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Article ; Online: ASO Author Reflections: Psychosocial Outcomes After Breast Cancer Treatment.

Lim, David W / Metcalfe, Kelly A

2021 Volume 28, Issue 11, Page(s) 5999–6000

MeSH term(s)	Breast ; Breast Neoplasms/therapy ; Female ; Humans
Language	English
Publishing date	2021-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-021-10017-x
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Article ; Online: Bilateral Mastectomy in Women With Unilateral Breast Cancer: A Review.

Lim, David W / Metcalfe, Kelly A / Narod, Steven A

JAMA surgery

2021 Volume 156, Issue 6, Page(s) 569–576

Abstract: Importance: Rates of bilateral mastectomy continue to increase in average-risk women with unilateral in situ and invasive breast cancer. Contralateral prophylactic mastectomy rates increased from 5% to 12% of all operations for breast cancer in the US ... ...

Abstract	Importance: Rates of bilateral mastectomy continue to increase in average-risk women with unilateral in situ and invasive breast cancer. Contralateral prophylactic mastectomy rates increased from 5% to 12% of all operations for breast cancer in the US from 2004 to 2012. Among women having mastectomy, rates of contralateral prophylactic mastectomy have increased from less than 2% in 1998 to 30% in 2012. Observations: The increased use of breast magnetic resonance imaging and genetic testing has marginally increased the number of candidates for bilateral mastectomy. Most bilateral mastectomies are performed on women who are at no special risk for contralateral cancer. The true risk of contralateral breast cancer is not associated with the decision for contralateral prophylactic mastectomy; rather, the clinical factors associated with the probability of distant recurrence are associated with bilateral mastectomy. Several changes in society and health care delivery appear to act concurrently and synergistically. First, the anxiety engendered by a fear of cancer recurrence is focused on the contralateral cancer because this is most easily conceptualized and provides a ready target that can be acted upon. Second, the modern woman with breast cancer is supported by the surgeon and the social community of breast cancer survivors. Surgeons want to respect patient autonomy, despite guidelines discouraging bilateral mastectomy, and most women have their expenses covered by a third-party payer. Satisfaction with the results is high, but the association with improved psychosocial well-being remains to be fully understood. Conclusions and relevance: Reducing the use of medically unnecessary contralateral prophylactic mastectomy in women with nonhereditary, unilateral breast cancer requires a social change that addresses patient-, physician-, cultural-, and systems-level enabling factors. Such a transformation begins with educating clinicians and patients. The concerns of women who want preventive contralateral mastectomy must be explored, and women need to be informed of the anticipated benefits (or lack thereof) and risks. Areas requiring further study are considered.
MeSH term(s)	Female ; Humans ; Patient Preference ; Patient Selection ; Practice Patterns, Physicians' ; Prophylactic Mastectomy ; Unilateral Breast Neoplasms/diagnosis ; Unilateral Breast Neoplasms/psychology ; Unilateral Breast Neoplasms/surgery
Language	English
Publishing date	2021-02-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.6664
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Article: Psychosocial Interventions for Women with a

Boghosian, Talin / McCuaig, Jeanna M / Carlsson, Lindsay / Metcalfe, Kelly A

Cancers

2021 Volume 13, Issue 7

Abstract: This scoping review aimed to explore the effectiveness of psychological and psychoeducational interventions ... ...

Abstract	This scoping review aimed to explore the effectiveness of psychological and psychoeducational interventions for
Language	English
Publishing date	2021-03-24
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers13071486
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Article ; Online: Theory-based behavior change intervention to increase uptake of risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 pathogenic variant: The PREVENT randomized controlled trial.

