a Western Norway Familial Cancer Center , Department of Medical Genetics, Haukeland University Hospital , Bergen , Norway.
b Department of Clinical Science , University of Bergen , Bergen, Norway.
Acta Oncol. 2019 Feb;58(2):175-181. doi: 10.1080/0284186X.2018.1502466. Epub 2018 Oct 18.
Genetic testing is increasing in patients newly diagnosed with cancer. This study investigated the levels, course and predictors of cancer-related distress, defined as intrusion and avoidance, in women undergoing BRCA1/2 testing without pretest genetic counseling shortly after a diagnosis of breast or ovarian cancer.
Unselected for family history or age, 259 women with breast cancer and 50 women with ovarian cancer, underwent BRCA1/2 testing shortly after diagnosis. Cancer-related distress was measured with the Impact of Event Scale before and after genetic testing. In order to identify predictors of distress, the subscale scores were regressed on baseline predictor variables including sociodemographic and medical variables, perceived social support, and decisional conflict regarding genetic testing.
The mean levels of intrusion and avoidance were in the moderate range both before and after genetic testing with a statistically significant decline during follow-up. Younger age, shorter time since diagnosis, lower levels of social support, and a diagnosis of ovarian cancer predicted higher levels of both intrusion and avoidance. In addition, higher levels of decisional conflict and living with a partner predicted higher levels of intrusion.
Women having genetic testing shortly after a diagnosis of breast or ovarian cancer had a moderate mean level of cancer-related distress, which decreased with time. Health personnel offering genetic testing to newly diagnosed women with breast or ovarian cancer should be aware of the potential predictors for increased cancer-related distress identified in this study: younger age, less perceived social support, higher levels of decisional conflict regarding genetic testing, and living with a partner.
新诊断癌症患者的基因检测正在增加。本研究调查了在乳腺癌或卵巢癌诊断后不久接受 BRCA1/2 检测但未接受检测前遗传咨询的女性中，与癌症相关的困扰（定义为侵入和回避）的水平、过程和预测因素。
在未选择家族史或年龄的情况下，259 名乳腺癌女性和 50 名卵巢癌女性在诊断后不久接受了 BRCA1/2 检测。在基因检测前后使用事件影响量表测量与癌症相关的困扰。为了确定困扰的预测因素，将亚量表评分回归到基线预测变量，包括社会人口学和医学变量、感知社会支持以及对基因检测的决策冲突。
侵入和回避的平均水平在基因检测前后均处于中度范围，随访期间呈统计学显著下降。年轻、诊断后时间较短、社会支持水平较低以及卵巢癌诊断预测侵入和回避的水平较高。此外，较高的决策冲突水平和与伴侣同住预测侵入水平较高。
在诊断为乳腺癌或卵巢癌后不久接受基因检测的女性，其与癌症相关的困扰程度平均处于中度水平，且随时间逐渐下降。向新诊断为乳腺癌或卵巢癌的女性提供基因检测的卫生人员应意识到本研究中确定的与癌症相关的困扰的潜在预测因素：年龄较小、感知社会支持较少、对基因检测的决策冲突水平较高以及与伴侣同住。
