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Power RF, Doherty DE, Horgan R, Fahey P, Gallagher DJ, Lowery MA, Cadoo KA. Modifiable risk factors for cancer among people with lynch syndrome: an international, cross-sectional survey. Hered Cancer Clin Pract 2024; 22:10. [PMID: 38877502 PMCID: PMC11177364 DOI: 10.1186/s13053-024-00280-w] [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: 03/10/2024] [Accepted: 05/14/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Lynch syndrome is the most common cause of hereditary colorectal and endometrial cancer. Lifestyle modification may provide an opportunity for adjunctive cancer prevention. In this study, we aimed to characterise modifiable risk factors in people with Lynch syndrome and compare this with international guidelines for cancer prevention. METHODS A cross-sectional study was carried out utilizing survey methodology. Following public and patient involvement, the survey was disseminated through patient advocacy groups and by social media. Self-reported demographic and health behaviours were collected in April 2023. Guidelines from the World Cancer Research Fund (WCRF) were used to compare percentage adherence to 9 lifestyle recommendations, including diet, physical activity, weight, and alcohol intake. Median adherence scores, as a surrogate for lifestyle risk, were calculated and compared between groups. RESULTS 156 individuals with Lynch syndrome participated from 13 countries. The median age was 51, and 54% were cancer survivors. The mean BMI was 26.7 and the mean weekly duration of moderate to vigorous physical activity was 90 min. Median weekly consumption of ethanol was 60 g, and 3% reported current smoking. Adherence to WCRF recommendations for cancer prevention ranged from 9 to 73%, with all but one recommendation having < 50% adherence. The median adherence score was 2.5 out of 7. There was no significant association between median adherence scores and age (p = 0.27), sex (p = 0.31), or cancer history (p = 0.75). CONCLUSIONS We have characterised the modifiable risk profile of people living with Lynch syndrome, outlining targets for intervention based on lifestyle guidelines for the general population. As evidence supporting the relevance of modifiable factors in Lynch syndrome emerges, behavioural modification may prove an impactful means of cancer prevention.
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Affiliation(s)
- Robert F Power
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cancer Genetics service, Trinity St James's Cancer Institute, Dublin, Ireland
| | - Damien E Doherty
- Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | | | - Pat Fahey
- Lynch syndrome Ireland, Dublin, Ireland
| | - David J Gallagher
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cancer Genetics service, Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Medical Oncology, Trinity St James's Cancer Institute, Dublin, Ireland
| | - Maeve A Lowery
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Medical Oncology, Trinity St James's Cancer Institute, Dublin, Ireland
| | - Karen A Cadoo
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Cancer Genetics service, Trinity St James's Cancer Institute, Dublin, Ireland.
- Department of Medical Oncology, Trinity St James's Cancer Institute, Dublin, Ireland.
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2
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Fusco KM, Hylind RJ, Cirino AL, Harris SL, Lubitz SA, Abrams DJR, Lakdawala NK. Cascade testing for inherited cardiac conditions: Risk perception and screening after a negative genetic test result. J Genet Couns 2022; 31:1273-1281. [PMID: 35763674 DOI: 10.1002/jgc4.1602] [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: 11/22/2021] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
First-degree relatives of a proband with an inherited cardiac condition (ICC) are offered predictive genetic testing for the pathogenic or likely pathogenic (P/LP) cardiac gene variant (CGV) to clarify their risk for the familial condition. Relatives who test negative for a familial P/LP CGV typically do not require longitudinal cardiac surveillance. To our knowledge, no previous study has investigated adjustment to risk reduction and subsequent screening practices in genotype-negative relatives from an ICC population. We thus investigated risk perception and ongoing screening practices in genotype-negative adults who received cardiac genetic counseling. Correlations between clinical and demographic variables and risk perception and screening practices were also investigated. On average, participants (n = 71) reported a perceived 19.5% lifetime risk of developing the ICC in their family, despite their negative genetic test result. The majority (54%) of participants reported having undergone cardiac screening after disclosure of their negative result. There were no significant correlations between clinical and demographic variables and risk perception or screening practices. Furthermore, risk perception was not found to impact the likelihood of cardiac screening. These findings suggest that even with comprehensive cardiac genetic counseling, a proportion of this population did not accurately comprehend or recall their cardiac disease risk. Additional interventions beyond traditional result disclosure should be explored to help genotype-negative individuals adjust to their reduction in risk for a familial ICC.
