Genetic Education to Promote Counseling Attendance after Surgical Treatment (GET

H. Lee Moffitt Cancer Ctr & Res Inst, Tampa FL

Investigators

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Abstract

DESCRIPTION (provided by applicant): In 2009, 192,370 new cases of female breast cancer (BC) were diagnosed in the U.S. Of these cases, 5%- 10% were attributed to BRCA mutations. This translates to approximately 9,000 to18,000 high-risk women who may be impacted by hereditary BC. In a given year, the number of high-risk BC patients is similar to or greater than the total number of cases of other cancers in women (e.g., oral cancer, n=10,480;stomach cancer, n=8,310;cervical cancer n=11,720;myeloma n=8,900). While, the relative proportion of BC patients at increased risk for hereditary BC may be considered small, the absolute number is comparable to the total number of female cases in certain cancer sites. Recent studies suggest BC patients with a BRCA mutation have a 3.5 to 4.5 times greater risk of contralateral breast cancer (CBC) than patients without a BRCA mutation. Thus, thousands of women each year not only face a current BC diagnosis but are also at significantly increased CBC risk. There are criteria put forth by several leading health and professional organizations including the National Comprehensive Cancer Network that help providers readily identify women at increased risk for hereditary BC(e.g., diagnosis <age 50, family history of breast and/or ovarian cancer). Given the numbers of women who may be affected by hereditary BC, their increased risks for CBC, and impact of risk on treatment selection, the breast oncology care setting represents a clinical opportunity to identify this group of patients. Once identified, referral for genetic counseling (GC) is a critical step in providing the most up-to-date and relevant information to this at-risk group. Studies in other settings suggest underutilization among BC patients with hereditary breast and ovarian cancer (HBOC) risk factors. While the decision to engage in any health care consultation (e.g., GC) is ultimately the patient's choice, our research and that of others suggests that patients may choose not to attend GC based on incomplete knowledge (e.g., misperceptions about the GC process), health beliefs (e.g., perceived susceptibility, benefits, or barriers), and psychosocial factors (e.g., feeling overwhelmed with the cancer diagnosis, disconnect between goal intentions and implementation intentions). Using a framework based on Health Belief Model (HBM), Implementation Intention Theory, and principles of health communication, the specific aims of this project are to develop and pilot test a psychoeducational intervention (PEI) to increase uptake of GC services among high-risk recently diagnosed BC patients. An objective set forth in Healthy People 2020 is to increase the number of women who use BRCA GC and genetic testing. The proposed study will be an important first step in achieving that goal among a group at increased risk for HBOC. PUBLIC HEALTH RELEVANCE: The proposed study, Genetic Education To Promote Counseling Attendance after Surgical Treatment (GET PAST) study will develop and evaluate a psychoeducational intervention (PEI) for high-risk, recently diagnosed, breast cancer patients about genetic counseling (GC).