Annal Surg Oncol：遗传咨询为乳腺癌病人带来认知和心理的积极影响

近日，来自莫菲特癌症中心的研究者表示，如果乳腺癌病人在进行手术前接受预测遗传咨询的话，病人会降低其疾病的痛苦。那些在手术后接受预测咨询的病人可以增强其疾病的风险决策，两组病人通过进行遗传咨询都增加了其对癌症的了解。相关研究成果刊登在了国际杂志Annals of Surgical Oncology上，研究经费由美国癌症协会提供支持。

研究者表示，告知乳腺癌患者乳腺癌基因在治疗和风险管理上的作用，患者或从遗传咨询和遗传检验中获益。然而保健医疗提供者更关注的是癌症妇女或许会因为痛苦而增加其发病风险，尤其是如果遗传咨询和遗传检测在癌症诊断、治疗上发生在同一个时间点上。

研究者Vadaparampil和其同事针对103个病人进行研究，其中87人经历了手术，16人没有；这些患者从24岁至69岁进行排列，这些病人都会进行基于个人和家族遗传史的风险评估，而且也会接受遗传性乳腺癌和卵巢癌相关的知识教育。

研究者Juliette表示，在外科手术前，病人会因为接受到了相关遗传咨询的知识（风险因子、外科手术风险等等）而感觉到很沮丧。然而在术后，病人往往更加応他们个人和家族的癌症遗传敏感性。

在这项研究中，研究数据揭示了外科手术前和外科手术后两组病人，由于都接受了相关的预测遗传咨询，因此其都表现出癌症相关知识的增长。而术前病人表现出的癌症相关苦恼度发生了降低。术后病人在决策制定上表现出了明显改进。

编译自：Pre-test genetic counseling increases cancer knowledge for BRCA patients

doi:10.1245/s10434-012-2460-x
PMC:
PMID:

Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients

Juliette Christie, Gwendolyn P. Quinn, Teri Malo, Ji-Hyun Lee, Xiuhua Zhao, Jessica McIntyre, Jennifer Brzosowicz, Paul B. Jacobsen and Susan T. Vadaparampil

PURPOSE: To examine changes in cancer-related knowledge, distress, and decisional conflict from pre- to post-genetic counseling (GC) in before (BDS) and after (ADS) definitive surgery breast cancer (BC) patients. METHODS: Sociodemographic and clinical characteristics were collected at baseline; primary outcome data were collected before (T1) and after (T2) pretest GC. Within group changes for cancer-related knowledge, distress, and decisional conflict over genetic testing were compared by Wilcoxon signed-rank tests. RESULTS: Of 103 BC patients, 87 were ADS and 16 were BDS. Analyses revealed that both groups reported significant increases in knowledge between T1 and T2 (median change 4.2, p = 0.004, and 2.7, p < 0.001, for BDS and ADS patients, respectively). Overall cancer-related distress showed a downward trend between T1 and T2 for both groups and was significant for BDS patients (p = 0.041). Reports of BDS patients trended toward overall and subscale-specific increases in decisional conflict, with the exception of the uncertainty which trended downward, but did not reach significance. Overall decisional conflict decreased in ADS patients, approaching marginal significance (p = 0.056), with significant improvements in informed decision making (median change -12.6, p < 0.001; i.e., pretest GC yielded improved knowledge of benefits, risks, and side effects of available options). CONCLUSIONS: These pilot data suggest that pretest GC increases cancer-related knowledge for both BDS and ADS patients, decreases distress in BDS patients, and improves informed decision making in ADS patients. Future studies with larger sample sizes are needed to replicate these results.