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Unmet support needs and distress among women with a BRCA1/2 mutation

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Abstract

Distress levels among female BRCA1/2 mutation carriers can be similar to levels found among breast cancer patients. While psychological distress has been associated with unmet needs among cancer patients no study has examined this among BRCA1/2 mutation carriers. The objectives of this study were to: (1) describe the unmet support needs of women with a known BRCA1/2 mutation, (2) determine how unmet needs are related to psychological distress, and (3) identify variables that predict level of unmet need and distress. Female BRCA1/2 mutation carriers were identified through Familial Cancer Centers in 3 Australian states. Two-hundred and seventy-nine participants completed surveys assessing need for help on 16 information and support items. The Impact of Events Scale assessed genetic test related distress. Participants reported an average of 5.4 (SD = 4.9) moderate to very high unmet needs. Twenty-one percent had scores indicating moderate distress, and 13 % indicating severe distress. Younger age (t = −3.34; p < 0.01), not having someone to confide in about the gene mutation (t = 2.57; p = 0.01) and shorter time since notification of mutation status (t = −2.49; p = 0.01) were associated with higher unmet need scores in linear regression analyses. Greater number of unmet needs was associated with a greater likelihood of moderate to severe levels of distress (OR = 1.19; p < 0.01) in logistic regression analyses. Identifying appropriate interventions that target unmet needs among younger women and those with no confidante may help to reduce distress. Interventions that provide an opportunity for women to confide in someone, such as Peer support programs, may be one way of meeting the emotional needs of this population.

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References

  1. Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, Loman N, Olsson H, Johannsson O, Borg A, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjakoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 72(5):1117–1130. doi:10.1086/375033

    Article  PubMed  CAS  Google Scholar 

  2. Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, van’t Veer L, Garber JE, Evans GR, Narod SA, Isaacs C, Matloff E, Daly MB, Olopade OO, Weber BL (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation barriers: the PROSE Study Group. J Clin Oncol 22(6):1055–1062

    Article  PubMed  Google Scholar 

  3. Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, van’t Veer L, Garber JE, Evans GR, Isaacs C, Daly MB, Matloff E, Olopade OO, Weber BL (2002) Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346(21):1616–1622

    Article  PubMed  Google Scholar 

  4. Clarke-Pearson DL (2009) Screening for ovarian cancer. N Engl J Med 361:170–177

    Article  PubMed  CAS  Google Scholar 

  5. Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD (2012) The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 36(3):237–248

    Article  PubMed  Google Scholar 

  6. Kriege M, Brekelmans C, Boetes C, Besnard P, Zonderland H, Obdeijn I, Manoliu R, Kok T, Peterse H, Tilanus-Linthorst M, Muller SH, Meijer S, Oosterwijk JC, Beex L, Tollenaar R, de Koning H, Rutgers E, Klijn JGM (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351(5):427–437

    Article  PubMed  CAS  Google Scholar 

  7. Meiser B, Butow P, Friedlander M, Barratt A, Schnieden V, Watson M, Brown J, Tucker K (2002) Psychological impact of genetic testing in women from high-risk breast cancer families. Eur J Cancer 38:2025–2033

    Article  PubMed  CAS  Google Scholar 

  8. Croyle R, Smith K, Botkin J, Baty B, Nash J (1997) Psychological responses to BRCA1 mutation testing: preliminary findings. Health Psychol 16:63–72

    Article  PubMed  CAS  Google Scholar 

  9. Braithwaite D, Emery J, Walter F, Prevost AT, Sutton S (2004) Psychological impact of genetic counseling for familial cancer: a systematic review and meta-analysis. J Natl Cancer Inst 96:122–123

    Article  PubMed  Google Scholar 

  10. Meiser B (2005) Psychological impact of genetic testing for cancer susceptibility: an update of the literature. Psychooncology 14(12):1060–1074. doi:10.1002/pon.933

    Article  PubMed  Google Scholar 

  11. Tjemsland L, Soreide J, Malt U (1998) Posttraumatic distress symptoms in operable breast cancer III: status one year after surgery. Breast Cancer Res Treat 47:141–151

