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Onnekink AM, Klatte DCF, van Hooft JE, van den Berg SH, van der Zwaan SMS, van Doorn R, Hinnen SCH, Potjer TP, Bleiker EMA, van Leerdam ME. Attitudes toward genetic testing, family planning and preimplantation genetic testing in families with a germline CDKN2A pathogenic variant. Fam Cancer 2024; 23:255-265. [PMID: 38822936 PMCID: PMC11255069 DOI: 10.1007/s10689-024-00401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
Individuals with a germline CDKN2A pathogenic variant (PV) have a highly increased life time risk of melanoma and pancreatic cancer. This cross-sectional study assessed the attitudes among toward genetic testing, family planning, and preimplantation genetic testing (PGT) in confirmed CDKN2A PV carriers and individuals with a 50% risk of the PV (at-risk carriers) using of a one-time questionnaire.A total of 537 individuals were screened for eligibility, of whom 208 of 366 (57%) confirmed carriers (56% female, median age 54 years [IQR 46-63]) and 39 of 171 (23%) at-risk carriers (59% female, median age of 26 years [IQR 22-32]) participated in the study. Primary motivations for genetic testing were to gain control over their personal and children's cancer risk, as well as increasing cancer surveillance practices. In contrast, concerns about obtaining a mortgage and life insurance were frequently cited as reasons for postponing genetic testing. Family planning decisions remained largely unaffected in both confirmed and at-risk carriers; however, the majority of confirmed carriers were still unaware of their familial or personal cancer risk when starting a family. More than 60% of the participants were unfamiliar with PGT and only a minority (19% of confirmed carriers and 10% of at-risk carriers) would be open to considering PGT as a reproductive option. This study found different attitudes toward genetic testing, family planning, and PGT among individuals affected by the CDKN2A PV. Understanding these different attitudes can help clinicians to address the complexities surrounding these issues, especially for younger individuals facing difficult decisions about the timing of genetic testing, family planning, and the potential use of assisted reproductive options.
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Affiliation(s)
- A M Onnekink
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
| | - D C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - S H van den Berg
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - S M S van der Zwaan
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - R van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - S C H Hinnen
- Department of Psycho-Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Psychology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - T P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Genetics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
- Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Nolan JJ, Forrest J, Ormondroyd E. Additional findings from the 100,000 Genomes Project: A qualitative study of recipient perspectives. Genet Med 2024; 26:101103. [PMID: 38411041 DOI: 10.1016/j.gim.2024.101103] [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: 06/27/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE Participants in the 100,000 Genomes Project, a clinical/research initiative delivered through the UK National Health Service, were offered screening for "additional findings" (AFs): pathogenic/likely pathogenic secondary findings in genes associated with familial hypercholesterolemia or a cancer predisposition syndrome. Understanding the psychological and behavioral responses to secondary findings can inform the clinical utility of a search and disclose policy. METHODS Thirty-two adult AF recipients took part in semi-structured interviews analyzed using deductive and inductive thematic analysis. RESULTS Five themes were constructed: cognitive responses to an AF, emotional and psychological responses, personal control, perceived risk of AF-associated disease, and family implications. Many participants had misunderstood or incompletely remembered consent for AFs, and most were surprised or shocked to receive an AF. Although many ultimately appreciated knowing about the risk conferred, some struggled to make sense of their disease risk, which complicated decision making about risk management, particularly for women with a BRCA AF. Recipients sought control through seeking clinical evaluation and information, and informing relatives. Difficulties with conceptualizing risk and lack of AF-associated disease family history meant that some hesitated to inform relatives. CONCLUSION Genome sequencing programs offering secondary findings require attention to consent processes. Post-disclosure care should aim to promote recipients' perceived personal control.
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Affiliation(s)
- Joshua J Nolan
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jamie Forrest
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
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Wafik M, Kilby MD, Kulkarni A. Prenatal and pre-implantation genetic testing for monogenic disorders for germline cancer susceptibility gene variants: UK joint consensus guidance. BJOG 2023; 130:1563-1567. [PMID: 37334763 DOI: 10.1111/1471-0528.17571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Mohamed Wafik
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Mark David Kilby
- University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Foundation Healthcare Trust, Birmingham, UK
| | - Anjana Kulkarni
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
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Barrett F, Shaw J, Besser AG, Grifo JA, Blakemore JK. Preimplantation genetic testing for monogenic disorders: clinical experience with BRCA1 and BRCA2 from 2010-2021. J Assist Reprod Genet 2023; 40:2705-2713. [PMID: 37691027 PMCID: PMC10643755 DOI: 10.1007/s10815-023-02925-6] [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: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE Our aim was to describe the reproductive decisions and outcomes of BRCA-positive patients who used preimplantation genetic testing for monogenic disorders (PGT-M). METHODS We performed a retrospective case series of all PGT-M cycles for BRCA variants between 2010-2021 at a large urban academic fertility center. All patients who underwent ≥ 1 cycle of IVF with PGT-M for BRCA1 or BRCA2 were included. The primary outcome was total number of BRCA-negative euploid embryos per patient. RESULTS Sixty four patients underwent PGT-M for BRCA variants. Forty-five percent (29/64) were BRCA1-positive females, 27% (17/64) were BRCA2-positive females, 16% (10/64) were BRCA1-positive males, 11% (7/64) were BRCA2-positive males, and one was a BRCA1 and BRCA2-positive male. There were 125 retrieval cycles with PGT-M, and all cycles included PGT for aneuploidy (PGT-A). Eighty-six percent (55/64) of patients obtained at least one BRCA- negative euploid embryo, with median of 1 (range 0-10) BRCA-negative euploid embryo resulted per cycle and median 3 (range 0-10) BRCA-negative euploid embryos accumulated per patient after a median of 2 (range 1-7) oocyte retrievals. Sixty-four percent (41/64) of patients attempted at least one frozen embryo transfer (FET) with a total of 68 FET cycles. Fifty-nine percent (40/68) of embryos transferred resulted in live births. Subgroup analysis revealed different reproductive pathways for BRCA1-positive females, BRCA2-positive females, and BRCA1/2-positive males (p < 0.05). CONCLUSION PGT-M is a viable option for BRCA-positive patients to avoid transmission while building their families. Most patients in our cohort achieved pregnancy with BRCA-negative euploid embryos.
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Affiliation(s)
- Francesca Barrett
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 159 East 53rd St, New York, NY, 10022, USA.
| | - Jacquelyn Shaw
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 159 East 53rd St, New York, NY, 10022, USA
| | - Andria G Besser
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 159 East 53rd St, New York, NY, 10022, USA
| | - James A Grifo
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 159 East 53rd St, New York, NY, 10022, USA
| | - Jennifer K Blakemore
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 159 East 53rd St, New York, NY, 10022, USA
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Wellman ML, Holton AE, Kaphingst KA. Previvorship Posting: Why Breast Cancer Previvors Share Their Stories on Social Media. HEALTH COMMUNICATION 2023; 38:2441-2449. [PMID: 35582752 DOI: 10.1080/10410236.2022.2074780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research on previvors, individuals with a genetic predisposition to develop hereditary breast and ovarian cancer but who have not yet been diagnosed with breast or other cancers, examines online information gathering and community support to alleviate uncertainty. However, research exploring online content published by previvors themselves is limited. We examined content published to Instagram and TikTok to explore how breast cancer previvors discussed their lived experience which included, but was not limited to, genetic testing, diagnosis with a BRCA1/2 pathogenic (i.e. risk-increasing) variant, the decision to undergo preventative measures like surgery and/or reconstruction, and how they cope after diagnosis and surgical procedures. In the findings, we explicate how many previvors feel a responsibility to share their authentic experience on social media in order to help others and mitigate their own feelings of uncertainty. This study offers a snapshot of how women are sharing breast cancer previvorship and building social connections with each other online.
