Maggie Watson

How do young women, who were identified as carrying a BRCA gene mutation before they had children, approach reproductive decision-making and what are their attitudes towards reproductive genetic testing? Reproductive decision-making within the context of cancer risk is complex and influenced by personal experiences of cancer. Younger women were not concerned with reproductive decision-making at the time of their genetic test; however, the impact on subsequent reproductive decision-making was considerable and left them with unanticipated dilemmas, such as having children who would be at risk of inheriting cancer predisposition, timing risk-reducing surgery and changing perceptions of responsibility. Individuals carrying gene mutations predisposing to hereditary breast/ovarian cancer have concerns about passing on the gene mutation to children. Qualitative methodology and thematic analysis. Data were collected through semi-structured interviews with 25 women aged 18–45 who had received a positive result for a BRCA1 or BRCA2 gene mutation while childless. Analysis revealed four central themes: (i) the impact of cancer on reproductive decision-making; (ii) motivation for genetic testing; (iii) risk management and timing of planning children; and (iv) optimism for future medical advancements. This study explores the views of female BRCA carriers. Further research should explore the views of couples, men, and include samples with greater ethnic and social diversity. This evidence highlights the need for reproductive decision-making to be addressed at the time of pretest genetic counselling. More information should be provided on reproductive options as well as counselling/support to guide women's reproductive decision-making and prenatal testing options at the time they undertake genetic testing. This research was supported by Cancer Research UK (Number C1226 A7920) and NIHR support to the Biomedical Research Centre at The Institute of Cancer Research and RMH. The authors have no conflicts of interest to declare. Not applicable.

Purpose: The purpose of this study was to analyse the impact of coping response on survival of breast cancer by using a new method of assessing coping.Method: Adjustment to cancer was assessed using a revised measure in a large cohort of breast cancer patients (N = 578) followed up over a period of 10 years. Impact of coping response measured early in the disease process (<4 months from primary diagnosis of early‐stage breast cancer) was assessed, and survival analyses were undertaken including known clinical staging data and cancer treatment details.Results: After 5 years of follow‐up from primary diagnosis, the effect of prior ‘negative adjustment’ was statistically significantly linked to increased risk of death and relapse of breast cancer, and for the 10‐year analysis, this result remained for both risk of death and relapse. There was no statistically significant effect on survival of the novel ‘positive adjustment’ response.Conclusions: Coping with cancer was assessed using a new methodology and is linked to an adverse impact of negative adjustment on overall survival. Positive adjustment was unrelated to survival. The current study strengthens previous evidence that there is a link between survival and coping response. The question remains of how coping response might affect physical outcome. It is considered that coping response likely impacts survival through the mediating effects on lifestyle and health behaviour that may contribute to an adverse prognosis. Copyright © 2012 John Wiley & Sons, Ltd.

Objective: The study aimed to evaluate Problem‐Focussed Interactive Telephone Therapy, an individual psychological therapy based on cognitive‐behavioural therapy adapted for telephone delivery to cancer patients with high psychological needs.Methods: A non‐randomised, within‐group prospective design was used. Outcome measures pre‐therapy and post‐therapy included were as follows: Hospital Anxiety and Depression Scale, Mental Adjustment to Cancer Scale: helpless/hopeless sub‐scale only, Checklist of Cancer Concerns, Cancer Coping Questionnaire and EQ‐5D quality of life. A study‐specific Service Evaluation Questionnaire was included. Eligible patients were either (i) offered out‐patient screening for anxiety/depression/helplessness (n = 649) or (ii) referred for psychological care by oncology clinicians (n = 160).Results: Thirty two percent (36/114) of screen‐identified cases and 22% (35/160) of referred patients participated, and 42 were available for analysis. There were significant post‐therapy improvements in Hospital Anxiety and Depression Scale anxiety (p = 0.002) and depression (p = 0.003), Mental Adjustment to Cancer Scale helpless/hopeless (p = 0.036), cancer concerns (p = 0.005) and overall quality of life (p = 0.048). Overall, 81% (34/42) of participants were defined as clinical cases at baseline and 32% were no longer cases post‐therapy. There were significant improvements in coping consistent with the therapy method.Conclusions: A minority of symptomatic patients opt for telephone psychological therapy; however, where they do, there are significant improvements indicating that telephone‐delivered therapy is feasible in patients with high needs. Findings are discussed in relation to current issues on the implementation of distress screening and psychological therapy provision within clinical settings. Copyright © 2012 John Wiley & Sons, Ltd.

