Telephone Offers a Viable Alternative to In-Person Genetic Counseling

Telephone Offers a Viable Alternative to In-Person Genetic Counseling

Many women at risk for hereditary breast and ovarian cancer are unable to receive comprehensive cancer genetics risk assessment from trained genetic cancer professionals because of an inability to travel to in-person counseling. However, a study has found that telephone counseling can be just as effective as in-person counseling for these women.

Researchers at the University of New Mexico (UNM) Comprehensive Cancer Center compared the effects of in-person counseling and counseling done over the phone. A group of 988 women with an increased risk for hereditary breast or ovarian cancer was recruited, and the women were divided into two groups. While one group traveled for in-person cancer genetic counseling, the other received counseling over the telephone. The counseling provided was standardized across both groups and the teaching materials sent to the women were identical.

After 1 year, the women were assessed based on their anxiety, cancer-related distress, mental and physical health-related quality of life, how much control and how informed they felt about their risk and medical recommendations. Both groups benefited similarly from genetic counseling.

The only significant difference was in the rate of test uptake, which was approximately 9% lower in the group counseled by telephone.

The researchers suggested that further testing could explore a more diverse selection of participants for evaluation. This study was limited to those with a history of cancer, as well as limited geographically (and therefore, ethnically); only patients from Utah were included in the study, and the pool was largely non-Hispanic white.

While test uptake was lower for the telephone group than for the in-person group, the authors note that overall rate of test uptake in this study was substantially lower than other studies. This could be because of the method in which participants were selected. Rather than a referral basis, they were directly recruited. As noted by the researchers, referral for genetic counseling and testing from a provider instills a greater sense of importance of the referral in a patient.

It is estimated that less than one-third of women at risk for hereditary breast and ovarian cancer receive genetic counseling from trained cancer genetic professionals. Providers alone do not have the expertise required to adequately counsel women at risk, and so, the study points out, a trained genetic counselor is required to assess risk in these women, support informed decision-making, provide risk-appropriate care recommendations, and attend to the potential deleterious psychosocial effects of providing new risk information.

However, due to time and cost restraints, many women in rural communities do not have access to in-person cancer genetic counseling. The researchers hope that expanding cancer genetic counseling to take place over the phone in addition to in person would extend the reach of counselors and, therefore, increase counseling in women who are at risk.

It can help to make cancer genetic services more widely accessible, which is an important consideration in rural states like New Mexico,” explained Anita Kinney, PhD, RN, associate director for Cancer Control and Population Sciences at the UNM Cancer Center who led the study. “We hope that our study’s results will help increase health insurance coverage of telephone counseling, so that more cancer patients and their family members can benefit from potentially lifesaving cancer risk information.”

As the study showed that benefits of phone counseling was non-inferior to in-person counseling, the researchers hope this mode can be implemented as a standard option to improve access for women in geographically remote areas. Merely offering two options for counseling could be beneficial, as the researcher’s noted that patients experience an increased perception of control when able to choose their preferred mode of counseling.

Benefits of telephone cancer genetic counseling are not limited to women at risk, the authors pointed out. Counselors unable to travel to provide in-person counseling could provide their services over the phone, as well.

Kinney AY, Steffen LE, Brumbach BH et al. Randomized Noninferiority trial of telephone delivery of brc1/2 genetic counseling compared with in-person counseling: 1-year follow-up. J Clin Oncol. 2016;34(24):2914-2924.