 1,322 respondents, 46% had breast cancer at age < 45 years, 61% had a first-degree relative with cancer, and 84% underwent genetic testing, of whom 56% had a risk-associated pathogenic variant. Most (86%; 95% CI, 84% to 88%) tested respondents were very satisfied with their testing decision, versus 34% (95% CI, 27% to 41%) of untested respondents. Factors that encouraged testing included relatives' cancer risk (75%; 95% CI, 73% to 78%), clinicians' recommendations (68%; 95% CI, 66% to 71%), and potential treatment implications (67%; 95% CI, 64% to 69%). Factors that discouraged testing included insurance concerns (14%; 95% CI, 12% to 16%), cost (14%; 95% CI, 12% to 16%), and discrimination (9%; 95% CI, 7% to 11%). Thirty-nine percent (95% CI, 36% to 41%) recalled hearing from a clinician that genetic discrimination is illegal. Respondents often recalled clinicians informing them about inheritance patterns (65%; 95% CI, 62% to 67%), surgical implications (65%; 95% CI, 63% to 68%), and other cancer risks (66%; 95% CI, 63% to 68%) but less often that results could have potential implications for clinical trial eligibility (38%; 95% CI, 36% to 42%) or targeted therapies (14%; 95% CI, 12% to 16%). Patients who had genetic counseling were twice as likely to recall clinicians informing them about all queried topics. Results did not vary by diagnosis year. CONCLUSION Among patients with high genetic risk, clinicians' recommendations, potential treatment implications, and protections against discrimination were motivating factors to undergo genetic testing, but fewer than half recalled clinicians providing all this information, and this did not improve over time. Clinicians influence testing decisions and should inform patients about legal protections and treatment implications.
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Affiliation(s)
- Danika Scott
- Stanford University School of Medicine, Stanford, CA
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Danchin N, Lahlou-Laforet K, Lemogne C. Informing on individual cardiovascular risk: from wishful thinking to hard facts. BRITISH HEART JOURNAL 2019; 105:973-974. [DOI: 10.1136/heartjnl-2019-314814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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