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Dean M, Hintz EA, Baker J, Reblin M, Quinn GP, Haskins C, Vadaparampil ST. Shared Decision-Making Experiences of Couples with Inherited Cancer Risk Regarding Family Building. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37078713 DOI: 10.1080/10810730.2023.2202630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Patients with hereditary cancer predisposition syndromes have a high likelihood of passing germline mutations to future offspring. Patients at risk for inherited cancer may not have started and/or completed building their families; thus, they must decide about having children and consider the possibility of passing on their germline mutation. Utilizing the Shared Decision Making (SDM) Model, this study explores family building decision-making communication processes in opposite-sex couples with inherited cancer risk (ICR). Fifteen couples completed two recorded, analogue discussions and dyadic interviews at two time points. Participants were recruited through social media and snowball sampling. The constant comparison method was utilized to thematically analyze the data. When couples discussed family building options (FBOs), several themes were identified: FBO risks, FBO considerations, genetic-related FBO logistics, and life FBOs logistics. When deliberating family building decisions, couples shared easy conversational topics (e.g. FBO options and potential child's cancer risk due to a genetic variant) and difficult/conflict-inducing topics (e.g. preparing for possibilities, parenting, emotions, finances, and timing). Last, couples self-reported primary and secondary FBOs. The findings of this study capture couples' decision-making communication process while considering their experiences. Clinicians and practitioners can utilize these findings to support couples' family building decisions considering their ICR.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Jonathan Baker
- Department of Communication, University of South Florida, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, Grossman School of Medicine, New York University, New York, USA
| | - Carolyn Haskins
- Department of Genetic Counseling, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Warner NZ, Groarke A. "There's gonna be a lot more heartache". Coping with a BRCA1/2 alteration: A qualitative reflexive thematic analysis. Eur J Oncol Nurs 2023; 64:102328. [PMID: 37141664 DOI: 10.1016/j.ejon.2023.102328] [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: 03/03/2022] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND This examines the coping needs of individuals with a BRCA1/2 alteration in Ireland. This study examined coping and information needs in this cohort, and was nested within a larger study in order to develop an online tool to promote positive adaptation following the identification of a BRCA1/2 alteration. METHOD A total of 18 participants took part in individual, semi-structured online interviews. A reflexive thematic analysis was employed to analyse data. A public and patient involvement panel of six individuals with a BRCA1/2 alteration provided input on terminology and study design. RESULTS Two key themes were identified. "Adjusting to a new perspective" was the first, referring to how individuals readjusted to their life after finding out about their BRCA1/2 genetic status. This theme had two subthemes (i) "emotional aspects", reflecting how participants navigated the emotive aspects of their BRCA1/2 alteration status and (ii) "relationships changing", which encompassed the ways in which interpersonal relationships were impacted by BRCA1/2. The second theme, "making sense of BRCA" had two subthemes, (i) "meaning making", depicting how participants found meaning through their BRCA1/2 alteration status, and (ii) "hope", which details the frequent reliance on hope as a means to cope with their genetic status. CONCLUSIONS Individuals with a BRCA1/2 alteration require specialised psychological support to assist with navigating their situation, with a focus on how to prepare for the emotional and relationship changes that the identification of BRCA1/2 alteration in the family can elicit. Providing decisional aids and informational tools may assist in meeting this need.
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Affiliation(s)
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
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Hayes AE, Wardell DW, Engebretson J, LoBiondo-Wood G, Allicock M. Psychosexual responses to BRCA gene mutations in women of childbearing age. J Am Assoc Nurse Pract 2023; 35:242-251. [PMID: 36947688 DOI: 10.1097/jxx.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Diagnosis of a BRCA gene mutation presents a dilemma because life-changing medical decisions must be made to prevent breast and ovarian cancer. There is minimal evidence regarding how psychosexual functioning, psychological well-being with regard to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (WCBA; 18-49 years) with a BRCA gene mutation. PURPOSE To explore, describe, and interpret the experience of women with a BRCA mutation during the treatment and decision-making process. METHODOLOGY A qualitative descriptive design was used to recruit participants online through social media postings and from national and local BRCA support groups. Participants participated in semistructured interviews exploring their experience after BRCA diagnosis. Interpretive descriptive analysis was used to identify themes. RESULTS The purposive sample comprised 18 women aged 21-49 years. Four major themes, such as body image, sexuality, femininity, and childbearing/childrearing, were identified that influenced decisions related to the diagnosis and management of a BRCA mutation. All participants voiced that concerns regarding body image and sexuality caused hesitancy in their decision to have prophylactic surgery. Women who had undergone bilateral prophylactic mastectomy were concerned about the impact of the surgery, scarring, breast disfigurement, and the lack of sensation resulting from surgical intervention. CONCLUSIONS Psychosexual concerns arise from internal and external influences that significantly affect the decision to undergo prophylactic measures. Therefore, body image, sexuality, and sexual orientation should all be addressed during the decision-making process. IMPLICATIONS Provider communication and preparation for realistic surgical outcomes can be improved to assist WCBA throughout the decision-making process and enhance psychosexual functioning.
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Affiliation(s)
- Alexis Elizabeth Hayes
- Department of Nursing, Center for Nursing Research, Education and Practice, Houston, Methodist Academic Institute, Houston, Texas
| | - Diane Wind Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Joan Engebretson
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Geri LoBiondo-Wood
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health, Dallas Campus the University of Texas Health Science Center at Houston, Texas
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Isselhard A, Lautz Z, Rhiem K, Stock S. Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review. Curr Oncol 2023; 30:3590-3608. [PMID: 37185387 PMCID: PMC10136916 DOI: 10.3390/curroncol30040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Female BRCA1/2 pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected BRCA1/2 pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected BRCA1/2 pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
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Padmanabhan H, Mariapun S, Lee SY, Hassan NT, Lee DSC, Meiser B, Wong SW, Lee YQ, Yip CH, Teo SH, Thong MK, Taib NAM, Yoon SY. Impact of BRCA1/2 cascade testing on anxiety, depression, and cancer worry levels among unaffected relatives in a multiethnic Asian cohort. J Genet Couns 2023; 32:43-56. [PMID: 35913122 DOI: 10.1002/jgc4.1619] [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: 09/13/2021] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022]
Abstract
Cascade testing for families with BRCA pathogenic variants is important to identify relatives who are carriers. These relatives can benefit from appropriate risk management and preventative strategies arising from an inherited increased risk of breast, ovarian, prostate, melanoma, and pancreatic cancers. Cascade testing has the potential to enable cost-effective cancer control even in low- and middle-income settings, but few studies have hitherto evaluated the psychosocial impact of cascade testing in an Asian population, where the cultural and religious beliefs around inheritance and destiny have previously been shown to influence perception and attitudes toward screening. In this study, we evaluated the short- and long-term psychosocial impact of genetic testing among unaffected relatives of probands identified through the Malaysian Breast Cancer Genetics Study and the Malaysian Ovarian Cancer Study, using validated questionnaires (Hospital Anxiety and Depression Scale and Cancer Worry Scale) administered at baseline, and 1-month and 2-year post-disclosure of results. Of the 305 unaffected relatives from 98 independent families who were offered cascade testing, 256 (84%) completed predictive testing and family history of cancers was the only factor significantly associated with uptake of predictive testing. We found that the levels of anxiety, depression, and cancer worry among unaffected relatives decreased significantly after result disclosure and remained low 2-year post-result disclosure. Younger relatives and relatives of Malay descent had higher cancer worry at both baseline and after result disclosure compared to those of Chinese and Indian descent, whereas relatives of Indian descent and those with family history of cancers had higher anxiety and depression levels post-result disclosure. Taken together, the results from this Asian cohort highlight the differences in psychosocial needs in different communities and inform the development of culture-specific genetic counseling strategies.
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Affiliation(s)
| | | | | | | | | | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Meow-Keong Thong
- Department of Paediatrics, Genetic Medicine Unit, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Dason ES, Drost L, Greenblatt EM, Scheer AS, Han J, Sobel M, Allen L, Jacobson M, Doshi T, Wolff E, McMahon E, Jones CA. Providers' perspectives on the reproductive decision-making of BRCA-positive women. BMC Womens Health 2022; 22:506. [PMID: 36482357 PMCID: PMC9730610 DOI: 10.1186/s12905-022-02093-2] [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: 06/22/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO). METHODS This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020. Individuals were included if they were identified to provide care to BRCA-positive women. In total, 19 providers were approached and 15 consented to participate. Providers were recruited from three clinics in Toronto, Ontario located at academic centers: [1] A familial ovarian cancer clinic, [2] A familial breast cancer clinic and [3] A fertility clinic, all of which treat carriers of the BRCA1/BRCA2 genetic mutation. The interview guide was developed according to the Ottawa Decision Support Framework and included questions regarding reproductive options available to patients, factors that impact the decision-making process and the role of decisional support. Interviews were transcribed and transcripts were analyzed thematically using NVIVO 12. RESULTS Providers identified three major decisions that reproductive-aged women face when a BRCA mutation is discovered: [1] "Do I want children?"; [2] "Do I want to take the chance of passing on this the mutation?"; and [3] "Do I want to carry a child?" Inherent decision challenges that are faced by both providers and patients included difficult decision type, competing options, scientifically uncertain outcomes, and challenging decision timing. Modifiable decisional needs included: inadequate knowledge, unrealistic expectations, unclear values and inadequate support or resources. Identified clinical gaps included counselling time constraints, lack of reliable sources of background information for patients or providers and need for time-sensitive, geographically accessible, and centralized care. CONCLUSION Our study identified a need for a patient information resource that can be immediately provided to patients who carry a BRCA genetic mutation. Other suggestions for clinical practice include more time during consultation appointments, adequate follow-up, value-centric counseling, access to psychosocial support, and a specialized decisional coach.
