Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study.

Brédart A1,2, Kop JL3, Dick J4, Cano A5, De Pauw A6, Anota A7, Brunet J8, Devilee P9, Stoppa-Lyonnet D6, Schmutzler R4, Dolbeault S10,11.

Author information

1: Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France anne.bredart@curie.fr.
2: Psychopathology and Health Process Laboratory, University Paris Descartes, Boulogne-Billancourt, Paris, France.
3: Département de Psychologie, Université de Lorraine, 2LPN (CEMA), Nancy, France.
4: Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany.
5: Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain.
6: Cancer Genetic Clinic, Institut Curie, Paris, France.
7: French National Quality of Life in Oncology Platform, and Methodology; Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
8: Medical Oncology Department, Catalan Institute of Oncology, Barcelona, Spain.
9: Division of Pathology; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.
10: Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France.
11: CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France.

Abstract

OBJECTIVES AND SETTING:

Advances in multigene panel testing for cancer susceptibility has increased the complexity of counselling, requiring particular attention to counselees' psychosocial needs. Changes in psychosocial problems before and after genetic testing were prospectively compared between genetic test results in women tested for breast or ovarian cancer genetic susceptibility in French, German and Spanish clinics.

PARTICIPANTS AND MEASURES:

Among 752 counselees consecutively approached, 646 (86%) were assessed after the initial genetic consultation (T1), including 510 (68%) affected with breast cancer, of which 460 (61%) were assessed again after receiving the test result (T2), using questionnaires addressing genetic-specific psychosocial problems (Psychosocial Aspects of Hereditary Cancer (PAHC)-six scales). Sociodemographic and clinical data were also collected.

RESULTS:

Seventy-nine (17.2%), 19 (4.1%), 259 (56.3%), 44 (9.6%) and 59 (12.8%) women received a BRCA1/2, another high/moderate-risk pathogenic variant (PV), negative uninformative, true negative (TN) or variant of uncertain significance result (VUS), respectively. On multiple regression analyses, compared with women receiving another result, those with a VUS decreased more in psychosocial problems related to hereditary predisposition (eg, coping with the test result) (ß=-0.11, p<0.05) and familial/social issues (eg, risk communication) (ß=-0.13, p<0.05), almost independently from their problems before testing. Women with a PV presented no change in hereditary predisposition problems and, so as women with a TN result, a non-significant increase in familial/social issues. Other PAHC scales (ie, emotions, familial cancer, personal cancer and children-related issues) were not affected by genetic testing.

CONCLUSIONS:

In women tested for breast or ovarian cancer genetic risk in European genetics clinics, psychosocial problems were mostly unaffected by genetic testing. Apart from women receiving a VUS result, those with another test result presented unchanged needs in counselling in particular about hereditary predisposition and familial/social issues.