title: Psychological Distress, Anxiety, and Depression of Cancer-Affected BRCA1/2 Mutation Carriers: a Systematic Review.
abstract: Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany. johanna.ringwald@med.uni-tuebingen.de.|Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany. johanna.ringwald@med.uni-tuebingen.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Ringwald
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Wochnowski
authors.affiliation: Institute of Medical Genetics and Applied Genomics, University Hospital Tuebingen, Tuebingen, Germany.|Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bosse
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.
authors.forename: Katrin Elisabeth
authors.initials: KE
authors.lastname: Giel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.|Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schäffeler
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.|Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.|Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D003863:Depression; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009369:Neoplasms / Q000235:genetics / Q000378:metabolism / Q000523:psychology*; D013315:Stress, Psychological; D055815:Young Adult
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: Anxiety; Brca mutation; Depression; Distress; Hereditary cancer; Psychological burden; Review