Prognostic Factors for Distress After Genetic Testing for Hereditary Cancer.

The psychological impact of an unfavorable genetic test result for counselees at risk for hereditary cancer seems to be limited: only 10-20 % of counselees have psychological problems after testing positive for a known familial mutation. The objective of this study was to find prognostic factors that can predict which counselees are most likely to develop psychological problems after presymptomatic genetic testing. Counselees with a 50 % risk of BRCA1/2 or Lynch syndrome completed questionnaires at three time-points: after receiving a written invitation for a genetic counseling intake (T1), 2-3 days after receiving their DNA test result (T2), and 4-6 weeks later (T3). The psychological impact of the genetic test result was examined shortly and 4-6 weeks after learning their test result. Subsequently, the influence of various potentially prognostic factors on psychological impact were examined in the whole group. Data from 165 counselees were analyzed. Counselees with an unfavorable outcome did not have more emotional distress, but showed significantly more cancer worries 4-6 weeks after learning their test result. Prognostic factors for cancer worries after genetic testing were pre-existing cancer worries, being single, a high risk perception of getting cancer, and an unfavorable test result. Emotional distress was best predicted by pre-existing cancer worries and pre-existing emotional distress. The psychological impact of an unfavorable genetic test result appears considerable if it is measured as "worries about cancer." Genetic counselors should provide additional guidance to counselees with many cancer worries, emotional distress, a high risk perception or a weak social network.

Risk-reducing mastectomy in BRCA1/2 mutation carriers: factors influencing uptake and timing.

INTRODUCTION: Strategies in case of high risk of breast cancer in BRCA1/2 mutation carriers are either intensive breast cancer screening or risk-reducing mastectomy (RRM). Both options have a high physical and psychosexual impact. The aim of this study is to investigate who chooses when to undergo RRM. METHODS: BRCA1/2 mutation carriers have been prospectively registered at the family cancer clinic between 1994 and 2011. Analyses were performed to assess the relation between characteristics of the BRCA1/2 mutation carriers and an earlier decision for RRM. RESULTS: A cumulative percentage of 35.6% of all women chose to undergo RRM within the first five years after disclosure of DNA test results. Women needed less time to choose for RRM measured from the first visit, if they were younger than 50 years of age (hazard ratio (HR)=2.67, 95% confidence interval (CI)=1.30-5.48) or had a mother who had had breast cancer (HR=1.51 95% CI=1.04-2.18). Also, women needed less time to choose for RRM in case of a previous breast cancer (HR=2.25, 95% CI=1.55-3.27). After a previous unilateral therapeutic mastectomy as a treatment for breast cancer, women needed less time to choose for RRM of the contralateral breast (HR=2.69, 95% CI=1.29-5.62) compared to women who had had breast-conserving therapy. CONCLUSION: BRCA1/2 mutation carriers aged under 50, having a mother with breast cancer, who had previous unilateral breast cancer and previous unilateral therapeutic mastectomy chose more often and earlier for RRM.

Coping and its effect on psychological distress of parents of pediatric cancer patients: a longitudinal prospective study.

OBJECTIVE: This prospective 5-year longitudinal study examined the use of coping styles of fathers and mothers of pediatric cancer patients over time and the prospective effects of coping on distress. METHODS: Psychological distress (General Health Questionnaire) and the use of seven coping styles (Utrecht Coping List: active problem focussing, palliative and passive reaction patterns, avoidance, social support seeking, expression of emotions, and comforting cognition) were assessed in 115 parents shortly after diagnosis, 6 and 12 months, and 5 years later. RESULTS: At diagnosis, parents' use of coping styles did not differ from the norm population except more frequent use of support seeking. No significant change over time was found in a palliative reaction pattern. Support seeking declined and emotional expression increased linearly, whereas use of the remaining coping styles decreased, followed by an increase. At 5 years, parents' use differed from the norm population only in less use of expression of emotions and comforting cognitions. Initial coping use significantly predicted fathers' future distress at 6 and 12 months but not at 5 years. This was not found for mothers. Changes in coping were significantly associated with both parents' changes in distress only during the first year. Increased passive reaction pattern and social support seeking were the risk factors for mothers. Increased avoidance, a passive reaction pattern, expression of emotions, and decreased active problem focussing formed the risk factors for fathers. CONCLUSION: Findings illustrate that coping seems to be a situation-specific process and that coping predictors vary as a function of parents' gender.

Retrospective denial as a coping method.

Worldwide, gastric cancer is one of the most common and fatal cancers. The majority of patients present with an advanced stage of disease. Even with use of palliative chemotherapy most patients die within 1 year after diagnosis. Medical psychological attention after a diagnosis of incurable cancer is focused on end of life support. This paper presents the care of a patient treated with palliative intent with chemotherapy for an irresectable histologically confirmed gastric cancer. When, unexpectedly prolonged symptom free survival followed, the reaction of the patient came as a surprise to the attending medical team. In this case history we urge those who care for incurable cancer patients, that the rare patient who survives against all odds may require special psychological care.

