What do cancer patients' relatives think about addressing cancer family history and performing genetic testing in palliative care?

Cléophat JE1,2,3, Marin A4,5,6, Pelletier S1, Joly Y7, Gagnon P1,3,8, Déry A9, Chiquette J1,3,5,10, Gagnon B1,3,10, Roy L5, Bitzas V11, Nabi H1,3,10,12, Dorval M13,14,15,16.

Author information

1: CHU de Québec-Laval University Research Center, Oncology Division, Quebec City, QC, Canada.
2: Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.
3: Laval University Cancer Research Center, Quebec City, QC, Canada.
4: Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC, Canada.
5: CHU de Québec-Laval University, Quebec City, QC, Canada.
6: CISSS de Chaudière-Appalaches, Ste-Marie, QC, Canada.
7: Center of Genomics and Policy, McGill University, Montreal, QC, Canada.
8: Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
9: Quebec Palliative Care Association, Granby, QC, Canada.
10: Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
11: Jewish General Hospital, Palliative Care Unit, Montreal, QC, Canada.
12: French National Institute of Health and Medical Research Institute, Epidemiology and Population Health Research Center, INSERM U.1018, Villejuif, France.
13: CHU de Québec-Laval University Research Center, Oncology Division, Quebec City, QC, Canada. michel.dorval@crchudequebec.ulaval.ca.
14: Faculty of Pharmacy, Laval University, Quebec City, QC, Canada. michel.dorval@crchudequebec.ulaval.ca.
15: Laval University Cancer Research Center, Quebec City, QC, Canada. michel.dorval@crchudequebec.ulaval.ca.
16: CISSS de Chaudière-Appalaches Research Center, Lévis, QC, Canada. michel.dorval@crchudequebec.ulaval.ca.

Abstract

Palliative care may be an opportunity to discuss cancer family history and familial cancer risks with patients' relatives. It may also represent the last opportunity to collect, from dying patients, clinical data and biospecimens that will inform cancer risk assessment and prevention in their surviving relatives. This study aims to explore the perspectives of cancer patients' relatives about cancer heritability, addressing cancer family history, and performing genetic testing in palliative care settings. Thirteen first-degree relatives of cancer patients who died in palliative care participated in the study. Two focus groups were conducted and transcribed verbatim. Two independent coders conducted a thematic content analysis. The themes included: (1) Knowledge of cancer heritability; (2) Experiences and expectations regarding cancer family history discussions, and (3) Views on genetic testing in palliative care patients and DNA biobanking. Participants seemed aware that cancer family history is a potential risk factor for developing the disease. They considered the palliative care period an inappropriate moment to discuss cancer heritability. They also did not consider palliative care providers as appropriate resources to consult for such matters as they are not specialized in this field. Participants welcomed DNA biobanking and genetic testing conducted at the palliative care patients' request. Cancer occurrence within families raises concerns among relatives about cancer heritability, but the palliative care period is not considered the most appropriate moment to address this issue. However, discussions about the risk to cancer patients' relatives might need to be considered on a case-by-case basis.