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Affiliation(s)
- Kelsey M Fusco
- MGH Institute of Health Professions Genetic Counseling Program, Boston, Massachusetts, USA.,New England Cancer Specialists, Scarborough, Maine, USA
| | - Robyn J Hylind
- Boston Children's Hospital Inherited Cardiac Arrhythmia Program, Boston, Massachusetts, USA
| | - Allison L Cirino
- MGH Institute of Health Professions Genetic Counseling Program, Boston, Massachusetts, USA.,Brigham and Women's Hospital Cardiovascular Genetics Center, Boston, Massachusetts, USA
| | - Stephanie L Harris
- Massachusetts General Hospital Cardiovascular Genetics Program, Boston, Massachusetts, USA
| | - Steven A Lubitz
- Massachusetts General Hospital Cardiovascular Genetics Program, Boston, Massachusetts, USA
| | - Dominic J R Abrams
- Boston Children's Hospital Inherited Cardiac Arrhythmia Program, Boston, Massachusetts, USA
| | - Neal K Lakdawala
- Brigham and Women's Hospital Cardiovascular Genetics Center, Boston, Massachusetts, USA
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3
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Gomes P, Matos PM, Silva ER, Silva J, Silva E, Sales CMD. Distress facing increased genetic risk of cancer: The role of social support and emotional suppression. PATIENT EDUCATION AND COUNSELING 2022; 105:2436-2442. [PMID: 35339327 DOI: 10.1016/j.pec.2022.03.018] [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: 11/07/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Healthy individuals from hereditary cancer families undergoing genetic testing for cancer susceptibility (GTC) report more distress when they perceive their social support as low and suppress their emotions. This study aimed to explore how suppressing emotions and perceiving others as unsupportive are related with cancer-risk distress. METHODS We performed a regression-based mediation analysis to assess if expressive suppression mediates or is mediated by perceived social support in the relation with cancer-risk distress. Participants were 125 healthy adults aged over 18 (M = 36.07, SD = 12.86), mostly female (72,4%), who undergone GTC to assess the presence of hereditary breast and ovarian cancer or Lynch syndromes. RESULTS Controlling for age and gender, we found a moderate size indirect effect of social support on cancer-risk distress through expressive suppression (β = -0.095) and a direct effect of expressive suppression on cancer-risk distress. CONCLUSIONS When healthy individuals from hereditary cancer families perceive their social network as less responsive, they tend to not express their emotions, which relates to increased distress facing GTC. PRACTICE IMPLICATIONS Practitioners may assess cancer-risk related distress before the GTC and offer distressed individuals interventions focused on changing emotion regulation strategies in a safe group context.
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Affiliation(s)
- Pedro Gomes
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal.
| | - Paula Mena Matos
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
| | - Eunice R Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Psychology Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal.
| | - João Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Medical Genetics Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal.