Metcalfe, Kelly A / Pal, Tuya / Narod, Steven A / Armel, Susan / Shickh, Salma / Buckley, Kathleen / Walters, Scott T / Brennenstuhl, Sarah / Kinney, Anita Y

Cancer medicine

2023 Volume 12, Issue 17, Page(s) 18246–18257

Abstract: Objective: To evaluate the effect of a theory-based behavioral intervention delivered by genetic counselors on the uptake of risk-reducing salpingo-oophorectomy (RRSO) at 12 and 24 months by women with a BRCA1 or BRCA2 pathogenic variant (PV) compared ... ...

Abstract	Objective: To evaluate the effect of a theory-based behavioral intervention delivered by genetic counselors on the uptake of risk-reducing salpingo-oophorectomy (RRSO) at 12 and 24 months by women with a BRCA1 or BRCA2 pathogenic variant (PV) compared to women who received usual care. Methods: In this two-arm, multi-site randomized controlled trial participants were randomized to receive a theoretically-guided behavioral telephone intervention or usual care. Outcome data were collected at 12 and 24 months. Participants in the usual care arm were offered the intervention after 12 months. Results: Data on 107 participants were included in the analysis. There was no significant difference in the proportion of women who had a RRSO by 1 year (28.6%- intervention; 22.9%- usual care (p = 0.54)). At 1 year, women who received the intervention had significantly lower mean decisional conflict (p Conclusions: A theory-based behavioral intervention delivered by genetic counselors to women with a BRCA PV who chose not to have the recommended RRSO was effective at reducing decisional conflict and increasing knowledge in women with a BRCA1 or BRCA2 PV.
MeSH term(s)	Female ; Humans ; Salpingo-oophorectomy ; Mutation ; BRCA1 Protein/genetics ; Risk Reduction Behavior ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/prevention & control ; Breast Neoplasms ; Genetic Predisposition to Disease ; BRCA2 Protein/genetics
Chemical Substances	BRCA1 Protein ; BRCA1 protein, human ; BRCA2 protein, human ; BRCA2 Protein
Language	English
Publishing date	2023-08-21
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2659751-2
ISSN	2045-7634 ; 2045-7634
ISSN (online)	2045-7634
ISSN	2045-7634
DOI	10.1002/cam4.6417
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Article ; Online: Recontact to return new or updated

Panchal, Seema / Mahajan, Radhika / Aujla, Navneet / McKay, Paul / Casalino, Selina / Di Gioacchino, Vanessa / Charames, George S / Lefebvre, Maude / Metcalfe, Kelly A / Akbari, Mohammad Reza / McCuaig, Jeanna Marie / Lerner-Ellis, Jordan

Journal of medical genetics

2024 Volume 61, Issue 5, Page(s) 477–482

Abstract: Objective: The purpose of this study was to recontact individuals with clinically actionable test results identified through a retrospective research study and to provide a framework for laboratories to recontact patients.: Methods: Genetic testing ... ...

Abstract	Objective: The purpose of this study was to recontact individuals with clinically actionable test results identified through a retrospective research study and to provide a framework for laboratories to recontact patients. Methods: Genetic testing was conducted on 2977 individuals originally referred for Results: Novel clinically actionable pathogenic variants were identified in the Conclusion: Novel pathogenic variants in
MeSH term(s)	Female ; Humans ; BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; Breast Neoplasms/genetics ; Duty to Recontact ; Fanconi Anemia Complementation Group N Protein/genetics ; Genetic Predisposition to Disease ; Genetic Testing ; Laboratories, Clinical ; Retrospective Studies
Chemical Substances	BRCA1 Protein ; BRCA2 Protein ; Fanconi Anemia Complementation Group N Protein ; PALB2 protein, human
Language	English
Publishing date	2024-04-19
Publishing country	England
Document type	Journal Article
ZDB-ID	220881-7
ISSN	1468-6244 ; 0022-2593
ISSN (online)	1468-6244
ISSN	0022-2593
DOI	10.1136/jmg-2023-109652
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Article ; Online: Uptake of Preimplantation Genetic Diagnosis in Female BRCA1 and BRCA2 Mutation Carriers.