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Affiliation(s)
- E. S. Dason
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,Mount Sinai Fertility, 7th Floor, 250 Dundas St. W, Toronto, ON M5T 2Z5 Canada
| | - L. Drost
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. M. Greenblatt
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - A. S. Scheer
- grid.415502.7Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, ON M5B 1W8 Canada
| | - J. Han
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - M. Sobel
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - L. Allen
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - M. Jacobson
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - T. Doshi
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. Wolff
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. McMahon
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8 Canada
| | - C. A. Jones
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
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12
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Dean M, Baker JT, Reblin M, Hintz EA, Vadaparampil ST, Haskins C, Quinn GP. Feasibility, acceptability, and outcomes of a pilot intervention facilitating communication about family building between patients with inherited cancer risk and their partners. PEC INNOVATION 2022; 1:100055. [PMID: 37213754 PMCID: PMC10194220 DOI: 10.1016/j.pecinn.2022.100055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 05/23/2023]
Abstract
Objective This study reports the feasibility, acceptability, and outcomes of a longitudinal, communication pilot intervention for patients with inherited cancer risk and their partners. Methods Couples were recruited through social media and snowball sampling. At Time 1 and 2, 15 couples completed a structured discussion task about family building concerns and decisions, followed by an online post-discussion questionnaire and dyadic interview to provide feedback about the experience. Interview data were analyzed to assess outcomes using applied thematic analysis. Results Participants reported the intervention created an opportunity for honest disclosure of family building goals and concerns. Participants also stated the structured nature of the discussion task was useful and did not cause additional stress. The intervention ultimately aided at-risk patients and their partners to realize their concordant concerns, discover/confront discordant concerns, and mutually agree upon next steps. Conclusions This pilot intervention is feasible and acceptable. Furthermore, it offers a framework to facilitate effective communication about family building between patients with inherited cancer risk and their partners. Innovation This intervention is the first conversational tool designed for at-risk patients and their partners.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Corresponding author at: Department of Communication, University of South Florida, 4202 E. Fowler Ave CIS 3068, Tampa, FL 33620, USA.
| | - Jonathan T. Baker
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, VT, USA
| | | | | | - Carolyn Haskins
- Department of Genetic Counseling, Moffitt Cancer Center, Tampa, FL, USA
| | - Gwendolyn P. Quinn
- Department of OB-GYN, Grossman School of Medicine, New York University, NY, USA
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13
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Kastner AM, Kocak HK, Fischer-Jacobs J, Hahne A, Zimmermann T. Desire for Children and Distress in Women with Hereditary Cancer Syndromes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14517. [PMID: 36361396 PMCID: PMC9654350 DOI: 10.3390/ijerph192114517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The diagnosis of a hereditary cancer syndrome can be psychologically stressful and influence family planning. This study aimed to gain insights into the relationship between the desire for children and the distress of female carriers. Women (N = 255) with different hereditary cancer syndromes were assessed from November 2019 to July 2021 at genetic counseling centers, the centers of the German HBOC-Consortium and the centers of the German HNPCC-Consortium regarding their distress levels with the NCCN Distress Thermometer (DT). The desire for children was measured by self-developed questions. Levels of distress and desire for children were evaluated descriptively. Factors influencing the desire for children and distress were calculated using binary logistic regression: 56% (n = 51) of 18- to 39-year-old participants reported a desire to have children; 70.6% of the carriers with a desire for children indicated a need for advice from their physicians regarding family planning. The diagnosis led 61.5% to postpone the timing of family planning, and the majority (68.8%) opted for an earlier birth. Carriers had higher levels of distress. Younger carriers (p = 0.037) and those living in poorer economic circumstances (p = 0.011) were more distressed. The diagnosis of hereditary cancer syndrome affects family planning. The results emphasize the importance of physicians addressing family planning in their counseling sessions.
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Affiliation(s)
- Anna Maria Kastner
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Hatice Kübra Kocak
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Josefine Fischer-Jacobs
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Andrea Hahne
- BRCA-Netzwerk e.V., Thomas-Mann-Street 40, 53111 Bonn, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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14
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Tutty E, Forbes Shepherd R, Hoskins C, Purvis R, Shanahan M, Boussioutas A, Forrest LE. Becoming and being a parent with an inherited predisposition to diffuse gastric cancer: A qualitative study of young adults with a CDH1 pathogenic variant. J Psychosoc Oncol 2022; 41:286-302. [PMID: 35959852 DOI: 10.1080/07347332.2022.2104676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE This study explored the experiences of young people with hereditary diffuse gastric cancer (HDGC), an inherited cancer predisposition syndrome, as they navigate becoming and being a parent. DESIGN We used interpretive description and conducted semi-structured interviews with 13 young Australians (18-39 years) with a CDH1 pathogenic variant (PV). Data were analyzed using team-based, reflexive thematic analysis. FINDINGS Participants' reproductive decisions centered on the perceived manageability of HDGC, namely via gastrectomy, and timing of their genetic testing. Participants yet to have children and those with challenging gastrectomy experiences favored using reproductive technologies to prevent passing on their PV. Parents who had children before genetic testing described complicated decisions about having more children. Gastrectomy was considered a parental responsibility but recovery diminished parenting abilities. CONCLUSION Young people with HDGC face unique challenges navigating reproductive decision-making and parenting with gastrectomy. Findings lend credence to calls for longitudinal, developmentally sensitive genetic counseling services.
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Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Cass Hoskins
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Rebecca Purvis
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Mary Shanahan
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Alex Boussioutas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Parkville, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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15
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Dibble KE, Donorfio LK, Britner PA, Bellizzi KM. Stress, anxiety, and health-related quality of life in BRCA1/2-positive women with and without cancer: A comparison of four US female samples. Gynecol Oncol Rep 2022; 42:101033. [PMID: 35769888 PMCID: PMC9234251 DOI: 10.1016/j.gore.2022.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Anxiety and stress were significantly worse in BRCA1/2-positive women compared to comparable US female samples. All health-related quality of life domains were better in BRCA1/2-positive women except energy/vitality, which was lower. Patient-provider training and mental health referrals are needed to lessen psychosocial consequences of genetic testing.
Introduction Women with BRCA1/2 mutations have a 11–72% increased risk of breast/ovarian cancers throughout their lifetime. The current study examines psychosocial differences between the current sample of BRCA1/2-positive women with and without cancer histories and three comparable United States (US) female samples without BRCA1/2 mutations. Methods Sixty BRCA1/2-positive women (with and without cancer histories) were recruited through multiple private online support groups in the US. Participants completed an online survey outlining sociodemographic and genetic counseling information, and anxiety, stress, and health-related quality of life (HRQoL) outcomes. Outcomes were compared to three similar US female normative samples via independent samples t-test analyses. Results State and trait anxiety (p = 0.00) and stress (p = 0.001) were significantly worse in the current sample of BRCA1/2-positive women compared comparable US female samples. All HRQoL domains were significantly better in the current sample except energy/vitality, which was significantly lower (p = 0.02) in the current sample. Results were stratified by cancer and recurrence status. Conclusions This study provides insight into how a sample of BRCA1/2-positive women both with and without cancer fare post-genetic counseling as compared to three normative female populations. Results infer the need for additional education, patient-provider training, and mental health referrals to support this population in order to circumvent unintended consequences and to improve psychosocial health in those being tested for, and those who test positive for, BRCA1/2 genetic mutations.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
- Corresponding author at: Johns Hopkins Bloomberg School of Public Health (JHSPH), 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Laura K.M. Donorfio
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
| | - Preston A Britner
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
| | - Keith M Bellizzi
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
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16
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Edaily S, Abdel-Razeq H. Management Strategies of Breast Cancer Patients with BRCA1 and BRCA2 Pathogenic Germline Variants. Onco Targets Ther 2022; 15:815-826. [PMID: 35923470 PMCID: PMC9343017 DOI: 10.2147/ott.s369844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Most of breast cancer cases are sporadic; however, 15–20% are associated with family history, and some are inherited. Among those, deleterious mutations in BRCA1 and BRCA2 tumor suppressor genes are the most commonly encountered pathogenic germline variants (PGVs). Given the availability and affordability of multi-gene panel sequencing technologies, testing for PGVs is commonly practiced. With our enhanced understanding of cancer genetics and specific molecular alterations, the better acceptance of risk-directed screening and prevention, and the recent introduction of novel targeted therapies, management of BRCA-positive breast cancers is taking a new direction, focusing more on risk-reducing interventions, including mastectomy and salpingo-oophorectomy, and incorporating special treatment regimens, including platinum-based chemotherapy, and the recently-introduced PARP (poly (ADP)-ribose polymerase) inhibitors. Given the recent advances in reproductive technology and molecular medicine, younger women with PGVs may have the option of embryo selection through preimplantation genetic testing and diagnosis, thus preventing the potential transmission of the implicated genes to the next generations. In this review, we cover the clinical implications of identifying a pathogenic germline mutation in BRCA1 and BRCA2 genes in breast cancer patients, and their relatives, across the continuum of care – from cancer prevention and early detection, through active treatment and up to survivorship issues.