Distress has been endorsed as the 6^th Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recognized as a necessary, integral part of oncology care. There has been significant development of this field over the last two decades in the area now commonly labelled “psycho-oncology”. Given the advances in psycho-oncology, it is helpful to overview the approaches to provision of psychological care, so we can better understand how to care for the emotional needs of cancer patients, their partners and families. The focus here is on patients with high and enduring levels of need in terms of emotional functioning and the formal therapies that are available to help patients and their families manage these needs.

Objectives: This study explores communication within families of clinically significant genetics research results, after the death of the patient participant. BRCA2 mutations were found in several men after their death from prostate cancer. Spouses were given the results in a genetic counselling session and asked to inform relatives. Methods: Cross‐sectional, qualitative exploratory study. Interviews with 13 relatives, including informers and recipients of the information, were analysed using interpretative phenomenological analysis. Results: Dissemination was hampered when communication channels between relatives were limited, because of family rifts or socially distant or problematic relationships. When informing other branches of the family, relatives approached individuals in the generation of the deceased man, regardless of their risk status, who were then responsible for informing younger relatives. Most people informed by a relative did not seek genetic counselling. The informing relative may not have sufficient authority for the information either to be taken seriously or to challenge individual constructions about the aetiology of cancer. This impeded information transmission to further at‐risk relatives. Most participants knew of relatives who had not been told about their cancer risk. Conclusions: The implications of this limited efficiency of information transfer among relatives are discussed in the context of a potential role for genetics services in contacting at‐risk relatives directly. Copyright © 2008 John Wiley & Sons, Ltd.

Objectives: The Mental Adjustment to Cancer (MAC) Scale is widely used to assess psychological response to cancer. There have been several attempts to replicate independently the original factor structure of the MAC. Evidence from these replication studies is reviewed. A re‐analysis of the MAC Scale was conducted on a substantial new cohort in order to clarify the factor structure.Methods: 1255 patients with various cancer diagnoses completed the MAC Scale.Results: Two results emerged: first, that the original MAC dimension of Helplessness/Hopelessness is extremely stable and robust; second, that the original factors can be subsumed within two overarching (first order) factors relating to positive and negative adjustment scores.Conclusions: The original MAC Scale remains a satisfactory measure of psychological outcome. Two‐higher order factors representing global adjustment are now available to provide an overall summary measure alongside the original specific sub‐scales. Copyright © 2008 John Wiley & Sons, Ltd.

Objective: To identify factors associated with psychological functioning in adolescent children of early‐stage breast cancer patients.Method: Adolescents' self‐reported psychological functioning using the Child Behaviour Checklist (YSR), Mental Health subscale of the Child Health Questionnaire (CHQ‐MH) and Child Impact of Events (C‐IES) scale. The Family Assessment Device (FAD) and the Family Environment Scale (FES cohesion subscale) assessed family functioning. Maternal depression was assessed on the Beck Depression Inventory (BDI) and quality of life using the SF8. Using a cross‐sectional within‐groups design, assessments were obtained for 56 adolescents of 11–17 years.Results: High rates of stress were found (C‐IES) in 33% males and 45% females. Thirty percent of adolescents reported psychological problems (YSR) (28% males and 32% females) when compared with published norms. Poor family functioning was linked with YSR internalising and externalising problems; poor family cohesion with higher externalising and total YSR psychological problems. Maternal depression was linked with adolescent‐reported internalising problems.Conclusions: When mothers have breast cancer, a substantial minority of their adolescent children have psychological and stress response‐related problems linked with poor family functioning. These results argue in favour of a family‐oriented approach to psychological support of breast cancer patients. Copyright © 2008 John Wiley & Sons, Ltd.