Distress in the cancer patient and its association with genetic testing and counseling for hereditary non-polyposis colon cancer

This study investigated the association between baseline measures of attitudes toward genetic testing and counseling for hereditary non-polyposis colon cancer (HNPCC) and the affective state of 269 colorectal cancer patients who had given blood for an HNPCC genetic testing study. We identified multivariate clusters of depression, anxiety, quality of life, and social support scale scores reflecting high vs. low distress among patients enrolled in the study. Patients in the high distress cluster (N = 59) had significantly higher scores on anxiety and depression measures and significantly lower scores on quality of life and social support scales compared with those in the low distress cluster (N = 210). A significantly higher proportion of the high distress group were more likely to indicate that they would worry about finding out that they were HNPCC mutation carriers and that they were unable to cope with problems regarding their test results. Patients in the high distress category had significantly higher mean scores on several items related to pros and cons for finding out test results and sharing results with relatives (e.g., relief at finding out one was not a carrier, increased concern about their relatives' cancer risk, worry about negatively affecting relationships with relatives by discussing hereditary cancer risk). We also evaluated psychological responses for 11 patients 2 weeks after they had undergone genetic counseling for disclosure of test results. Overall, mean depression and anxiety scores decreased from baseline to 2 weeks following disclosure of results, but continued to be higher in the high distress group compared with the low distress group. These findings suggest the need for psychological support throughout the genetic counseling and testing process for a subgroup of patients who are characterized by high depressive symptoms and anxiety, and low quality of life and perceived social support.