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Affiliation(s)
- Sarah Edaily
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- Correspondence: Hikmat Abdel-Razeq, Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan, Tel +962-6 5300460, Ext: 1000, Email
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17
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Lombardi L, Trumello C, Stuppia L, Antonucci I, Brandão T, Babore A. BRCA1/2 pathogenetic variant carriers and reproductive decisions: Gender differences and factors associated with the choice of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). J Assist Reprod Genet 2022; 39:1433-1443. [PMID: 35661074 PMCID: PMC9365893 DOI: 10.1007/s10815-022-02523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the way carriers of a BRCA1/2 pathogenetic variant make their reproductive decisions and to examine the factors associated with the choice of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). Methods We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Results A total of 16 articles published from 2000 to 2021 were included in this review. Data were overall collected from 3564 participants (86% females). Three important themes were identified across studies: changes in family planning, factors associated with family plans, and with acceptance or regret of PGD and PND. Conclusion This review may contribute to the knowledge of the experience of those who have a BRCA1/2 mutation and want a child. These results may help genetic counselors and healthcare professionals that support people with a BRCA pathogenetic variant with reproductive issues.
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Affiliation(s)
- Lucia Lombardi
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Dei Vestini, 66100, Chieti, Italy.
| | - Carmen Trumello
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Dei Vestini, 66100, Chieti, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Dei Vestini, 66100, Chieti, Italy.,Center for Advanced Studies and Technology-CAST, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Ivana Antonucci
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Dei Vestini, 66100, Chieti, Italy.,Center for Advanced Studies and Technology-CAST, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Tânia Brandão
- CIP, Department of Psychology, Universidade Autónoma de Lisboa "Luís De Camões, Lisbon, Portugal.,CPUP, Center for Psychology, University of Porto, Porto, Portugal
| | - Alessandra Babore
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Dei Vestini, 66100, Chieti, Italy
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18
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Impact of BRCA Status on Reproductive Decision-Making and Self-Concept: A Mixed-Methods Study Informing the Development of Tailored Interventions. Cancers (Basel) 2022; 14:cancers14061494. [PMID: 35326645 PMCID: PMC8946482 DOI: 10.3390/cancers14061494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 02/06/2023] Open
Abstract
This mixed-methods study sought to deepen our understanding of self-concept and experiences in balancing cancer risk/reproductive decisions after learning of BRCA+ status. First, a quantitative survey of BRCA+ women (n = 505) examined the childbearing status, risk-reducing surgery, and self-concept. At the time of testing, 307/505 (60.8%) women were of reproductive age (<40 years-old), 340/505 (67.3%) had children, and 317/505 (62.8%) had undergone risk-reducing surgery. A younger age at the time of the testing was significantly associated with the decision to have children after learning BRCA+ status or undergoing risk-reducing surgery (p < 0.001). Compared to older women, BRCA+ women of reproductive age, exhibited a more negative self-concept with significantly higher vulnerability ratings (p < 0.01). Women with a cancer diagnosis exhibited a more negative mastery ratings and worse vulnerability ratings (p < 0.01) than women without a cancer history. Compared to childless counterparts, significantly higher vulnerability ratings were observed among BRCA+ women who had children before learning their BRCA status and/or undergoing risk-reducing surgery (p < 0.001). Subsequently, a subset of women (n = 40) provided in-depth interviews to explore their experiences in decision-making. The interviews provided insights into the effects of BRCA status on decisions regarding relationships, childbearing, cancer risk management, and communicating BRCA risk to children. Integrating quantitative and qualitative findings identifies targets for tailored interventions to enhance precision health for BRCA+ women of reproductive age.
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19
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Jeong J, Park B, Kim D, Kim J, Lee BY, Yoon J, Kim SW. Sex Differences in Attitudes Toward Marriage and Childbearing Based on the Assumption of Being BRCA1/2 Mutation Carriers Among Young People. J Breast Cancer 2022; 25:233-243. [PMID: 35775702 PMCID: PMC9250881 DOI: 10.4048/jbc.2022.25.e25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This study investigated changes in attitudes toward marriage and childbearing assuming a BRCA1/2 mutation carrier status among healthy, unmarried individuals in Korea. Methods A nationally representative sample of healthy, unmarried individuals aged 20–39 years was surveyed. A questionnaire on marriage and childbearing intentions was administered to the participants before and after providing them with information on BRCA1/2 mutation carriers’ breast and ovarian cancer risks and their autosomal dominant inheritance pattern. The participants were asked about their attitudes toward childbearing through preimplantation genetic diagnosis (PGD). Results Of the participants who initially wanted to marry, the assumption that they or their partners had BRCA1/2 mutation caused 25.3% to no longer want to get married and 36.2% to change their attitude from wanting to bear children to no longer wanting them. Females were more likely than males to change their attitudes toward marriage and childbearing. The participants who had negative attitudes toward genetic testing were more likely to change their attitudes regarding marriage and childbearing than those who were favorable toward both disclosure and testing. More than 50% of the participants who did not want children were willing to bear children through PGD when it was assumed that they were BRCA mutation carriers. Conclusion On the assumption of being carriers, general, young, and healthy females were more likely than males to negatively change their attitudes toward marriage and childbearing. Public education on the implications of living with mutation carriers and reproductive options may be required.
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Affiliation(s)
- Jiwon Jeong
- Department of Internal Medicine, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dongwon Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jiyoung Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Bom-Yi Lee
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Junghyun Yoon
- Department of Health Sciences, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
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20
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Somigliana E, Costantini MP, Filippi F, Terenziani M, Riccaboni A, Nicotra V, Rago R, Paffoni A, Mencaglia L, Magnolfi S, Zuccarello D, Rienzi L, Spinella F, Capalbo A, Scaravelli G, Testa S. Fertility counseling in women with hereditary cancer syndromes. Crit Rev Oncol Hematol 2022; 171:103604. [DOI: 10.1016/j.critrevonc.2022.103604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 12/29/2022] Open
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21
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Forbes Shepherd R, Werner-Lin A, Keogh LA, Delatycki MB, Forrest LE. Reproduction and Genetic Responsibility: An Interpretive Description of Reproductive Decision-Making for Young People With Li-Fraumeni Syndrome. QUALITATIVE HEALTH RESEARCH 2022; 32:168-181. [PMID: 34781775 DOI: 10.1177/10497323211046240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The reproductive decision-making of young people (aged 15-39 years) with Li-Fraumeni syndrome (LFS), an early onset inherited cancer syndrome, has not been studied in depth. Using interpretive description methodology, we conducted semi-structured interviews with 30 young Australians (mean age 25.5 years) diagnosed with LFS or at 50% genetic risk. With reflexive thematic analysis, we show how young people's reproductive decision-making and ideals for family formation were shaped by a sense of genetic responsibility to ensure the health of future biological kin. Reproductive technology provided choices for family formation in the context of LFS and also complicated reproductive decisions, as these choices were difficult to understand, make, or carry out. We uphold that reproductive decision-making when living with LFS is a profoundly moral practice that may pose significant challenges for young people navigating their formative years. We offer genetic counseling practice recommendations to support individuals with LFS when making reproductive decisions.
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Affiliation(s)
- Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, 3085Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, 2281The University of Melbourne, Melbourne, VIC, Australia
- Bruce Lefroy Centre for Genetic Health Research, 34361Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Allison Werner-Lin
- School of Social Policy and Practice, 6572The University of Pennsylvania, Philadelphia, PA, USA
| | - Louise A Keogh
- Melbourne School of Population and Global Health, 2281The University of Melbourne, Melbourne, VIC, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, 34361Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, 2281The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Parkville, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, 3085Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, 2281The University of Melbourne, Melbourne, VIC, Australia
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22
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Buonomo B, Massarotti C, Dellino M, Anserini P, Ferrari A, Campanella M, Magnotti M, De Stefano C, Peccatori FA, Lambertini M. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Med 2021; 19:205. [PMID: 34503502 PMCID: PMC8431919 DOI: 10.1186/s12916-021-02081-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Healthy individuals and patients with cancer who are carriers of germline pathogenic variants in the BRCA1/2 genes face multiple reproductive challenges that require appropriate counseling and specific expertise. MAIN BODY On December 5th-7th, 2019, patient advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to "San Giuseppe Moscati" Hospital in Avellino (Italy) for a workshop on reproductive management of women with germline pathogenic variants in the BRCA1/2 genes. From the discussion regarding the current evidence and future prospective in the field, eight main research questions were formulated and eight recommendations were developed regarding fertility, fertility preservation, preimplantation genetic testing, and pregnancy in healthy carriers and patients with cancer. CONCLUSION Several misconceptions about the topic persist among health care providers and patients often resulting in a discontinuous and suboptimal management. With the aim to offer patient-tailored counseling about reproductive issues, both awareness of current evidences and research should be promoted.