| | - Eliana Silva
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
| | - Célia M D Sales
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
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Psychological Impact of TP53-Variant-Carrier Newborns and Counselling on Mothers: A Pediatric Surveillance Cohort. Cancers (Basel) 2022; 14:cancers14122945. [PMID: 35740610 PMCID: PMC9221115 DOI: 10.3390/cancers14122945] [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: 04/28/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Counselling and genetic testing (CGT) after neonatal screening may increase depression and anxiety (DA) levels during cancer surveillance. This study assessed the DA scores in mothers of newborns from Paraná state, Southern Brazil, carrying the TP53 p.R337H variant. To understand and adjust DA conditions during term of pregnancy, we initially detected sociodemographic covariates [marital status (MS), number of children (NC), and/or education level (EL): MS-NC-EL] on an independent group of pregnant women (not subjected to genetic testing). The Hospital Anxiety and Depression Scale (HADS) was used to assess risk factors in pregnant (cross-sectional analysis) and unrelated mothers (at 2-month intervals, longitudinal study) of TP53 p.R337H-tested newborns (three sessions of HADS analysis) using Wilcoxon (Mann-Whitney) and Kruskal-Wallis nonparametric tests. Lower anxiety levels were observed in mothers of noncarriers (without MS-NC-EL = 6.91 ± 1.19; with MS-NC-EL = 6.82 ± 0.93) than in mothers of p.R337H carriers in the first session (without MS-NC-EL = 6.82 = 8.49 ± 0.6025, with MS-NC-EL = 6.82 = 9.21 ± 0.66). The anxiety levels significantly decreased 4 months after CGT (third session) in mothers of p.R337H carriers. We did not find a significant change in depression scores. Mothers with mental health instability requiring medications need periodical psychological support during and after CGT.
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Warner N, Groarke A, Gleeson C, Fahey P, Horgan R. Experiences of living with Lynch Syndrome: A reflexive thematic analysis. Eur J Oncol Nurs 2022; 58:102117. [DOI: 10.1016/j.ejon.2022.102117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Gomes P, Pietrabissa G, Silva ER, Silva J, Matos PM, Costa ME, Bertuzzi V, Silva E, Neves MC, Sales CMD. Family Adjustment to Hereditary Cancer Syndromes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031603. [PMID: 35162625 PMCID: PMC8834948 DOI: 10.3390/ijerph19031603] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family’s adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research.
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Affiliation(s)
- Pedro Gomes
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
- Correspondence:
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy; (G.P.); (V.B.)
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20122 Milan, Italy
| | - Eunice R. Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Psychology Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - João Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Medical Genetics Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Paula Mena Matos
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Maria Emília Costa
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Vanessa Bertuzzi
- Department of Psychology, Catholic University of the Sacred Heart, 20123 Milan, Italy; (G.P.); (V.B.)
| | - Eliana Silva
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Maria Carolina Neves
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (E.R.S.); (J.S.); (M.C.N.)
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
| | - Célia M. D. Sales
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; (P.M.M.); (M.E.C.); (E.S.); (C.M.D.S.)
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Patient-Reported Outcomes following Genetic Testing for Familial Hypercholesterolemia, Breast and Ovarian Cancer Syndrome, and Lynch Syndrome: A Systematic Review. J Pers Med 2021; 11:jpm11090850. [PMID: 34575627 PMCID: PMC8467628 DOI: 10.3390/jpm11090850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Patient-reported outcomes (PROs) and PRO measures (PROMs) are real-world evidence that can help capture patient experiences and perspectives regarding a clinical intervention such as genetic testing. Objective: To identify and capture methods and qualitative PRO themes among studies reporting PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Methods: A systematic review was conducted via PubMed/MEDLINE, EMBASE, and Yale University’s TRIP Medical Databases on articles published by April 2021. Results: We identified 24 studies published between 1996 and 2021 representing 4279 participants that reported PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Studies collected and reported PROs from validated PROM instruments (n = 12; 50%), validated surveys (n = 7; 26%), and interviews (n = 10; 42%). PRO themes ranged across all collection methods (e.g., psychological, knowledge, coping and satisfaction, concern about stigma/discrimination, etc.). Conclusions: Important gaps identified include (1) most studies (n = 18; 75%) reported PROs following genetic testing for breast and ovarian cancer, and (2) populations reporting PROs overall were largely of White/Caucasian/Northern European/Anglo-Saxon descent. We offer recommendations and describe real-world implications for the field moving forward.
