Telephone genetic counseling before BRCA1/2 gene testing appears to be a cost-effective, convenient alternative to in-person genetic counseling, according to results of a randomized, noninferiority trial.
The study included 669 women aged 21 to 85 years who had not been previously diagnosed with cancer. Researchers randomly assigned 334 women to receive in-person pre- and post-test counseling, classified as usual care. The other 335 women were counseled exclusively by telephone.
The researchers defined the study’s primary outcomes as knowledge, perceived stress, satisfaction, decision conflict, cancer distress and quality of life. Secondary outcomes included comparability of BRCA1 and BRCA2 test follow-through, as well as cost comparison of telephone counseling vs. usual care.
Results showed telephone counseling was noninferior to usual care across all primary outcome measures.
At a follow-up 2 weeks after initial pretest counseling, the group differences and CIs recorded with regard to knowledge, perceived stress and satisfaction did not surpass the established 1-point noninferiority limit. Decision conflict and cancer distress did not exceed an established 4-point noninferiority limit. These findings remained consistent at 3 months.
Although researchers found that telephone counseling rendered a cost savings of $114 per patient, it was not equal to usual care in terms of BRCA1/2 test uptake (90.1% for usual care vs. 84.2% for telephone counseling).
The researchers theorized that this discrepancy may have been related to the convenience of being able to undergo the test immediately after an in-person consultation.
These findings are increasingly relevant in light of greater awareness of and momentum toward BRCA1 and BRCA2 gene testing, Lisa Madlensky, PhD, director of the Family Cancer Genetics Program at the University of California, San Diego Moores Cancer Center, wrote in an accompanying editorial.
“The results of this well-designed trial should provide reassurance for the oncology and genetic counseling communities alike, as well as patients,” Madlensky wrote. “Telephone genetic testing for BRCA1/2 is already happening in a wide range of service delivery models. It is time to embrace telephone genetic testing as a legitimate and effective way to increase patient access to genetic counseling services.”
Disclosure: One researcher reports various financial relationships with AstraZeneca, Myriad Genetics, Novartis, Pfizer and Tesaro.