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Affiliation(s)
- Barbara Buonomo
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), School of Medicine, University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Miriam Dellino
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - Maria Campanella
- aBRCAdabra, National Patient Advocacy Association for carriers of BRCA genes mutation, Palermo, Italy
| | - Mirosa Magnotti
- ACTO Campania, Alleanza Contro il Tumore Ovarico, Avellino, Italy
| | - Cristofaro De Stefano
- Department of Women's and Children's Health, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy. .,Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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23
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Haddad JM, Robison K, Beffa L, Laprise J, ScaliaWilbur J, Raker CA, Clark MA, Hofstatter E, Dalela D, Brown A, Bradford L, Toland M, Stuckey A. Family planning in carriers of BRCA1 and BRCA2 pathogenic variants. J Genet Couns 2021; 30:1570-1581. [PMID: 33904624 DOI: 10.1002/jgc4.1423] [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: 09/04/2020] [Revised: 12/10/2020] [Accepted: 03/21/2021] [Indexed: 01/02/2023]
Abstract
BRCA1 and BRCA2 pathogenic variant carriers have a high lifetime risk of developing breast and ovarian malignancies. Given the risks and significant ramifications of undergoing risk-reducing surgeries, many pathogenic variant carriers unaffected by cancer (previvors) struggle with family planning and reproductive decision making. The objective of this study was to determine the attitudes and practices of BRCA1 and BRCA2 pathogenic variant carriers with respect to family planning decision making. A cross-sectional survey was conducted of BRCA1 and BRCA2 previvors at four Northeastern medical centers. The survey was administered electronically via email using REDCap. The survey included demographic information as well as questions about genetic testing, prophylactic surgeries, family planning, and partnering. Data were analyzed with Fisher's exact tests and t tests. The survey was completed by 139 of 422 BRCA1 and BRCA2 pathogenic variant carriers (response rate 33%). Thirteen were excluded from analysis due to self-reported cancer history. Of the remaining 126, 21 (16.7%) were male and 105 (83.3%) were female. Female participants <35 years old at the time of genetic testing were significantly more likely than those 35 or greater to report feeling urgency to have a family after finding out about their BRCA1 and BRCA2 pathogenic variant (p < 0.0001). Younger women also reported their genetic status had a stronger impact on their romantic relationships (p = 0.029). Men were significantly more likely to report that they felt no urgency to have a family compared to women (p < 0.0001). Our study reflects the complex decision making for previvors and the intricacies of family planning in this population. Providers can use this knowledge as a guide to counsel patients about reproductive options.
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Affiliation(s)
- Jessica M Haddad
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Katina Robison
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lindsey Beffa
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica Laprise
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer ScaliaWilbur
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina A Raker
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Melissa A Clark
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Hofstatter
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Disha Dalela
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Amy Brown
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | - Leslie Bradford
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, ME, USA
| | - Maris Toland
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, ME, USA
| | - Ashley Stuckey
- Department of Obstetrics-Gynecology, Women and Infants' Hospital, Cancer Genetics and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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24
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Skrovanek E, Dunbar-Jacob J, Dunwoody C, Wesmiller S. Integrative Review of Reproductive Decision Making of Women Who Are BRCA Positive. J Obstet Gynecol Neonatal Nurs 2020; 49:525-536. [PMID: 32926832 DOI: 10.1016/j.jogn.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To synthesize research findings about reproductive decision making among women who are BRCA positive. DATA SOURCES PubMed and CINAHL. STUDY SELECTION Articles published in English between 2000 and June 28, 2020, about the reproductive decision making of women with a confirmed BRCA1 or BRCA2 mutation. DATA EXTRACTION We extracted data about participants, study design, analysis, follow-up, and results. We used the modified Downs and Black checklist and Kennelly's qualitative data analysis to rate studies for quality and applicability by using. DATA SYNTHESIS We included five of 257 screened articles in our synthesis. The total sample size of the five studies was 1,468 women. The most prevalent factors related to reproductive decision making were the impending decisions regarding childbearing and family choices, including decisions about biological children, preventive surgery, preimplantation genetic diagnosis, and prenatal diagnosis to prevent further transmission of a BRCA mutation, and family planning. CONCLUSION A lack of knowledge exists about the reproductive decision-making processes of women who are BRCA positive. A better understanding of this process would provide nurses and other clinicians with the knowledge needed to support these women through their reproductive life choices.
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Reumkens K, Tummers MHE, Severijns Y, Gietel-Habets JJG, van Kuijk SMJ, Aalfs CM, van Asperen CJ, Ausems MGEM, Collée M, Dommering CJ, Kets M, van der Kolk LE, Oosterwijk JC, Tjan-Heijnen VCG, van der Weijden T, de Die-Smulders CEM, van Osch LADM. Reproductive decision-making in the context of hereditary cancer: the effects of an online decision aid on informed decision-making. J Community Genet 2020; 12:101-110. [PMID: 32880035 PMCID: PMC7846643 DOI: 10.1007/s12687-020-00484-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022] Open
Abstract
Individuals having a genetic predisposition to cancer and their partners face challenging decisions regarding their wish to have children. This study aimed to determine the effects of an online decision aid to support couples in making an informed decision regarding their reproductive options. A nationwide pretest-posttest study was conducted in the Netherlands among 131 participants between November 2016 and May 2018. Couples were eligible for participation if one partner had a pathogenic variant predisposing for an autosomal dominant hereditary cancer syndrome. Participants completed a questionnaire before use (T0), and at 3 months (T3) after use of the decision aid to assess the primary outcome measure informed decision-making, and the secondary outcome measures decisional conflict, knowledge, realistic expectations, level of deliberation, and decision self-efficacy. T0-T3 comparisons show an overall positive effect for all outcome measures (all ps < 0.05; knowledge (ES = - 1.05), decisional conflict (ES = 0.99), participants' decision self-efficacy (ES = -0.55), level of deliberation (ES = - 0.50), and realistic expectations (ES = - 0.44). Informed decision-making increased over time and 58.0% of the participants made an informed reproductive decision at T3. The online decision aid seems to be an appropriate tool to complement standard reproductive counseling to support our target group in making an informed reproductive decision. Use of the decision aid may lessen the negative psychological impact of decision-making on couples' daily life and wellbeing.
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Affiliation(s)
- Kelly Reumkens
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Marly H E Tummers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Yil Severijns
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands. .,Department of Health Promotion, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Postbox 616, 6200, MD, Maastricht, the Netherlands.
| | - Joyce J G Gietel-Habets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Amsterdam UMC, Academic Medical Centre, Amsterdam, the Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Margreet G E M Ausems
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Charlotte J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marleen Kets
- Department of Human Genetics, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | | | - Jan C Oosterwijk
- Department of Genetics, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Medical Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Liesbeth A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Health Promotion, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Postbox 616, 6200, MD, Maastricht, the Netherlands
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26
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Getachew-Smith H, Ross AA, Scherr CL, Dean M, Clements ML. Previving: How Unaffected Women with a BRCA1/2 Mutation Navigate Previvor Identity. HEALTH COMMUNICATION 2020; 35:1256-1265. [PMID: 31163995 DOI: 10.1080/10410236.2019.1625002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Receiving a positive result for a BRCA1/2 (BRCA) mutation - indicating a high lifetime risk to develop hereditary breast and ovarian cancer - can significantly alter a woman's identity. BRCA-positive women who have not been diagnosed with cancer may be labeled "previvors," which distinguishes those at-risk for developing cancer, but have not had cancer. Using semi-structured interviews (N = 25), this study explored how unaffected BRCA-positive women navigate the previvor identity. Women in this sample differed on their definitions of previvor, views of acceptance, rejection, or ambivalence toward the label, and identification as a previvor. Understanding how women interpret and embrace the previvor identity may help inform communication for those with BRCA genetic mutations, but whom have not been diagnosed with cancer.
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Affiliation(s)
| | - Amy A Ross
- Department of Communication Studies, Northwestern University
| | | | - Marleah Dean
- Department of Communication, University of South Florida
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27
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Knowledge and attitude of hereditary breast cancer among Japanese university female students. J Hum Genet 2020; 65:591-599. [PMID: 32203254 DOI: 10.1038/s10038-020-0743-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/08/2022]
Abstract
BRCA1/2 genetic testing to use PARP inhibitor for breast cancer has a possibility of the "secondary finding" among the younger nonaffected family members of the patient, which turns them into at-risk for hereditary breast cancer. Proper understanding of the background of the hereditary cancer is now required for appropriate acceptance of the risk. Therefore, we investigated the level of knowledge and attitudes of younger women on hereditary breast cancer in Japan. Study subject was Japanese university women between 20 and 30 years of age, without medical history of breast cancer. We conducted the anonymous self-answering questionnaire to them. We received responses from 353 women. The levels of knowledge, awareness, and interest were relatively high. Women with a family history of breast cancer were less likely to undergo testing than women without (92.8% vs. 74.5%, p < 0.001). The rates of positive response toward risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) was significantly high for medical majors compared with that for other majors (RRM: medical 71.6% vs. science 54.5% vs. humanities 53.8%, p = 0.008, RRSO: 35.4% vs. 36.3% vs. 48.4%, p = 0.027). Approximately half of respondents answered that they would hesitate to get married (45.3%) or to have children (55.4%), if they were a BRCA1/2 mutation carrier. The results may help to establish the methods for supporting the decision-making for reproduction of younger women who are unexpectedly labeled as being at-risk for HBOC.