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Olivier R, Randrian V, Tougeron D, Saurin JC. Endoscopy to Diagnose and Prevent Digestive Cancers in Lynch Syndrome. Cancers (Basel) 2021; 13:cancers13143505. [PMID: 34298719 PMCID: PMC8305049 DOI: 10.3390/cancers13143505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/23/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
Lynch syndrome patients could benefit from various recommendations to prevent digestive cancers. In this review, we summarize the criteria to identify Lynch syndrome in patients with digestive cancers. We detail endoscopic screening procedures in patients with Lynch syndrome for gastric, small bowel, pancreatic, and colorectal cancers. We review the precise modalities of endoscopic follow-up, particularly the discrepancies that exist between the guidelines of the various scientific societies. We discuss the treatment of colorectal cancers in Lynch syndrome cases and patient adherence to endoscopic follow-up programs.
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Affiliation(s)
- Raphael Olivier
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
- Correspondence: ; Tel.:+33-05-49-44-37-51; Fax: +33-05-49-44-38-35
| | - Violaine Randrian
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
| | - David Tougeron
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
| | - Jean-Christophe Saurin
- Gastroenterology Department, Hospices Civils de Lyon—Centre Hospitalier Universitaire, 69002 Lyon, France;
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Beck AT, Sutton EJ, Chow CPY, Curtis SH, Kullo IJ, Sharp RR. "Who Doesn't Like Receiving Good News?" Perspectives of Individuals Who Received Genomic Screening Results by Mail. J Pers Med 2021; 11:jpm11050322. [PMID: 33919001 PMCID: PMC8142970 DOI: 10.3390/jpm11050322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
As genomic sequencing expands to screen larger numbers of individuals, offering genetic counseling to everyone may not be possible. One approach to managing this limitation is for a genetic counselor to communicate clinically actionable results in person or by telephone, but report other results by mail. We employed this approach in a large genomic implementation study. In this paper, we describe participants' experiences receiving genomic screening results by mail. We conducted 50 semi-structured telephone interviews with individuals who received neutral genomic screening results by mail. Most participants were satisfied receiving neutral results by mail. Participants generally had a good understanding of results; however, a few participants had misunderstandings about their genomic screening results, including mistaken beliefs about their disease risk and the comprehensiveness of the test. No one reported plans to alter health behaviors, defer medical evaluations, or take other actions that might be considered medically problematic. Reporting neutral results by mail is unlikely to cause recipients distress or generate misunderstandings that may result in reduced vigilance in following recommended preventive health strategies. Nonetheless, some individuals may benefit from additional genetic counseling support to help situate their results in the context of personal concerns and illness experiences.
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Affiliation(s)
- Annika T. Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Erica J. Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Carolyn P. Y. Chow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Susan H. Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
| | - Iftikhar J. Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA;
| | - Richard R. Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (A.T.B.); (E.J.S.); (C.P.Y.C.); (S.H.C.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55901, USA
- Correspondence:
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Hadley DW, Eliezer D, Addissie Y, Goergen A, Ashida S, Koehly L. Uptake and predictors of colonoscopy use in family members not participating in cascade genetic testing for Lynch syndrome. Sci Rep 2020; 10:15959. [PMID: 32994442 PMCID: PMC7525436 DOI: 10.1038/s41598-020-72938-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
Cascade genetic testing provides a method to appropriately focus colonoscopy use in families with Lynch syndrome (LS). However, research suggests that up to two-thirds at risk to inherit LS don’t participate. Within the United States, no studies have assessed colonoscopy use within this elusive and high-risk subset. We set forth to (1) document colonoscopy use within those not undergoing genetic testing (NGT) and (2) identify factors associated with completing colonoscopy. Data came from a cross sectional survey of families with molecularly confirmed LS. One hundred seventy-six (176) adults participated; 47 of unknown variant status and 129 with variant status known (59 carriers/70 non-carriers). Despite a high level of awareness of LS (85%) and identical recommendations for colonoscopy, NGT reported significantly lower use of colonoscopy than carriers (47% vs. 73%; p = 0.003). Our results show that perceived risk to develop colon cancer (AOR = 1.99, p < 0.05) and physician recommendations (AOR = 7.64, p < 0.01) are significant predictors of colonoscopy use across all family members controlling for carrier status. Given these findings, health care providers, should assess patients’ perceived risk to develop cancer, assist them in adjusting risk perceptions and discuss recommendations for colonoscopy with all members in families with LS. Trial Registration Clinical Trials.gov Identifier: NCT00004210.
