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Riddle L, Joseph G, Caruncho M, Koenig BA, James JE. The role of polygenic risk scores in breast cancer risk perception and decision-making. J Community Genet 2023; 14:489-501. [PMID: 37311883 PMCID: PMC10576692 DOI: 10.1007/s12687-023-00655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Abstract
Polygenic risk scores (PRS) have the potential to improve the accuracy of clinical risk assessments, yet questions about their clinical validity and readiness for clinical implementation persist. Understanding how individuals integrate and act on the information provided by PRS is critical for their effective integration into routine clinical care, yet few studies have examined how individuals respond to the receipt of polygenic risk information. We conducted an embedded Ethical, Legal, and Social Implications (ELSI) study to examine if and how unaffected participants in a US population breast cancer screening trial understood and utilized PRS, as part of a multifactorial risk score combining traditional risk factors with a genetic risk assessment, to make screening and risk-reduction decisions. Semi-structured qualitative interviews were conducted with 24 trial participants who were designated at elevated risk for breast cancer due to their combined risk score. Interviews were analyzed using a grounded theory approach. Participants understood PRS conceptually and accepted it as one of many risk factors to consider, yet the value and meaning they ascribed to this risk estimate varied. Most participants reported financial and insurance barriers to enhanced screening with MRI and were not interested in taking risk-reducing medications. These findings contribute to our understanding of how PRS may be best translated from research to clinical care. Furthermore, they illuminate ethical concerns about identifying risk and making recommendations based on polygenic risk in a population screening context where many may have trouble accessing appropriate care.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Ann Koenig
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Elyse James
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA.
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Ghamari D, Dehghanbanadaki H, Khateri S, Nouri E, Baiezeedi S, Azami M, Ezzati Amini E, Moradi Y. The Prevalence of Depression and Anxiety in Women with Ovarian Cancer: An Updated Systematic Review and Meta-Analysis of Cross-Sectional Studies. Asian Pac J Cancer Prev 2023; 24:3315-3325. [PMID: 37898834 PMCID: PMC10770678 DOI: 10.31557/apjcp.2023.24.10.3315] [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: 03/16/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The results of this study included the prevalence of anxiety and depression in women with ovarian cancer. METHODS A thorough search of numerous databases, including PubMed (Medline), Scopus, Web of Science, Embase, and PsycoInfo, was conducted to identify relevant cross-sectional studies published between July 2013 and October 2021. STATA 16 was used to analyses the data, and a random effects model was used to determine the pooled prevalence and a 95% confidence interval (95%CI). RESULTS Of the 18 cross-sectional studies reviewed, 17 reported the prevalence of anxiety and 16 reported the prevalence of depression in patients with ovarian cancer. There was a moderate degree of heterogeneity between studies, as the pooled prevalence of depression was 27% (95%CI: 14%-41%; I2=69.44%). Similarly, there was a greater degree of heterogeneity in the pooled prevalence of anxiety, which was found to be 33% (95%CI: 21%-44%; I2=78.55%). CONCLUSION The findings of this study show that, compared to the overall female population, ovarian cancer patients have much greater rates of sadness and anxiety. These results highlight the necessity for healthcare policymakers to prioritize the provision of resources and support for carrying out additional research, such as longitudinal studies or cohorts, to ascertain the efficacy of various treatments or interventions intended to lessen mental health disorders in women diagnosed with ovarian cancer. Healthcare practitioners can enhance the general wellbeing and quality of life for women with this disease by addressing the psychological components of care.
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Affiliation(s)
- Darya Ghamari
- Student Research Committee, Kurdistan University of Medical Sciences Sanandaj, Iran.
| | - Hojat Dehghanbanadaki
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sorour Khateri
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Elham Nouri
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Sheno Baiezeedi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences Sanandaj, Iran.
| | - Elnaz Ezzati Amini
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Yousef Moradi
- Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Heames L, Williamson IR, Song J, Lond B. Living in the shadow of Lynch Syndrome: British women's accounts. Health Care Women Int 2022:1-23. [PMID: 35904976 DOI: 10.1080/07399332.2022.2101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
In this paper we explore accounts of eight British women living with Lynch Syndrome: a hereditary syndrome that increases the risk of developing bowel and gynecological cancers. We collected data via semi-structured interviews and analyzed them using Interpretative Phenomenological Analysis. Two themes, 'It's Up to Us': The Lynch Patient Experience; and 'The Biggest Challenge': The Lynch Parent Experience, illustrate the experiential burden and emotional labor of living with Lynch Syndrome. We theorize our analysis through Corbin and Strauss's concept of 'Health Work', and Hochschild's concept of 'Emotion Work'. Recommendations for clinical care and familial support are discussed.
