Psychological impact of multi-gene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain
Esteban I (1,2), Vilaró M (3), Adrover E (4), Angulo N (5), Carrasco E (1), Gadea N (6), Sánchez A (7), Ocaña T (7), Llort G (8), Jover R (9), Cubiella J (10), Servitja S (11), Herráiz M (12), Cid L (13), Martínez S (14), Oruezábal-Moreno MJ (15), Garau I (16), Khorrami S (17), Herreros de Tejada A (18), Morales R (19), Cano JM (20), Serrano R (21), López-Ceballos MH (22), González-Santiago S (22), Juan-Fita MJ (23), Alonso-Cerezo C (24), Casas A (25), Graña-Suarez B (26), Teulé A (27), Alba E (28), Antón A (29), Guillén-Ponce C (30), Sánchez-Heras AB (31), Alés-Martínez JE (32), Brunet J 33, Balaguer F (7), Balmaña J (1,2,6).
(1) Hereditary Cancer Unit, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
(2) Genetics Department, Universidad Autònoma de Barcelona Barcelona, Spain.
(3) Oncology Data Science, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
(4) Medical Oncology Department, Hospital General de Albacete, Spain.
(5) Myriad genetics Spain.
(6) Medical Oncology Department, Vall d´Hebron Hospital, Barcelona, Spain.
(7) Gastroenterology Department, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd) - Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain.
(8) Medical Oncology Department, Hospital Sabadell-Parc Taulí, Sabadell, Spain.
(9) Gastroenterlogy Department, Hospital General Universitario de Alicante, Spain.
(10) Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, Spain.
(11 Medical Oncology Department, Hospital del Mar, Barcelona, Spain.
(12) Gastroenterology Department, Clínica Universitaria de Navarra, Spain.
(13) Gastroenterology Department, Instituto Investigación Biomédica, Complexo Hospitalario Universitario de Vigo, Spain.
(14) Medical Oncology Department, Hospital de Mataró, Madrid, Spain.
(15) Medical Oncology Department, Hospital Rey Juan Carlos, Madrid, Spain.
(16) Medical Oncology Department, Hospital Son Llatzer, Palma de Mallorca, Spain.
(17) Gastroenterology Department, Hospital Son Espases, Palma de Mallorca, Spain.
(18) Gastroenterlogy Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.
(19) Medical Oncology Department, Hospital La Mancha Centro, Spain.
(20) Medical Oncology Department, Hospital General de Ciudad Real, Spain.
(21) Medical Oncology Department, Hospital Reina Sofia de Córdoba, Spain.
(22) Medical Oncology Department, Hospital San Pedro de Alcántara, Cáceres, Spain.
(23) Medical Oncology Department, Instituto Valencia de Oncología, Valencia, Spain.
(24) Genetics Department, Hospital La Princesa, Madrid, Spain.
(25) Medical Oncology Department, Hospital Virgen del Rocío de Sevilla, Spain.
(26) Medical Oncology Department, Hospital Universitario de A Coruña, Spain.
(27) Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet, Spain.
(28) Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
(29) Medical Oncology Department, Hospital Miguel Servet de Zaragoza, Spain.
(30) Medical Oncology Department, Hospital Ramón y Cajal, Madrid, Spain.
(31) Medical Oncology Department, Hospital General Universitario de Elche, Spain.
(32) Medical Oncology Department, Hospital de Nuestra Señora de Sonsoles, Ávila, Spain.
(33) Hereditary Cancer Program, Catalan Institute of Oncology, Girona, Spain.
Date: Mar 2, 2018High Risk Digestive Tumours Prevention Consultation Unit [SP] Digestive [SP]
Patients' psychological reactions to multi-gene cancer panel testing might differ compared with the single-gene testing reactions due to the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multi-gene panel testing is important to adapt the genetic counselling model.
One hundred and eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pre-test genetic counseling and at one week, three months and twelve months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty.
A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants) and 54 patients had at least one VUS. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (p value=0.87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared to carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long-term (p value<0.001). The majority of patients reported the wish to know all genetic results.
Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrants further research.
CITATION Psychooncology. 2018 Mar 2. doi: 10.1002/pon.4686
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