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Affiliation(s)
- Donald W Hadley
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, 35 Convent Drive, MSC 3717, Bldg. 35, Room 1B205, Bethesda, MD, 20892-3717, USA.
| | - Dina Eliezer
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yonit Addissie
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Goergen
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Laura Koehly
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Solomon I, Rybak C, Van Tongeren L, Kuzmich L, Blazer K, Nehoray B, Niell-Swiller M, Bray S, Bray TH, Hurley K, Weitzel JN, Slavin TP. Experience Gained from the Development and Execution of a Multidisciplinary Multi-syndrome Hereditary Colon Cancer Family Conference. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1204-1212. [PMID: 30259397 PMCID: PMC6437007 DOI: 10.1007/s13187-018-1430-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Genetic healthcare professionals provide genetic cancer risk assessment and follow-up care for patients facing hereditary cancers. To meet the needs of those affected by hereditary colorectal cancer, City of Hope and the Hereditary Colon Cancer Foundation collaborated to develop a "Family Day" conference. We describe the development of our conference based upon the Hereditary Colon Cancer Foundation's "Family Day" program model, with refinements completed using the Participatory Action Research theoretical framework, which incorporated input from conference participants and researchers. Thirty-one participants attended the conference, representing patients with, or families, friends, and caregivers of those with, multiple colorectal cancer predisposition syndromes, including Lynch, familial adenomatous polyposis, and juvenile polyposis. Participants who completed the feedback surveys (n = 22) were highly satisfied with the presentation content, ranking the keynote lecture on family communication the highest of the conference events. Participants also provided feedback regarding how to improve future conferences. In conclusion, we share our experience and provide guidance for developing a successful hereditary colon cancer predisposition patient and family conference.
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Affiliation(s)
- Ilana Solomon
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Christina Rybak
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | | | - Lili Kuzmich
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Kathleen Blazer
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | - Bita Nehoray
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA
| | | | - Shawnie Bray
- Hereditary Colon Cancer Foundation, Portland, OR, USA
| | - Travis H Bray
- Hereditary Colon Cancer Foundation, Portland, OR, USA
| | | | - Jeffrey N Weitzel
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA.
| | - Thomas P Slavin
- City of Hope, Division of Clinical Cancer Genomics, Duarte, CA, USA.
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Burton-Chase AM, Parker WM, Donato KM, McCormick S, Gritz ER, Amos CI, Lu KH, Lynch PM, Rodriguez-Bigas MA, Nancy You Y, Peterson SK. Health-related quality of life in colorectal cancer survivors: are there differences between sporadic and hereditary patients? J Patient Rep Outcomes 2018; 2:21. [PMID: 29757305 PMCID: PMC5934923 DOI: 10.1186/s41687-018-0047-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/17/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors with sporadic CRC to those with hereditary cancer, specifically Lynch syndrome (LS). Methods Participants completed a mailed self-administered questionnaire that assessed, among other things, demographics, clinical characteristics, and health-related quality of life. Using a case-case design, CRC survivors with LS or sporadic cancer were matched on age, sex, race/ethnicity, cancer stage, geography, and time since diagnosis. Participants were recruited from patient registries at The University of Texas MD Anderson Cancer Center (MD Anderson) (n = 33 LS; n = 75 sporadic) and through social media (n = 42 LS). The final sample included 71 LS and 74 sporadic CRC survivors. Results For LS patients, the mean FACT-C HRQoL score was 84.8 (11.9) [Median = 86.0; Interquartile Range-17] compared to sporadic patients mean score of 85.8 (16.7) [Median = 92.0; Interquartile Range-21], which indicates high quality of life for both groups. LS patients and sporadic CRC patients had similar HRQoL mean scores across 7 different HRQoL metrics, with no significant differences between groups. Exploratory regression analyses indicate some differences in known predictors of HRQoL by group despite no bivariate differences. Conclusions HRQoL is an important component of survivorship in CRC patients. Given the clinical distinctions between LS and sporadic patients, we expected to find significant differences between these patients. However, the patients’ experiences/quality of life does not appear to illustrate such a clear dissimilarity within CRC survivors. Given the limited data in this area, larger studies, ideally with data obtained from multiple sites, is needed to better investigate the alignment between clinical determination and patient experience as well as to explore the relationship between HRQOL, treatment regimens, and health outcomes.