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Affiliation(s)
- Lauren Heames
- Psychology Division, De Montfort University, Leicester, UK
| | | | - John Song
- Psychology Division, De Montfort University, Leicester, UK
| | - Benjamin Lond
- Psychology Division, De Montfort University, Leicester, UK
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Hong SJ. Uncertainty in the Process of Communicating Cancer-related Genetic Risk Information with Patients: A Scoping Review. JOURNAL OF HEALTH COMMUNICATION 2020; 25:251-270. [PMID: 32271688 DOI: 10.1080/10810730.2020.1745963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the era of precision medicine, patients must manage the uncertainty caused by ambiguous genetic information. To aid health practitioners in effectively communicating genetic information, this study classified the types of uncertainty involved in these communication processes. A search of recent literature turned up 64 articles that measured and/or discussed patients' perceptions and/or feelings of uncertainty related to the communication process of cancer-related genetic information. In reviewing these papers, six types of uncertainty regarding cancer-related genetic information were identified: (1) uncertainty about understanding genetic information (n = 25; 39.1%); (2) uncertainty about future cancer risks (n = 34; 53.1%); (3) uncertainty about managing known genetic information or mutation status (n = 33; 51.6%); (4) uncertainty about the utility of genetic information (n = 5; 7.8%); (5) uncertainty about genetic test results before undergoing testing or receiving the results (n = 10; 15.6%); and (6) uncertainty about the impact of genetic results on family and life (n = 11; 17.2%). These six types of uncertainty serve as a helpful taxonomy for developing, validating, and utilizing future measures of uncertainty in the context of cancer-related genetic risk communication.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
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Goh LH, Spigelman AD. Assessing the adherence to guidelines in Lynch syndrome patients: a pilot study. ANZ J Surg 2020; 90:1130-1135. [PMID: 32039553 DOI: 10.1111/ans.15690] [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: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer surveillance is important in the management of Lynch syndrome. In New South Wales, management guidelines for Lynch syndrome are published on the eviQ website. Benefits of cancer surveillance are maximized through adherence to guidelines. This has yet to be investigated in Sydney. Hence, this study aimed to determine the adherence rate of patients to these guidelines, assess their knowledge of the guidelines and determine potential factors hindering regular colonoscopies in these patients. METHODS A cross-sectional study was conducted among Lynch syndrome patients from the St Vincent's Hospital Cancer Genetics Unit, Sydney. Patients who appropriately fulfilled our inclusion criteria were mailed a questionnaire. The questionnaire was mailed twice to increase the response rate. Demographic and medical information were collected from patient medical records. Patient responses were analysed to determine adherence to the guidelines. RESULTS Sixty-two individuals were invited to participate in this study. Among them, 47 responded (76%) with two being excluded, due to potential confounding factors. Thirty (67%) had their colonoscopies at recommended intervals, while 15 (33%) had delays. Within these two groups, many were ultimately deemed non-adherent to the guidelines due to over-screening with other tests. In total, 31 (69%) participants were considered over-screening for cancer, leaving only seven (16%) participants fully adherent to the guidelines. Only three (7%) had knowledge of the eviQ guidelines. CONCLUSIONS Adherence to the eviQ guidelines was poor. The majority of participants were being over-screened for cancer. Knowledge of the guidelines needs to be improved.
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Affiliation(s)
- Li-Han Goh
- Faculty of Medicine, St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Allan D Spigelman
- Faculty of Medicine, St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, New South Wales, Australia
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Donato KM, Moore K, Parker WM, Peterson SK, Gritz ER, Amos CI, Lu KH, Lynch PM, Rodriguez-Bigas MA, You YN, Burton-Chase AM. Health and lifestyle behaviors in colorectal cancer survivors with and without Lynch syndrome. J Community Genet 2020; 11:59-63. [PMID: 31016603 PMCID: PMC6962402 DOI: 10.1007/s12687-019-00421-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/08/2019] [Indexed: 02/03/2023] Open
Abstract
Lynch syndrome (LS), a hereditary cancer syndrome, accounts for approximately 3% of colorectal cancers (CRC). Positive health behaviors and surveillance are preventive strategies, but research on whether recommended behavioral guidelines are followed by individuals with LS is limited. Additional health education and promotion could be beneficial to the improved survivorship of CRC survivors. Explore health and lifestyle behaviors in CRC survivors with and without LS. We conducted a case-control study of CRC survivors with and without LS using a mailed questionnaire. Recruitment was conducted via patient registries at The University of Texas MD Anderson Cancer Center (cases n = 33; controls n = 75) and through social media (cases n = 42). CRC survivors with and without LS in our study had substantially lower smoking prevalence (5.5% and 2.7%) compared to national prevalence (18.0%). However, they had higher levels of alcohol consumption (36.8% and 10.3% for male and female LS survivors, respectively, and 35.8% and 22.0% for male and female sporadic survivors, respectively) compared to national prevalence of 13.88% for males and 6.02% for females. Both groups of CRC survivors participate in negative health behaviors that impact survivorship. More research is needed to examine the relationship between personal engagement in preventive behaviors and patient-provider relationships to improve health behaviors and explore strategies for intervention. Additionally, better health education and lifestyle change recommendations would promote and reinforce positive health outcomes in the CRC population and especially in LS survivors.
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Affiliation(s)
- Kirsten M Donato
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, New York, 12208, USA.
| | - Katelyn Moore
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, New York, 12208, USA
| | - Wendy M Parker
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, New York, 12208, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher I Amos
- Department of Community and Family Medicine, Dartmouth College, Hanover, NH, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick M Lynch
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miguel A Rodriguez-Bigas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allison M Burton-Chase
- Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, New York, 12208, USA
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