Work disability after whiplash: a prospective cohort study.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To investigate the consequences of neck pain after motor vehicle accidents in terms of disability for work and the relationship this has with symptom and work-related factors. SUMMARY OF BACKGROUND DATA: Previous studies on work disability related to whiplash are very heterogeneous, are often limited in sample size and show a wide variability in terms of results. A relationship has been suggested between poor recovery from or persistent work disability after whiplash and female gender, older age, marital status, heavy manual work, self-employment, prior psychological problems, subjective complaints of poor concentration, pain catastrophizing, and kinesiophobia. METHODS: Individuals with neck complaints after involvement in traffic accidents, who initiated compensation claim procedures with a Dutch insurance company (n = 879), were sent questionnaires (Q1) concerning the accident, the injuries that they had sustained, their complaints at that time, and questions regarding work and disability. The course of complaints and work disability was monitored at 6 (Q2) and 12 months (Q3) after the accident. RESULTS: A total of 58.8% of the population with neck complaints studied was work-disabled after the accident. Age and impaired concentration complaints after 1 month were found to be related to work disability at 1 year, independent of physical complaints and work characteristics. CONCLUSION: Age and concentration complaints were important independent predictors of long-lasting work disability, whereas no evidence emerged to indicate that the degree of manual labor (blue or white collar work) or educational level was involved in persistent work disability in postwhiplash syndrome. The current results suggest that work disability could benefit most from interventions related to recovery from cognitive complaints and less from physically related interventions.

The influence of coping styles and perceived control on emotional distress in persons at risk for a hereditary heart disease.

This prospective study investigates the influence of two coping styles (monitoring and blunting) and perceived control (health locus of control and mastery) on emotional distress in persons at risk of a hereditary cardiac disease. Emotional distress in people at risk for a hereditary cardiac disease does not differ from the normal population, neither before nor after disclosure of the DNA-or clinical test results. Less monitoring reflects less emotional distress before the results of the DNA-test or clinical investigations are known, while a stronger feeling of mastery reflects less emotional distress both before and after the results of the tests are known. These results indicate that the negative effect of monitoring is temporary. Mastery is a more powerful predictor than health locus of control in this situation.

Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints.

OBJECTIVE: This study investigates the relationship between posttraumatic stress disorder (PTSD) symptoms (avoidance, reexperiencing, and hyperarousal) and the presence, severity, and duration of neck complaints after motor vehicle accidents. METHODS: Individuals who had been involved in traffic accidents and had initiated compensation claim procedures with a Dutch insurance company were sent questionnaires (Q1) containing complaint-related questions and the Self-Rating Scale for PTSD. Of the 997 questionnaires that were dispatched, 617 (62%) were returned. Only car accident victims were included in this study (n=240). Complaints were monitored using additional questionnaires that were administered 6 months (Q2) and 12 months (Q3) after the accident. RESULTS: PTSD was related to the presence and severity of concurrent post-whiplash syndrome. More specifically, the intensity of hyperarousal symptoms that were related to PTSD at Q1 was found to have predictive validity for the persistence and severity of post-whiplash syndrome at 6 and 12 months follow-up. CONCLUSION: Results are consistent with the idea that PTSD hyperarousal symptoms have a detrimental influence on the recovery and severity of whiplash complaints following car accidents.

Can kinesiophobia predict the duration of neck symptoms in acute whiplash?

OBJECTIVES: In low back pain, clinical studies suggest that kinesiophobia (fear of movement/(re)injury) is important in the etiology of chronic symptoms. In this prospective cohort study, the predictive role of kinesiophobia in the development of late whiplash syndrome was examined. METHODS: Victims of car collisions with neck symptoms who initiated compensation claim procedures with a Dutch insurance company were sent a questionnaire containing symptom-related questions and the Tampa Scale of Kinesiophobia (TSK-DV). Follow-up questionnaires were administered 6 and 12 months after the collision. Survival analysis was used to study the relationship between the duration of neck symptoms and explanatory variables. RESULTS: Of the 889 questionnaires sent, 590 (66%) were returned and 367 used for analysis. The estimated percentage of subjects with neck symptoms persisting 1 year after the collision was 47% (SE 2.7%). In a regression model without symptom-related variables, kinesiophobia was found to be related to a longer duration of neck symptoms (P=0.001). However, when symptom-related information was entered into the model, the effect of kinesiophobia did not reach statistical significance (P=0.089). CONCLUSIONS: Although a higher score on the TSK-DV was found to be associated with a longer duration of neck symptoms, information on early kinesiophobia was not found to improve the ability to predict the duration of neck symptoms after motor vehicle collisions.