    Article  PubMed  CAS  Google Scholar 

  12. Lindberg NM, Wellisch DK (2004) Identification of traumatic stress reactions in women at increased risk for breast cancer. Psychosomatics 45:7–16

    Article  PubMed  Google Scholar 

  13. van Oostrom I, Meijers-Heijboer H, Lodder LN, Duivenvoorden HJ, van Gool AR, Seynaeve C, van der Meer CA, Klijn JGM, van Geel BN, Burger CW, Wladimiroff JW, Tibben A (2004) Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: a 5-year follow-up study. J Clin Oncol 21:3867–3874

    Article  Google Scholar 

  14. Hodgkinson K, Butow P, Hunt GE (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523

    Article  PubMed  Google Scholar 

  15. Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17:1117–1128

    Article  PubMed  Google Scholar 

  16. Thewes B, Meiser B, Tucker M, Tucker K (2003) The unmet information and support needs of women with a family history of breast cancer: a descriptive survey. J Genet Couns 12(1):61–76

    Article  Google Scholar 

  17. Iredale R, Brain K, Edwards L, Gray J, France E (2003) The information and support needs of women at high risk of familial breast and ovarian cancer: how can cancer genetic services give patients what they want? Fam Cancer 2:119–121

    Article  PubMed  Google Scholar 

  18. Werner-Lin A (2008) Formal and informal support needs of young women with BRCA mutations. J Psychosoc Oncol 26(4):111–133

    Article  PubMed  Google Scholar 

  19. Beckmann K, Tait C, McCormack J, Suthers G (2004) Information and support needs of people with genetic errors associated with increased cancer risk: summary report of study findings. SA Clinical Genetics Service and The Cancer Council South Australia, Adelaide, South Australia

    Google Scholar 

  20. Metcalfe KA, Liede A, Hoodfar E, Scott A, Foulkes WD, Narod SA (2000) An evaluation of needs of female BRCA1 and BRCA2 carriers undergoing genetic counselling. J Med Genet 37:866–874

    Article  PubMed  CAS  Google Scholar 

  21. Mor V, Allen SM, Siegel K, Houts P (1992) Determinants of needs and unmet need among cancer patients residing at home. Health Serv Res 27:337–360

    PubMed  CAS  Google Scholar 

  22. Schmid-Buchi S, Halfens RJG, Muller M, Dassen T, van den Borne B (2012) Factors associated with supportive care needs of patients under treatment for breast cancer. Eur J Oncol Nurs. doi:http://dx.doi.org/10.1016/j.ejon.2012.02.003

  23. Butow PN, Phillips F, Schweder J, White K, Underhill C, Goldstein D (2011) Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer 20(1):1–22

    Article  PubMed  Google Scholar 

  24. Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Cancer 88(1):226–237

    Article  PubMed  CAS  Google Scholar 

  25. Fatouros M, Baltoyiannis G, Roukos DH (2007) The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol 15(1):21–33

    Article  PubMed  Google Scholar 

  26. Bonevski B, Sanson-Fisher R, Girgis A, Burton L, Cook P, Boyes A, Supportive Care Review Group (2000) Evaluation of an instrument to assess the needs of patients with cancer. Cancer 88(1):217–225

    Article  PubMed  CAS  Google Scholar 

  27. Foot G, Sanson-Fisher R (1995) Measuring the unmet needs of people living with cancer. Cancer Forum 19(2):131–135

    Google Scholar 

  28. Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218

    PubMed  CAS  Google Scholar 

  29. Horowitz M (2006) Impact of events scale. http://www.mardihorowitz.com/impact_of_events_scale.2011

  30. Finch A, Metcalfe KA, Chiang J, Elit L, McLaughlin J, Springate C, Esplen MJ, Demsky R, Murphy J, Rosen B, Narod SA (2011) The impact of prophylactic salpingo-oophorectomy on quality of life and psychological distress in women with a BRCA mutation. Psychooncology. doi:10.1002/pon.2041

    PubMed  Google Scholar 

  31. Thewes B, Meiser B, Hickie IB (2001) Psychometric properties of the Impact of Event Scale amongst women at increased risk for hereditary breast cancer. Psychooncology 10(6):459–468