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28
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Exploring patient and provider perspectives on the intersection between fertility, genetics, and family building. Support Care Cancer 2020; 28:4833-4845. [PMID: 31982959 DOI: 10.1007/s00520-020-05315-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Adolescent and young adult (AYA) cancer patients have distinct medical and psychosocial needs and fertility is a key concern. Early age of onset is a risk factor for hereditary cancer and AYAs are more likely to experience reduced fertility. This has implications for future family building decisions and fertility preservation (FP) and genetic testing/counseling (GT/GC) education. METHODS Patients diagnosed with cancer between the ages of 18 and 39 and health care providers (HCPs) who treat AYA cancer patients were recruited from a single institution. Qualitative interviews explored AYA patients' and HCPs' concerns regarding their experiences discussing genetics and FP. RESULTS The majority of patients (n = 17) were female (59%), and the majority of HCPs (n = 18) were male (67%). Overall, participants had differing perceptions of FP and GT/GC-related information provided during the clinical visit. Patients indicated initiating the conversation about FP and did not recall HCPs discussing GT/GC with them. HCPs indicated patients were often overwhelmed with too much information and comprehension of this discussion is limited. HCPs also felt patients' emotions/beliefs determined their information-seeking behavior specific to FP and GT/GC. Participants felt educational materials should be developed and delivered in a video format depicting a patient-provider interaction or patient testimonial. CONCLUSION AYA patients are often overwhelmed by a cancer diagnosis; the complexity/volume of information regarding FP and GT/GC may hinder understanding and decision-making about family building. Educational materials that help patients understand what questions to ask HCPs about FP and GT/GC should be developed to improve knowledge, psychosocial well-being, and future family building decisions.
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29
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Ter Welle-Butalid MEE, Vriens IJHI, Derhaag JGJ, Leter EME, de Die-Smulders CEC, Smidt MM, van Golde RJTR, Tjan-Heijnen VCGV. Counseling young women with early breast cancer on fertility preservation. J Assist Reprod Genet 2019; 36:2593-2604. [PMID: 31760547 PMCID: PMC6910894 DOI: 10.1007/s10815-019-01615-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. METHODS A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. RESULTS Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. CONCLUSIONS Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.
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Affiliation(s)
- M E Elena Ter Welle-Butalid
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - I J H Ingeborg Vriens
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J G Josien Derhaag
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - E M Edward Leter
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - C E Christine de Die-Smulders
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - M Marjolein Smidt
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - R J T Ron van Golde
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - V C G Vivianne Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Reumkens K, de Die-Smulders CEM, van Osch LADM. Exploring the preferences of involved health professionals regarding the implementation of an online decision aid to support couples during reproductive decision-making in hereditary cancer: a mixed methods approach. Fam Cancer 2019; 18:285-291. [PMID: 30656480 PMCID: PMC6449279 DOI: 10.1007/s10689-019-00119-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To support persons having a genetic predisposition to cancer and their partners during reproductive decision-making, an online decision aid was developed and evaluated. To maximize the impact of the support tool, this mixed methods study aims at developing the optimal implementation strategy for the decision aid. A questionnaire to assess the critical determinants that may affect this implementation was completed by health professionals involved in oncogenetic counselling (N = 46). Subsequently, semi-structured focus groups (N = 19) and individual telephonic interviews (N = 15) were performed with a subset of health professionals. All health professionals indicated to be willing to refer couples to the decision aid, preferably at the moment of receiving the genetic test result. They agreed that the primary requirement for implementation in daily practice was ease of referring couples and preferably free online accessibility. Referral to the tool was able to be included in the standard report couples receive after consultation, thereby making the use of additional paper-based materials redundant (e.g. flyers). Furthermore, incorporating the link to the decision aid on patient organization websites was suggested. Health professionals agreed that implementation would benefit more from promoting awareness regarding the decision aid rather than the inclusion of the tool in official clinical guidelines. To foster implementation of the decision aid, the distribution of online newsletters and the designation of a contact person charged with continued implementation in each Clinical Genetic Center were suggested. Based on these preferences and recommendations, the implementation of the online decision aid will be nationally executed to optimize impact.
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Affiliation(s)
- Kelly Reumkens
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Health Promotion, School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study. Fam Cancer 2019; 18:137-146. [PMID: 29846879 PMCID: PMC6323089 DOI: 10.1007/s10689-018-0092-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples’ decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest–posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.
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Liu QQ, Sun HF, Yang XL, Chen MT, Liu Y, Zhao Y, Zhao YY, Jin W. Survival following radiotherapy in young women with localized early-stage breast cancer according to molecular subtypes. Cancer Med 2019; 8:2840-2857. [PMID: 31016890 PMCID: PMC6558475 DOI: 10.1002/cam4.2186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate the significance and benefit of radiotherapy (RT) in young early‐stage breast cancer patients according to different molecular subtypes. Methods We conducted a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results database with known hormone receptor (HoR) and human epidermal growth factor receptor 2 (HER2) status. Female patients aged 18‐45, received RT treatment, and diagnosed with stage T1‐3, N0‐3, M0 primary breast cancer between 2010 and 2013 were identified. Results Of all the 23 148 included patients, 14 708 (63.54%), 3385 (14.62%), 1225 (5.29%), and 3830 (16.55%) were diagnosed with luminal‐A (HoR + HER2‐), luminal‐B (HoR + HER2+), HER2‐enriched (HoR‐HER2+), and triple‐negative (HoR‐HER2‐) breast cancer, respectively. RT was significantly correlated with improved overall survival (OS, HR: 0.295; 95% CI:0.138‐0.63, P = 0.002) and breast cancer‐specific survival (BCSS, HR: 0.328; 95% CI: 0.153‐0.702, P = 0.004) in HER2‐enriched patients. In addition, a significantly prolonged OS was also observed when RT was given to luminal‐A (HR: 0.696; 95% CI: 0.538‐0.902, P = 0.006) and luminal‐B (HR: 0.385; 95% CI:0.199‐0.744, P = 0.005) breast cancer patients compared to those without RT. Multivariable‐adjusted analyses showed that HER2 was a significant favorable factor for RT benefit in breast cancer patients. Conclusions RT could offer significant survival benefit in luminal‐A, luminal‐B, and especially HER2‐enriched young early‐stage breast cancer female patients. The results enabled clinicians to predict the benefits of RT and improve evidence‐based treatment for breast cancer patients.
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Affiliation(s)
- Qi-Qi Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - He-Fen Sun
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xue-Li Yang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Meng-Ting Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan-Yuan Zhao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Jin
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Reumkens K, Tummers MHE, Gietel-Habets JJG, van Kuijk SMJ, Aalfs CM, van Asperen CJ, Ausems MGEM, Collée M, Dommering CJ, Kets CM, van der Kolk LE, Oosterwijk JC, Tjan-Heijnen VCG, van der Weijden T, de Die-Smulders CEM, van Osch LADM. Online decision support for persons having a genetic predisposition to cancer and their partners during reproductive decision-making. J Genet Couns 2018; 28:533-542. [PMID: 30629779 PMCID: PMC7380023 DOI: 10.1002/jgc4.1056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
A nationwide pretest–posttest study was conducted in all clinical genetic centres in the Netherlands, to evaluate the effects of an online decision aid to support persons who have a genetic predisposition to cancer and their partners in making an informed decision regarding reproductive options. Main outcomes (decisional conflict, knowledge, realistic expectations, level of deliberation, and decision self‐efficacy) were measured before use (T0), immediately after use (T1), and at 2 weeks (T2) after use of the decision aid. Paired sample t tests were used to compute differences between the first and subsequent measurements. T0–T1 and T0–T2 comparisons indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict. Furthermore, use of the decision aid resulted in increased knowledge levels and improved realistic expectations. Level of deliberation only increased for participants with lower baseline levels of deliberation. Decision self‐efficacy increased for those with low baseline scores, whereas those with high baseline scores showed a reduction at T2. It can be concluded that use of the decision aid resulted in several positive outcomes indicative of informed decision‐making. The decision aid is an appropriate and highly appreciated tool to be used in addition to reproductive counseling.
