Telephone-Based Counseling Effective for Women at Risk of Hereditary Breast and Ovarian Cancer

The use of telephone counseling for hereditary breast and ovarian cancer was noninferior to in-person counseling with no significant adverse effects on long-term outcomes, according to the results of a study published August 20 in the Journal of Clinical Oncology. However, the testing uptake was lower for patients who received telephone counseling.

“This study provides strong long-term evidence that telephone counseling for women at risk of hereditary breast and ovarian cancer is not inferior to in-person counseling with regard to fostering informed decision making, minimizing adverse psychologic and quality-of-life outcomes, and promoting perceived personal control 1 year after counseling,” wrote Anita Y. Kinney, PhD, RN, of the University of New Mexico, and colleagues. “Alternative care delivery approaches, such as telephone communication, can make cancer genetic services more widely accessible without sacrificing safety.”

According to the study, it is recommended that women at risk for hereditary cancer get clinical genetic risk assessments from trained cancer genetic professionals, however, previous research has shown that as few as one-third of at-risk women receive genetic counseling.

For this study the researchers used population-based sampling to identify women at risk for hereditary breast and ovarian cancer and randomly assigned them to in-person (n = 495) or telephone-based (n = 493) genetic counseling and testing. Both in-person counseling and telephone-based counseling included an educational brochure and visual aids. These women could decide to provide a sample at their appointment or bring a BRCA1/2 buccal test kit home. Women assigned to telephone counseling were mailed sealed packets containing the same printed materials. If the women decided to undergo testing they were mailed a testing kit.

At 1 year, the researchers found that telephone-based counseling was noninferior to in-person counseling for all of the psychosocial and informed decision-making outcomes: anxiety, cancer-specific distress, perceived personal control, and decisional conflict about their testing decision.

By 1 year, more women who had in-person counseling underwent testing than did women who received telephone counseling (27.9% vs 37.3%).

“A contributing factor to the lower overall uptake of testing in this study may be the active recruitment strategy, which identified eligible women from population-based sources without any direct involvement of or referral from their primary health care providers,” the researchers wrote. “In general, recommendation from a health care provider strengthen perceptions about the importance of genetic risk assessment.”

Testing among women in rural areas was higher for both telephone counseling (38.7% vs 25.9%) and in-person counseling (41.3% vs 36.6%) compared with testing in women in urban areas. According to the researchers, this suggested that “BRCA1/2 testing interests were satisfied by expanding access to genetic counseling through the two modalities.”