Psychological Impact of Genetic Counseling for Familial Cancer: A Systematic Review and Meta-analysis

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Psychological Impact of Genetic Counseling for
Familial Cancer A Systematic Review and
Meta-analysis

• Dejana Braithwaite, Jon Emery, Fiona Walter, Toby
  Prevost, Stephen Sutton
• Presentation by Jennifer Kyanko

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PURPOSE

• To determine the quality and strength of evidence
  related to psychological outcomes of genetic
  counseling for familial cancer due to the
  identification of a genetic basis of certain
  types of these cancers.

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Genetic Counseling

• Definition Individual counseling aimed at
  supporting discussion about familial cancer risk
  and its management, including cancer surveillance
  and genetic testing.
• Can be conducted before or after genetic testing.
• Genetic counseling was implemented on patients at
  risk for breast, ovarian, and colorectal cancer.

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Dependent Measures

• Anxiety
• Distress
• Depression
• Cancer Worry
• Risk Perception
• Knowledge

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Literature Review

• Inception-December 2001
• Methods
• Databases included MEDLINE, PsycINFO,
  Cancer-Lit, Cinahl, EMBASE, and the Web of
  Science Citation Index.
• Used terms breast neoplasms, ovarian neoplasms,
  colorecatal neoplasms, genetics medical, risk
  assessment, risk management, genetic counseling,
  and risk counseling.
• 43 studies, 18 extracted for not fitting
  definition lacking prospective data

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Results
Domain of Measurement Time Point of Follow up Standardized Differences (95 CI)
Anxiety Post clinic 2 weeks Short term 4-6 months 9 months Long Term 0.11 (-0.05, 0.28) -0.01 (-0.54, 0.52) 0.10 (-0.06,0.26) -0.28 (-.096, 0.39) 0.10 (-0.07, 0.27) 0.05 (-0.21, 0.31)
Distress 3 Months -0.08 (-0.34, 0.17)
Depression 2 weeks 4-6 months 0.07 (-0.46, 0.60) -0.37 (-1.05, 0.31)
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Results (continued)
Domain of Measurement Time Point of Follow up Standardized Differences (95 CI)
Cancer Worry Post Clinic 2 Weeks Short Term 3 months 4-6 months 9 months Long Term 0.02 (-0.15, 0.19) -0.26 (-0.79, 0.27) -0.01 (-0.17, 0.15) -0.30 (-0.56, -0.05) -0.21 (-0.89, 0.46) -0.03 (-0.19, 0.14) -0.14 (-0.35, 0.06)
Risk Perception Post Clinic 1 month Short Term 9 months -0.15 (-0.32, 0.02) 0.00 (-0.23, 0.23) -0.10 (-0.23, 0.04) -0.13 (-0.29, 0.04)
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Results (continued)
Domain of Measurement Time Point of Follow up Standardized Difference (95 CI)
Knowledge Post clinic 2 weeks 1 month Short Term 4-6 months 0.26 0.94 0.96 0.70 0.80
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Potential Moderators

• General reaction regarding cancer is high
  anxiety, distress, depression, worry.
• Most may seek accuracy of their perceived risk
  and more knowledge about the type of cancer.
• Mostly women
• Few studies conducted with accurate data
• Communication strategies

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Conclusions

• Genetic counseling does not significantly
  decrease anxiety, distress,depression, cancer
  worry, nor does it significantly increase risk
  perception.
• Significantly increases knowledge about cancer,
  cancer prevention, and risk factors