Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care-related fears influence cancer worry and risk perception?

BACKGROUND: The impact of family and personal cancer history and emotional factors, such as depression and anxiety, on disease representation has received limited attention in studies investigating the development of cancer-related worry and risk perception within the context of genetic counseling. The current study endeavors to fill this gap by exploring the extent to which depression and anxiety influence cancer worry and risk perception, and the role of health care-related fear as potential mediator in this relationship. METHODS: A sample of 178 women who underwent their first genetic counseling for breast/ovarian cancer, 52% of whom had previous cancer diagnoses, completed questionnaires assessing sociodemographic and clinical information, emotional distress in terms of anxiety and depression, cancer-related worry, risk perception, and health care-related fears. RESULTS: Results of mediation analyses showed that cancer-related worry and risk perception increased with rising levels of depression and anxiety, with health care-related fears acting as a mediator in the relationship of depression and anxiety with cancer worry and risk perception. Covariate analysis revealed that previous cancer diagnosis increases cancer-related worry but not risk perception, while the number of family members affected by cancer increases both outcomes. CONCLUSION: These findings emphasize the need for a holistic approach in genetic counseling and have implications for the clinical practice.

The Cancer Worry Scale Revised for Breast Cancer Genetic Counseling.

BACKGROUND: The Cancer Worry Scale was revised to be used in breast cancer genetic counseling (CWS-GC). This scale is used to identify dimensions that are relevant in the genetic counseling context, such as worry about developing breast cancer, impact of worries on daily life, and risk perception in women attending a counseling session for BRCA1/2 mutations. OBJECTIVE: The aim of this study was to estimate the psychometric properties of the CWS-GC in a sample of Italian women. METHODS: A total of 304 women aged 19 to 90 years, 58% with history and 42% with no history of breast or ovarian cancer, participated in the study. Validity, reliability, and sensitivity to change of the CWS-GC were assessed. RESULTS: Confirmatory factor analysis suggested a 2-factor structure of the CWS-GC measuring cancer worry and risk perception and with Cronbach's α coefficients of .90 and .70, respectively. Criterion validity was attested by substantial yet not overlapping correlations with anxiety and fear of medical procedures. In a subsample of 50 women, test-retest reliability at a 4-week interval ranged from 0.70 to 0.87, and the CWS-GC was able to detect small to medium changes 1 month after genetic counseling. CONCLUSIONS: Overall, the CWS-GC showed good psychometric characteristics in this population. IMPLICATIONS FOR PRACTICE: The CWS-GC would be appropriate for use by healthcare professionals to better understand how women react and adapt to information on genetic cancer risk to provide them with emotional support and encourage surveillance behaviors.

Burnout among physicians and nurses working in oncology.

BACKGROUND: The phenomenon of Burnout is an important occupational problem which affects those working in the "helping professions" to a greater degree since they have continuous and constant contact with suffering patients. AIMS: We aimed to assess the Burnout level and its correlation with organizational stressors. METHODS: The aim was achieved through administration of a questionnaire, the organizational check-up survey (OCS) among 80 physicians and 102 nurses working in a cancer institute. RESULTS: The results showed significant levels of Burnout (Exhaustion and Cynicism) associated with perceived discrepancy between the worker's values and those promoted by the hospital management, mainly among longer serving staff work overload reported by staff working in the intensive care and medical oncology departments; lack of recognition reported by permanent staff and also those who had no contact with the patients. CONCLUSIONS: The study confirmed the multiple factors involved in the phenomenon of Burnout and the usefulness of the OCS tool for the diagnosis and management of Burnout via appropriate intervention programmes. Furthermore, it also seemed to confirm the need to pay particular attention to the wellbeing of health professionals working in care and treatment of cancer patients via individual measures associated with other organizational measures.

Factors associated with an individuals' decision to withdraw from genetic counseling for BRCA1 and BRCA2 genes mutations: are personality traits involved?

The aim of the study was to evaluate factors associated with early withdrawal from oncogenetic counseling. A comparison of psycho-social and personality characteristics of two samples of subjects, attendees and withdrawers was carried out. Self-report questionnaires were completed by 112 individuals who had completed counseling and to 56 individuals who withdrew from it. Individuals with few children (OR. 1,724; p = 0,017; CI = 1,101-2,700), a lower number of cancer affected relatives (OR. 1,301; p = 0,000; CI = 1,145-1,479), and with a lower hypomanic scale score (OR. 1,070; p = 0,004; CI = 1,022-1,121), were more likely to withdraw from counseling. It is important for the counselees to draw more attention to the fact that their cancer risk management and prevention is as fundamental as that of their children. Also, it is important to highlight the fact that having less cancer affected relatives does not necessarily mean being at lower risk. In conclusion, that subjects with low levels of psychological and emotional energy are those who probably need greater psychological support during the decision making process. We deem necessary that psychologists, involved in genetic counseling, investigate these aspects during their sessions in order to implement suitable interventions of psychological support during the entire counseling process.

Subjective versus objective risk in genetic counseling for hereditary breast and/or ovarian cancers.

BACKGROUND: Despite the fact that genetic counseling in oncology provides information regarding objective risks, it can be found a contrast between the subjective and objective risk. The aims of this study were to evaluate the accuracy of the perceived risk compared to the objective risk estimated by the BRCApro computer model and to evaluate any associations between medical, demographic and psychological variables and the accuracy of risk perception. METHODS: 130 subjects were given medical-demographic file, Cancer and Genetic Risk Perception, Hospital Anxiety-Depression Scale. It was also computed an objective evaluation of the risk by the BRCApro model. RESULTS: The subjective risk was significantly higher than objective risk. The risk of tumour was overestimated by 56%, and the genetic risk by 67%. The subjects with less cancer affected relatives significantly overestimated their risk of being mutation carriers and made a more inaccurate estimation than high risk subjects. CONCLUSION: The description of this sample shows: general overestimation of the risk, inaccurate perception compared to BRCApro calculation and a more accurate estimation in those subjects with more cancer affected relatives (high risk subjects). No correlation was found between the levels of perception of risk and anxiety and depression. Based on our findings, it is worth pursuing improved communication strategies about the actual cancer and genetic risk, especially for subjects at "intermediate and slightly increased risk" of developing an hereditary breast and/or ovarian cancer or of being mutation carrier.

The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancer. A descriptive study of an Italian sample.

BACKGROUND: Oncogenetic counselling is seldom followed through, even when individuals are eligible according to the test criteria. The basic variables which influence the decision to undergo the genetic counselling process are: risk perception, expected benefit or limitations of genetic testing, general psychological distress or cancer-specific distress, lack of trust in one's emotional reactions when faced with negative events, expected level of family support and communications within the family. The aim of this study was to describe the psychosocial variables of an Italian sample that forgoes genetic counselling. METHODS: From May 2002 to December 2006 a psychological questionnaire was sent out to one hundred and six subjects, who freely requested a first genetic informative consultation, and never asked to have a second visit and the family tree drawn up in order to inquire about their eligibility for genetic testing. Statistical analysis was performed by Pearson chi-square test, t-test and Spearman RHO coefficient. RESULTS: The survey presents a lack of emotional cohesion and structured roles and rules within the family system and a positive correlation between the number of children, anxiety and risk perception. The main reasons for giving up on counselling were a sense that testing was a waste of time and the inability to emotionally handle the negative consequences of the test outcome. The subjects who maintained that test and an early diagnosis were a "waste of time" experienced more anxiety. CONCLUSION: The study revealed the importance to ac knowledging the whole persona and their family system as well as provide information highlighting usefulness of early diagnosis.