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Affiliation(s)
- Allison M Burton-Chase
- 1Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208 USA
| | - Wendy M Parker
- 1Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208 USA
| | - Kirsten M Donato
- 1Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208 USA
| | - Shannon McCormick
- 1Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY 12208 USA
| | - Ellen R Gritz
- 2Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Christopher I Amos
- 3Department of Community and Family Medicine, Dartmouth College, Hanover, NH USA
| | - Karen H Lu
- 4Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Patrick M Lynch
- 5Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Miguel A Rodriguez-Bigas
- 5Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Y Nancy You
- 6Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Susan K Peterson
- 2Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Steel E, Robbins A, Jenkins M, Flander L, Gaff C, Keogh L. How does genetic risk information for Lynch syndrome translate to risk management behaviours? Hered Cancer Clin Pract 2017; 15:1. [PMID: 28070225 PMCID: PMC5217251 DOI: 10.1186/s13053-016-0061-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system. Methods Participants of the Australasian Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis. Results Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies, and spoke about their discomfort with the screening process and a lack of faith in the procedure’s ability to reduce their risk of developing colorectal cancer. Of the female carriers (n = 9), 2 could not recall being informed about the associated risk of gynaecological cancers. Conclusion Non-carriers and female carriers of Lynch syndrome could benefit from further clarity and advice about appropriate risk management options. For those carriers who did not adhere to colonoscopy screening, a lack of faith in both genetic test results and screening were evident. It is essential that consistent advice is offered to both carriers and non-carriers of Lynch syndrome.
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Affiliation(s)
- Emma Steel
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Andrew Robbins
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
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Galiatsatos P, Rothenmund H, Aubin S, Foulkes WD. Psychosocial Impact of Lynch Syndrome on Affected Individuals and Families. Dig Dis Sci 2015; 60:2246-50. [PMID: 25786861 DOI: 10.1007/s10620-015-3626-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 03/03/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Lynch syndrome is the most common hereditary colorectal cancer syndrome, conferring a heightened risk not only of colon cancer but also of various extracolonic tumors. Studies in hereditary breast cancer have shown a negative psychological impact for patients testing positive for BRCA1 or BRCA2 mutations, but there is a paucity of literature looking at psychosocial impact of LS testing for probands and families. METHODS A literature search of PubMed English-language articles was performed using the keywords "Lynch syndrome" combined with "psychological impact," "depression," and "anxiety." RESULTS Lynch syndrome mutation carriers, whether or not they have had cancer, suffer a transient increase in depression and anxiety scores post-disclosure, which seem to normalize by 6-12 months. Younger patients with higher colorectal cancer risk perception, higher education level, married, and employed are more likely to accept genetic testing. Major motivators for testing are predicting one's own risk of cancer and risk to offspring. Carrier status influences family planning, and there is growing interest for preimplantation genetic diagnosis. CONCLUSIONS Psychosocial ramifications of LS mutation positivity need to be explored further.
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Affiliation(s)
- Polymnia Galiatsatos
- Division of Gastroenterology, Department of Medicine, Room E-110, Jewish General Hospital, McGill University, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada,
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