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Affiliation(s)
- Kelly Reumkens
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marly H E Tummers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joyce J G Gietel-Habets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - C Marleen Kets
- Department of Human Genetics, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | - Jan C Oosterwijk
- Department of Genetics, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Medical Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, School CAPHRI, Maastricht University, Maastricht, The Netherlands
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34
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Dean M, Rauscher EA. Men's and Women's Approaches to Disclosure About BRCA-Related Cancer Risks and Family Planning Decision-Making. QUALITATIVE HEALTH RESEARCH 2018; 28:2155-2168. [PMID: 30051759 DOI: 10.1177/1049732318788377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about how men and women who test positive for a BRCA gene mutation or have a strong family history of carrying a BRCA mutation manage disclosures about their BRCA-related cancer risks and family planning decision-making. By conducting interviews with 25 men and 20 women, this study investigated men's and women's approaches to disclosing their BRCA-related cancer risks and family planning decision-making. Guided by the Disclosure Decision-Making Model (DD-MM), this study demonstrates that men and women assess both information and the recipients of disclosures when making disclosure decisions. Theoretical implications for the DD-MM are discussed along with practical implications for hereditary cancer risk and family planning.
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35
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Mor P, Brennenstuhl S, Metcalfe KA. Uptake of Preimplantation Genetic Diagnosis in Female BRCA1 and BRCA2 Mutation Carriers. J Genet Couns 2018; 27:1386-1394. [DOI: 10.1007/s10897-018-0264-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/22/2018] [Indexed: 01/26/2023]
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36
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Gietel-Habets JJG, de Die-Smulders CEM, Derks-Smeets IAP, Tibben A, Tjan-Heijnen VCG, van Golde R, Gomez-Garcia E, van Osch LADM. Support needs of couples with hereditary breast and ovarian cancer during reproductive decision making. Psychooncology 2018; 27:1795-1801. [PMID: 29644780 DOI: 10.1002/pon.4729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/23/2018] [Accepted: 03/20/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Reproductive decision making for couples with hereditary breast and ovarian cancer (HBOC) is complex and can result in decisional conflict or regret. This study investigated couples' support needs and aimed to identify vulnerable couples. Ultimately, we should strive to develop a clear standard of care guideline regarding reproductive decision support. METHODS Mixed methods were used for data collection. A focus group study was conducted among 18 couples (N = 35) with HBOC who had made a reproductive decision after reproductive counselling. Subsequently, 129 similar couples (N = 258) were invited to complete a cross-sectional survey based on the focus group study. RESULTS Clinical and practical aspects of reproductive counselling were positively evaluated in the focus group study, although couples indicated a need for additional support with emotional and social concerns in which their relationship, social environment, and the way they picture their desired family were key elements. The survey was completed by 86 participants. Making a reproductive choice was experienced as (very) difficult by 43%, and 69% showed a need for additional support during decision making. Younger participants and those who opted for a natural pregnancy experienced more difficulty with reproductive decision making, and partners showed a higher need for psychological support than carriers. CONCLUSIONS Couples with HBOC who need to make a reproductive decision have specific needs for guidance and support, of which the desired content and methods can vary. It is therefore important to identify vulnerable couples and to attune counselling to couples' needs.
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Affiliation(s)
- J J G Gietel-Habets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - I A P Derks-Smeets
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A Tibben
- Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - V C G Tjan-Heijnen
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - R van Golde
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - E Gomez-Garcia
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L A D M van Osch
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
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37
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Reproductive decision making: interviews with mothers of children with undiagnosed developmental delay. J Community Genet 2018; 9:315-325. [PMID: 29392580 DOI: 10.1007/s12687-017-0354-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/25/2017] [Indexed: 02/03/2023] Open
Abstract
Reproductive decision making is complex and personal. Having a child with undiagnosed developmental delay can further complicate these decisions, as recurrence risks are unknown. This qualitative study is an exploration of the experiences of parents who have a child with an undiagnosed developmental disorder, focusing on their reproductive decisions. The aims of the research were to explore the reproductive decision making process and examine the factors that influence these decisions. Data were collected from in-depth semi-structured interviews with five mothers of children without a diagnosis. Transcripts were analysed using an interpretative phenomenological analysis. Analysis identified five factors that were considered by participants when contemplating reproductive decisions: future uncertainty, perceptions of risk, the potential impact a child would have on their current children, expectations of a family and the desire for another child. Being aware of the factors that influence reproductive decisions for these mothers and being sensitive to them can enable genetic counsellors to carry out their role more effectively, as they are aware of the factors that need to be discussed and explored before a decision is made.
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Dean M, Scherr CL, Clements M, Koruo R, Martinez J, Ross A. "When information is not enough": A model for understanding BRCA-positive previvors' information needs regarding hereditary breast and ovarian cancer risk. PATIENT EDUCATION AND COUNSELING 2017; 100:1738-1743. [PMID: 28385363 DOI: 10.1016/j.pec.2017.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate BRCA-positive, unaffected patients' - referred to as previvors - information needs after testing positive for a deleterious BRCA genetic mutation. METHODS 25 qualitative interviews were conducted with previvors. Data were analyzed using the constant comparison method of grounded theory. RESULTS Analysis revealed a theoretical model of previvors' information needs related to the stage of their health journey. Specifically, a four-stage model was developed based on the data: (1) pre-testing information needs, (2) post-testing information needs, (3) pre-management information needs, and (4) post-management information needs. Two recurring dimensions of desired knowledge also emerged within the stages-personal/social knowledge and medical knowledge. CONCLUSIONS While previvors may be genetically predisposed to develop cancer, they have not been diagnosed with cancer, and therefore have different information needs than cancer patients and cancer survivors. PRACTICE IMPLICATIONS This model can serve as a framework for assisting healthcare providers in meeting the specific information needs of cancer previvors.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL, USA.
| | - Courtney L Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - Meredith Clements
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Rachel Koruo
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Jennifer Martinez
- Department of Communication, University of South Florida, Tampa, FL, USA
| | - Amy Ross
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
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39
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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40
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Dean M, Rauscher EA. “It was an Emotional Baby”: Previvors’ Family Planning Decision-Making Styles about Hereditary Breast and Ovarian Cancer Risk. J Genet Couns 2017; 26:1301-1313. [DOI: 10.1007/s10897-017-0069-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/15/2017] [Indexed: 01/14/2023]
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41
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Reproductive Decision-Making in Women with BRCA1/2 Mutations. J Genet Couns 2016; 26:594-603. [PMID: 27796678 DOI: 10.1007/s10897-016-0035-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
Expanded genetic testing of BRCA mutations has led to identification of more reproductive-aged women who test positive for the mutation which might impact attitudes and decisions about relationships, childbearing and the use of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). A cross-sectional survey was administered to 1081 self-reported BRCA carriers to investigate how knowledge of BRCA status influences these issues. The mean age at BRCA test disclosure was 44 years and 36 % reported a personal history of cancer. Of 163 women who were unpartnered, 21.5 % felt more pressure to get married. Of 284 women whose families were not complete, 41 % reported that carrier status impacted their decision to have biological children. Women with a history of cancer were more likely to report that knowledge of BRCA+ status impacted their decision to have a child (OR 1.8, 95 % CI 1-3.2). Fifty-nine percent thought PGD should be offered to mutation carriers and 55.5 % thought PND should be offered. In conclusion, knowledge of BRCA status impacts attitudes regarding relationships and childbearing, and most carriers believe that PGD and PND should be offered to other carriers. This study suggests that BRCA carriers desire and would benefit from reproductive counseling after test disclosure.
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42
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Mancini J, Mouret-Fourme E, Noguès C, Julian-Reynier C. Impact of BRCA1/2 mutation on young women's 5-year parenthood rates: a prospective comparative study (GENEPSO-PS cohort). Fam Cancer 2016; 14:273-9. [PMID: 25550141 DOI: 10.1007/s10689-014-9777-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous qualitative and intentions surveys have shown that the disclosure of a BRCA1/2 mutation might deter young women from becoming pregnant. However, to our knowledge, no comparative studies have ever documented the possibility that positive genetic test results might affect these women's future reproductive rates. Our aim was therefore to quantify the impact of BRCA1/2 mutation disclosure on long-term relationships between partners and childbearing rates. Participants were cancer-free women belonging to families in which a deleterious BRCA1/2 mutation had been identified, who had attended one of the 29 participating cancer genetic clinics for BRCA1/2 testing between 2000 and 2006. Logistic regression models were used to determine predictors of the 5-year self-reported parenthood rate. The sample consisted of 271 women aged 18-45 years (126 BRCA1/2 mutation carriers and 145 non-carriers). Couples had separated more frequently among BRCA1/2 carriers than non-carriers (10 vs. 3%, p = .040), especially among nulliparous carriers (13%). Among the 104 women who were childless at disclosure, disclosure of a BRCA1/2 mutation was not significantly associated with childbearing during the 5-year follow-up period [adjusted odds ratio .64, 95% confidence interval (CI) (.26, 1.57), p = .334]. Among the 167 women with at least one child at disclosure of a BRCA1/2 mutation had no conspicuous effect on the childbearing trends [adjOR .88, 95% CI (.35, 2.21), p = .787]. The disclosure of a BRCA1/2 mutation might impact couples' relationships and future mothering rates, particularly among nulliparous women. Studies on larger populations are now required to confirm these findings.