Mor, Pnina / Brennenstuhl, Sarah / Metcalfe, Kelly A

Journal of genetic counseling

2018 Volume 27, Issue 6, Page(s) 1386–1394

Abstract: Women with a germline pathogenic variant in the BReast CAncer susceptibility genes (BRCA1 or BRCA2) have an increased risk of early-onset breast and ovarian cancer. In addition to weighing cancer screening and risk-reduction options, healthy BRCA ... ...

Abstract	Women with a germline pathogenic variant in the BReast CAncer susceptibility genes (BRCA1 or BRCA2) have an increased risk of early-onset breast and ovarian cancer. In addition to weighing cancer screening and risk-reduction options, healthy BRCA mutation carriers of childbearing age may choose to preclude passing the mutation to the next generation. In the current study, we report on preimplantation genetic diagnosis (PGD) practices in BRCA-positive Israeli women who were offered PGD at no cost. Methods: we measured PGD uptake, decision satisfaction or regret, and predictors of uptake. Of the 70 participant female carriers, only 25.7% chose to use PGD to prevent transmission of the mutation, and were not predicted by age or religious affiliation. For those who chose IVF/PGD, satisfaction with the decision regarding IVF and PGD was significantly higher than those who did not have IVF and PGD (p < 0.04). Experiencing previous infertility was the only significant predictor of uptake of IVF/PGD (p < 0.001), which may suggest that BRCA status is secondary to infertility in the decision-making process for PGD in women with a BRCA mutation.
MeSH term(s)	Adult ; BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; Female ; Genetic Carrier Screening ; Humans ; Mutation ; Patient Acceptance of Health Care ; Patient Satisfaction ; Pregnancy ; Preimplantation Diagnosis
Chemical Substances	BRCA1 Protein ; BRCA1 protein, human ; BRCA2 Protein ; BRCA2 protein, human
Language	English
Publishing date	2018-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1117799-8
ISSN	1573-3599 ; 1059-7700
ISSN (online)	1573-3599
ISSN	1059-7700
DOI	10.1007/s10897-018-0264-2
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Article ; Online: A Qualitative Study of the Everyday Impacts of Cognitive Difficulties After Stem Cell Transplantation.

Mayo, Samantha J / Wozniczka, Isabel / Edwards, Beth / Rourke, Sean B / Howell, Doris / Metcalfe, Kelly A / Taghavi Haghayegh, Arta / Lipton, Jeffrey H

Oncology nursing forum

2022 Volume 49, Issue 4, Page(s) 315–325

Abstract: Purpose: To explore how cognitive difficulties affect the everyday lives of survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT).: Participants & setting: 20 survivors of allo-HSCT attending follow-up care at a tertiary cancer ... ...

Abstract	Purpose: To explore how cognitive difficulties affect the everyday lives of survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Participants & setting: 20 survivors of allo-HSCT attending follow-up care at a tertiary cancer center in Toronto, Canada. Methodologic approach: This qualitative, descriptive study used semistructured interviews. Findings: Cognitive symptoms affected the everyday lives of allo-HSCT survivors by changing the experience of everyday tasks, provoking emotional responses, and prompting adoption of mitigation strategies. Subthemes within each of these themes highlight the ways in which cognitive impairment shapes how allo-HSCT survivors feel about themselves, interact with others, and navigate coping challenges. Implications for nursing: These findings demonstrate the multidimensional experience of cognitive difficulties following allo-HSCT and may inform the development of patient-centered approaches to assessing and managing cognitive difficulties.
MeSH term(s)	Cognition ; Cognitive Dysfunction/etiology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/psychology ; Humans ; Qualitative Research ; Survivors/psychology
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604886-9
ISSN	1538-0688 ; 0190-535X ; 1538-0688
ISSN (online)	1538-0688 ; 0190-535X
ISSN	1538-0688
DOI	10.1188/22.ONF.315-325
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Article: Reflex BRCA1 and BRCA2 tumour genetic testing for high-grade serous ovarian cancer: streamlined for clinicians but what do patients think?