    Article  PubMed  CAS  Google Scholar 

  32. Froot KA (1989) Consistent covariance matrix estimation with cross-sectional dependence and heteroskedasticity in financial data. J Fin Quant Anal 24:333–355

    Article  Google Scholar 

  33. Thewes B, Butow P, Girgis A, Pendlebury S (2004) The psychosocial needs of breast cancer survivors: a qualitative study of the shared and unique needs of younger versus older survivors. Psychooncology 13:177–189

    Article  PubMed  CAS  Google Scholar 

  34. Thewes B, Meiser B, Taylor A, Phillips KA, Capp PA, Dalley D, Goldstein D, Baber R, Friedlander ML (2005) Fertility and menopause related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23(22):5155–5165

    Article  PubMed  CAS  Google Scholar 

  35. Hoey LM, Ieropoli SC, White VM, Jefford M (2008) Systematic review of peer-support programs for people with cancer. Patient Educ Couns 70(3):315–337

    Article  PubMed  Google Scholar 

  36. Ganz PA (2008) Psychological and social aspects of breast cancer. Oncology 22(6):642–646

    PubMed  Google Scholar 

  37. Schwartz MD, Peshkin BN, Hughes C, Main D, Isaacs C, Lerman C (2002) Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. J Clin Oncol 20(2):514–520

    Article  PubMed  Google Scholar 

  38. Smith K, West J, Croyle R, Botkin JR (1999) Familial context of genetic testing for cancer susceptibility: moderating effect of siblings’ test results on psychological distress one to two weeks after BRCA1 mutation testing. Cancer Epidemiol Biomarkers Prev 8:385–392

    PubMed  CAS  Google Scholar 

  39. den Heijer M, Seynaeve C, Vanheusden K, Duivenvoorden HJ, Bartels CCM, Menke-Pluymers MBE, Tibben A (2011) Psychological distress in women at risk for hereditary breast cancer: the role of family communication and perceived social support. Psychooncology 2:1317–1323

    Article  Google Scholar 

  40. Hamilton R, Hurley KE (2010) Conditions and consequences of a BRCA mutation in young, single women of childbearing age. Oncol Nurs Forum 37(5):627–634

    Article  PubMed  Google Scholar 

  41. Madalinska JB, Hollenstein J, Bleiker E, van Beurden M, Valdimarsdottir HB, Massuger LF, Katja N, Gaarenstroom KN, Mourits MJE, Verheijen RHM, van Dorst EBL, van der Putten H, van der Velden K, Boonstra H, Aaronson NK (2005) Quality of life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol 23(28):6890–6898

    Article  PubMed  Google Scholar 

  42. Bresser PJC, Seynaeve C, Van Gool AR, Niermeijer MF, Duivenvoorden HJ, van Dooren S, van Geel AN, Menke-Pluijmers M, Klijn JGM, Tibben A (2007) The course of distress in women at increased risk of breast and ovarian cancer due to an (identified) genetic susceptibility who opt for prophylactic mastectomy and/or salpingo oophorectomy. Eur J Cancer 43:95–103

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This research was funded by The National Breast Cancer Foundation, Grant [PG-08-01]. Bettina Meiser is supported by a Career Development Award Level 2 from the National Health and Medical Research Council of Australia and a Career Development Fellowship from the Cancer Institute New South Wales. The authors would like to thank the study participants, as well as the genetic counsellors at the Familial Cancer Centres at Monash Medical Centre, Peter MacCallum Cancer Centre, Prince of Wales Hospital, Westmead Hospital, the Royal Melbourne Hospital, and South Australia Clinical Genetics Service. The authors would also like to acknowledge the work of Ms Jane Hayman on this research project. No funding source had any role in the design; collection, analysis and interpretation of data for this study; or in the writing of the report and decision to submit the paper for publication.

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The authors declare that they have no conflict of interest.

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Correspondence to Ashley Farrelly.

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Farrelly, A., White, V., Meiser, B. et al. Unmet support needs and distress among women with a BRCA1/2 mutation. Familial Cancer 12, 509–518 (2013). https://doi.org/10.1007/s10689-012-9596-5

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