Genetic counseling works as well over the phone as in person, study finds

WASHINGTON — Genetic counseling delivered via telephone matched up with the traditional in-person consultation in long-term psychosocial outcomes for women at risk of hereditary breast and ovarian cancer in a randomized trial, a researcher said here.

“This is one of the first studies to show comparable outcomes,” said Marc Schwartz, of Georgetown University’s Lombardi Comprehensive Cancer Center, after his presentation at the American Psychological Association’s annual convention. That’s important not only for these at-risk women, but also because “as testing becomes more popular for other cancers, there’s just not enough capacity to see [everyone] in person.”

Schwartz’s research team — spanning Georgetown, Dana-Farber Cancer Institute, the University of Vermont, and Mount Sinai — sought to address this looming treatment gap by studying a “telegenetic counseling and testing intervention designed to enhance genetic testing access,” with women’s psychosocial outcomes evaluated at two-week, three-month, and 12-month intervals.

At the 12-month follow-up, women counseled via telephone showed “clear evidence” of non-inferior outcomes, Schwartz said, on all five psychosocial outcomes measured (distress, quality of life, knowledge, decisional conflict, and satisfaction), compared to women receiving in-person attention.

Calling telephone counseling “safe and effective” for this population, Schwartz encouraged providers to consider these telemedicine approaches. “Waiting lists for initial [in-person] appointments are often quite long,” he said, averaging 2.3 months at Georgetown.

“A lot of studies have shown tele-delivery is non-inferior” in other areas of medicine, he noted.
In the multi-site, randomized, non-inferiority trial, Schwartz and colleagues enrolled 669 women ages 21-85 with at least a 10 percent risk for carrying BRCA1/2 mutations. Women newly diagnosed with metastatic cancer were excluded.

Women in the telemedicine arm were issued “content comparable to in-person genetic counseling,” according to Schwartz’s presentation; women meeting with counselors received “standard BRCA1/2 genetic counseling and result disclosure.”

The research team in 2014 had reported results from the two-week and three-month follows-ups, as well as economic factors.

Schwartz noted (as was true in the 2014 data) that “telephone delivery is cost-saving compared to standard counseling,” averaging $114 less per case.

Overall: “In a series of studies, we have shown that BRCA1/2 mutation testing rarely results in adverse psychosocial outcomes” and fosters risk management behaviors, the researchers wrote in the abstract. “Regardless of delivery mode,” Schwartz concluded, “distress tends to decrease among non-carriers and remains relatively stable among carriers.”

The study was funded by the National Cancer Institute and the Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research.

This story was originally published by MedPage Today.