McCuaig, Jeanna M / Ferguson, Sarah E / Vicus, Danielle / Ott, Karen / Stockley, Tracy L / Kim, Raymond H / Metcalfe, Kelly A

Hereditary cancer in clinical practice

2022 Volume 20, Issue 1, Page(s) 15

Abstract: Background: Reflex (automatic) BRCA1 and BRCA2 (BRCA1/2) genetic testing of tumour tissue is being completed for all newly diagnosed high-grade serous ovarian cancer (HGSOC) in the province of Ontario, Canada. The objective of this study was to measure ... ...

Abstract	Background: Reflex (automatic) BRCA1 and BRCA2 (BRCA1/2) genetic testing of tumour tissue is being completed for all newly diagnosed high-grade serous ovarian cancer (HGSOC) in the province of Ontario, Canada. The objective of this study was to measure the psychological impact of tumour genetic testing among individuals with a new diagnosis of HGSOC. Methods: Participants had a new diagnosis of HGSOC and received reflex BRCA1/2 tumour genetic testing as a component of their care. Eligible individuals were recruited from two oncology centres in Toronto, Canada. One week after disclosure of tumour genetic test results, consenting participants were asked to complete a questionnaire that measured cancer-related distress, dispositional optimism, knowledge of hereditary breast/ovarian cancer, recall of tumour genetic test results, satisfaction, and the psychological impact of receiving tumour genetic test results. The Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire was used to measure the psychological impact of tumour genetic testing. Results: 76 individuals completed the study survey; 13 said they did not receive their tumour test results. Of the remaining 63 participants, the average MICRA score was 26.8 (SD = 16.3). Higher total MICRA scores were seen among those with children (p = 0.02), who received treatment with primary surgery (p = 0.02), and had higher reported cancer-related distress (p < 0.001). Higher dispositional optimism (p < 0.001) and increasing age (p = 0.03) were associated with lower total MICRA scores. Most (83.5%) participants reported being satisfied/highly satisfied with having tumour testing completed; however, 40.8% could not accurately recall their tumor test results. Conclusions: This study is the first to assess psychological outcomes following reflex BRCA1/2 tumour genetic testing in women newly diagnosed with HGSOC. Increased dispositional optimism provided a protective effect, while increased cancer-related distress increased the psychological impact of tumour genetic testing. Educational resources are needed to help increase patient understanding and recall of tumour results, particularly when tumour genetic testing includes analysis of genes that may have implications for hereditary cancer risk. Additional research is required to better understand the patient experience of reflex tumour genetic testing.
Language	English
Publishing date	2022-04-13
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2252512-9
ISSN	1897-4287 ; 1731-2302
ISSN (online)	1897-4287
ISSN	1731-2302
DOI	10.1186/s13053-022-00221-5
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Article ; Online: Patient-reported outcomes associated with reflex BRCA1/2 tumor and subsequent germline panel genetic testing for high-grade serous ovarian cancer.

McCuaig, Jeanna M / Stockley, Tracy L / Ferguson, Sarah E / Vicus, Danielle / Brennenstuhl, Sarah / Ott, Karen / Kim, Raymond H / Metcalfe, Kelly A

Journal of genetic counseling

2022 Volume 32, Issue 2, Page(s) 503–513

Abstract: Reflex genetic testing of tumor tissue is being completed to direct cancer treatment; however, the patient impact of this genetic testing model is unknown. This survey study evaluates psychological outcomes following tumor and germline genetic testing in ...