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Affiliation(s)
- Julien Mancini
- Aix Marseille Université, Inserm, IRD, UMR912 SESSTIM, 13385, Marseille, France,
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43
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Olesen AP, Nor SNM, Amin L. Attitudes Toward Pre-implantation Genetic Diagnosis (PGD) for Genetic Disorders Among Potential Users in Malaysia. SCIENCE AND ENGINEERING ETHICS 2016; 22:133-146. [PMID: 25724710 DOI: 10.1007/s11948-015-9639-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
While pre-implantation genetic diagnosis (PGD) is available and legal in Malaysia, there is an ongoing controversy debate about its use. There are few studies available on individuals' attitudes toward PGD, particularly among those who have a genetic disease, or whose children have a genetic disease. To the best of our knowledge, this is, in fact, the first study of its kind in Malaysia. We conducted in-depth interviews, using semi-structured questionnaires, with seven selected potential PGD users regarding their knowledge, attitudes and decisions relating to the use PGD. The criteria for selecting potential PGD users were that they or their children had a genetic disease, and they desired to have another child who would be free of genetic disease. All participants had heard of PGD and five of them were considering its use. The participants' attitudes toward PGD were based on several different considerations that were influenced by various factors. These included: the benefit-risk balance of PGD, personal experiences of having a genetic disease, religious beliefs, personal values and cost. The study's findings suggest that the selected Malaysian participants, as potential PGD users, were supportive but cautious regarding the use of PGD for medical purposes, particularly in relation to others whose experiences were similar. More broadly, the paper highlights the link between the participants' personal experiences and their beliefs regarding the appropriateness, for others, of individual decision-making on PGD, which has not been revealed by previous studies.
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Affiliation(s)
| | - Siti Nurani Mohd Nor
- Department of Science and Technology, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Section for Co-curricular Courses, External Faculty Electives * TITAS (SKET), University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Latifah Amin
- Pusat Citra UKM, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia.
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Quinn GP, Peshkin BN, Sehovic I, Bowman M, Tamargo C, Vadaparampil ST. Oncofertility in adolescent and young adult hereditary cancer: Considerations for genetics professionals. World J Med Genet 2015; 5:52-59. [DOI: 10.5496/wjmg.v5.i4.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/07/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Adolescents and young adults (AYA) with a cancer diagnosis or those at risk for cancer due to hereditary cancer syndromes may benefit from genetic counseling and testing not only to manage personal risk but also to address reproductive concerns, especially fertility. The opportunity for genetic counselors to provide important risk information is relevant to both the newly diagnosed as well as to unaffected carriers and survivors. However, genetic counselors may need additional training in reproductive options related to AYA cancer to provide this valuable counsel. This commentary uses hereditary breast and ovarian cancer syndrome as a model to highlight important considerations when discussing preimplanatation genetic diagnosis and prenatal diagnosis, particularly in the context of expanded testing for hereditary cancer risk including multigene panels or whole exome or whole genome sequencing. Other hereditary cancers are also addressed; however, less is known about the psychosocial and fertility concerns in these AYA populations. Additionally, we provide an overview of the concept of “oncofertility” - the linkage between cancer care and reproductive medicine that aims to expand the reproductive opportunities of cancer patients - and offer support for the expansion of guidelines to include genetic counselors in AYA cancer patients’ treatment planning related to reproductive health and fertility.
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45
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Reproductive Decision-Making in MMR Mutation Carriers After Results Disclosure: Impact of Psychological Status in Childbearing Options. J Genet Couns 2015; 25:432-42. [PMID: 26392361 DOI: 10.1007/s10897-015-9888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/08/2015] [Indexed: 01/13/2023]
Abstract
Reproductive techniques such as prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD), although debated, are legally forbidden in France in case of Lynch syndrome. The preference of mutation carriers about their reproductive options is not systematically considered in France. We aimed to prospectively assess the reproductive preferences of mismatch repair mutation carriers consulting in our institution (2003-2010, n = 100). We also considered the short- and long-term post-disclosure psychological impact using the Impact of Events Scale-Revised questionnaire to measure the prevalence of posttraumatic stress disorder (PTSD) in those patients. Complete data were obtained for 34 respondents (17 males, 17 females, median age of 33.5 years [22-59]). Seventeen respondents (57 %) preferred spontaneous natural conception versus 28 % and 35 % choosing PND and PGD, respectively. At results disclosure, respondents mainly explained their distress by fear of premature death (43 %) and transmitting mutated genes (42 %). One year later, this last fear remained predominant in 55 % of subjects. None of the main socio-demographical, psychological or medical variables (including fear of transmitting mutations) was significantly associated with the reproductive preferences. Results disclosure had a real and time-decreasing psychological impact on mutation carriers. Reproductive techniques, expected to decrease the hereditary risk, were not significantly preferred to natural conception.
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46
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Hamilton RJ, Innella NA, Bounds DT. Living With Genetic Vulnerability: a Life Course Perspective. J Genet Couns 2015; 25:49-61. [PMID: 26323596 DOI: 10.1007/s10897-015-9877-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/11/2015] [Indexed: 01/01/2023]
Abstract
This is the second article of a two part series about utilizing the life course perspective (LCP) in genetic counseling. Secondary data analysis was conducted on a grounded theory, longitudinal study which provided a wide focus on living with hereditary breast and ovarian cancer (HBOC) risk. The aim of this analysis was to explore the longitudinal data for both the temporal and social context of living with BRCA mutation genetic test results. Sixteen women from two previous studies were interviewed on multiple occasions over an 8 year time period. The LCP was used to direct a thematic analysis of the data. Families experience the consequences of knowing they carry a BRCA1 or BRCA2 gene mutation long after the initial diagnosis. These women's experiences across time reflect the concepts of the LCP and show how life is changed when families know they live with a genetic vulnerability to an adult-onset and potentially life-threatening disease. Different emphases on concepts from the LCP were evident across the different age groups. For example, the group of 40-50 year old women emphasized the concept of linked lives, those in their 30's focused on human agency and women in their 20's were more focused on timing of events. This study helps give direction to healthcare providers counseling women living with a BRCA mutation.
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Affiliation(s)
- Rebekah J Hamilton
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA.
| | - Nancy A Innella
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
| | - Dawn T Bounds
- Department of Women, Children & Family Nursing, Rush University College of Nursing, 2624 Newcastle Dr., Carrollton, TX, 75007, USA
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47
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Non-invasive Prenatal Diagnosis for BRCA Mutations – a Qualitative Pilot Study of Health Professionals’ Views. J Genet Couns 2015; 25:198-207. [DOI: 10.1007/s10897-015-9858-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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48
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El Hachem H, Atallah D, Grynberg M. Fertility preservation in breast cancer patients. Future Oncol 2015; 10:1767-77. [PMID: 25303056 DOI: 10.2217/fon.14.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women of reproductive age, and is characterized by a high survival rate owing to improved antineoplastic treatments. Young survivors face the prospect of a diminished fertility as a consequence of the gonadotoxic chemotherapy, and many are seeking ways to preserve their fertility. Embryo and/or oocyte cryopreservation following controlled ovarian stimulation is currently the fertility preservation method of choice, but breast cancer patients may have contraindications to exogenous gonadotropin administration and may not have enough time to undergo ovarian stimulation prior to chemotherapy. Fortunately, many other options are available for these women, such as the letrozole-follicle-stimulating hormone ovarian stimulation protocol, in vitro maturation of oocytes and ovarian tissue cryopreservation. In this review, we discuss the benefits and disadvantages of the different fertility preservation techniques that can be offered to breast cancer patients.
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Affiliation(s)
- Hady El Hachem
- Service de Gynécologie-Obstétrique, Hôpital Hôtel-Dieu de France, Beyrouth, Liban
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49
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Experiences of Women Who Underwent Predictive BRCA 1/2 Mutation Testing Before the Age of 30. J Genet Couns 2015; 25:90-100. [DOI: 10.1007/s10897-015-9845-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
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50
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Rubin LR, Werner-Lin A, Sagi M, Cholst I, Stern R, Lilienthal D, Hurley K. ‘TheBRCAClock is Ticking!’: Negotiating medical concerns and reproductive goals in preimplantation genetic diagnosis. HUM FERTIL 2014; 17:159-64. [DOI: 10.3109/14647273.2014.940003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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