WASHINGTON — Genetic counseling delivered over the telephone is as effective as face-to-face counseling, finds the largest randomized study to date comparing the two methods. The multi-center study, led by researchers at Georgetown Lombardi Comprehensive Cancer Center, was reported today in the Journal of Clinical Oncology.
The landscape of genetic testing has broadened to include a range of diseases, and demand for testing and counseling has greatly increased because of direct-to-consumer marketing, says the study's lead investigator, Marc Schwartz, PhD, co-leader of Georgetown Lombardi's Cancer Prevention and Control Program.
"It's important that all people interested in testing have access to thorough information so they can consider the implications of test results and interpret them in the context of family history," says Schwartz, who is also co-leader of the Fisher Center for Familial Cancer Research at Georgetown. "Counseling on the phone reduces costs and expands genetic counseling and testing access to rural areas, where counseling isn't always available."
While this study was conducted with women considering testing for mutations in the breast or ovarian cancer genes BRCA1 and/or BRCA2, the findings "may extend to genetic counseling for other hereditary cancers and complex conditions in adults such as heart disease," says co-author Beth N. Peshkin, MS, CGC, a professor of oncology and senior genetic counselor at Georgetown Lombardi.
Researchers at Icahn School of Medicine at Mount Sinai, Vermont Cancer Center, Dana Farber Cancer Institute and the Huntsman Cancer Institute participated in this study, which randomized 669 women to receive telephone or in-person genetic counseling. However, of women approached about participating in the study, about one-third declined because they did not want to receive phone counseling.
"In-person conversations can be intimidating and there's a lot to process," says Angela Smith, of Burlington, Vermont, who participated in study.
Smith's counseling for BRCA mutation testing was done via telephone. She says talking to a genetic counselor from home was comfortable. "I'm a bit introverted so for me, talking about something so personal was easier with the 'protection' of the phone."
The majority of participants had been treated for breast or ovarian cancer, and the rest were at risk for the disease because a family member had a mutation previously identified in the BRCA1 or BRCA2 genes.
Participants received genetic counseling either by phone or in-person before and after genetic testing, and were surveyed on a number of variables, including their knowledge of the test, perceived stress, satisfaction and decision conflict.
The findings demonstrate that telephone counseling is as effective as in-person counseling. "We hypothesized that telephone counseling would be comparable to in-person counseling overall and would be preferable for some participants," Peshkin says. "It's important for us to learn more about why people prefer one type of counseling over another, and how that affects use and outcomes of genetic counseling."
The study was supported by the National Cancer Institute (grants R01 CA108933, U01 CA152958, P30 CA051008), the Georgetown Lombardi Biostatistics and Bioinformatics Shared Resource and the Jess and Mildred Fisher Center for Familial Cancer Research.
About Georgetown Lombardi Comprehensive Cancer Center
Georgetown Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center and MedStar Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Georgetown Lombardi is one of only 41 comprehensive cancer centers in the nation, as designated by the National Cancer Institute, and the only one in the Washington, DC area. For more information, go to http://lombardi.georgetown.edu.
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis – or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization (BGRO), which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.
Journal
Journal of Clinical Oncology