Abstract	Reflex genetic testing of tumor tissue is being completed to direct cancer treatment; however, the patient impact of this genetic testing model is unknown. This survey study evaluates psychological outcomes following tumor and germline genetic testing in individuals with a new diagnosis of high-grade serous ovarian cancer (HGSOC). Individuals were recruited from two hospitals in Toronto, Canada. Participants completed surveys 1 week after receiving tumor results and 1 week after receiving germline results (which included genetic counseling). Outcomes included cancer-related distress (Impact of Events Scale: IES), genetic testing-related distress (Multidimensional Impact of Cancer Risk Assessment: MICRA), and patient satisfaction. Paired t-tests were used to evaluate differences in outcomes following each genetic test result; Cohen's d was used to evaluate effect size. Subgroup analyses were undertaken according to age at diagnosis (<60 years vs. ≥60 years) and test results (any positive vs. both negative). McNemar's test assessed differences in satisfaction. Fifty-two individuals were included in the analyses. Mean IES scores were similar following disclosure of tumor and germline results (27.39 vs. 26.14; p = 0.481; d = 0.101). Compared to following tumor result disclosure, MICRA scores were significantly lower following receipt of germline results with genetic counseling (27.23 vs. 22.69; p = 0.007; d = 0.435). Decreases in MICRA scores from tumor to germline result disclosure were greater for those diagnosed <60 years or those who received only negative test results. Most individuals were satisfied/highly satisfied following tumor (85.7%) and germline (89.8%) results disclosure (p = 0.774). Reflex tumor, and subsequent germline, genetic testing is a new model of care for cancer patients. In our cohort, genetic testing-related distress decreased significantly following receipt of germline results with genetic counseling, especially for individuals diagnosed under 60 years and those receiving only negative results. Most individuals were satisfied with this model of care.
MeSH term(s)	Humans ; Female ; Middle Aged ; Ovarian Neoplasms/diagnosis ; Genetic Testing/methods ; Genetic Counseling/psychology ; Reflex ; Germ Cells ; Patient Reported Outcome Measures ; Genetic Predisposition to Disease ; BRCA1 Protein/genetics
Chemical Substances	BRCA1 protein, human ; BRCA1 Protein
Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1117799-8
ISSN	1573-3599 ; 1059-7700
ISSN (online)	1573-3599
ISSN	1059-7700
DOI	10.1002/jgc4.1661
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Article ; Online: Oophorectomy for breast cancer prevention in women with BRCA1 or BRCA2 mutations.

Metcalfe, Kelly A

Women's health (London, England)

2009 Volume 5, Issue 1, Page(s) 63–68

Abstract: Owing to the significant breast cancer risk associated with BRCA1 or BRCA2 mutations, women with these mutations have several options available to them by which to reduce the risk of breast cancer. These include surgical (prophylactic mastectomy and ... ...

Abstract	Owing to the significant breast cancer risk associated with BRCA1 or BRCA2 mutations, women with these mutations have several options available to them by which to reduce the risk of breast cancer. These include surgical (prophylactic mastectomy and prophylactic oophorectomy) and medical (chemoprevention) options. The breast cancer risk reductions associated with these options range from a 90% risk reduction associated with prophylactic mastectomy to approximately 50% with oophorectomy or tamoxifen. This article reviews the efficacy of prophylactic oophorectomy for the prevention of breast cancer in BRCA1 and BRCA2 mutation carriers. The predictors of uptake of the preventive surgery will be discussed, in addition to the psychosocial implications of the surgery.
MeSH term(s)	Adult ; Age Factors ; Breast Neoplasms/epidemiology ; Breast Neoplasms/genetics ; Breast Neoplasms/prevention & control ; Female ; Genes, BRCA1 ; Genes, BRCA2 ; Genetic Predisposition to Disease/epidemiology ; Genetic Predisposition to Disease/prevention & control ; Humans ; Menopause, Premature/psychology ; Middle Aged ; Ovariectomy/psychology ; Risk Factors
Language	English
Publishing date	2009-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2274503-8
ISSN	1745-5065 ; 1745-5057
ISSN (online)	1745-5065
ISSN	1745-5057
DOI	10.2217/17455057.5.1.63
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