BRCA mutation carriers: Risk factors for psychosocial and physiologic disruption.

Abstract

9139 Background: BRCA mutation carriers live with unique psychosocial and health-specific stressors. The purpose of this study is to further identify variables which may contribute to stressors among BRCA mutation carriers and investigate correlates with stress-associated biomarkers. Methods: Women with maternally transmitted deleterious BRCA mutations were assigned to one of four focus groups, based on personal cancer history and mothers’ survival status. Focus group themes included life stress, health care decision-making, childbearing, and coping skills. One day in advance, a quality of life (QOL) survey and first morning salivary cortisol were obtained. Patient characteristics including personal diagnosis of cancer, prophylactic surgery, and mother’s vital status were evaluated in a multivariate linear model to identify factors associated with quality of life domains and perceived stress. Secondary assessment of serum cytokine levels was conducted. Results: Participants (N=32) were predominantly NonHispanic White. After controlling for age, women who lost their mothers due to cancer reported significantly lower QOL (p=0.002) and more perceived stress (p=0.015), intrusive thoughts related to cancer risk (p=0.026), and emotional distress (p=0.004) including depression (p=0.033) and anxiety (p=0.002) compared to women whose mothers were alive. Lower quality of life was also associated with higher bereavement scores (r=-0.78, p<0.001). In women whose mothers were deceased patient-reported outcomes were significantly correlated with cytokine profiles best summarized as being globally suppressed. Biological correlates were similarly associated with bereavement scores, with negative correlations for IL-17, IL-8, and GM-CSF (p<0.05). Personal cancer history and prophylactic surgery were not associated with quality of life after adjusting for age and mother’s status. Conclusions: BRCA mutation carriers whose mothers are deceased from cancer report lower quality of life, more stress and distress. This suggests that subpopulations of carriers are potentially at higher risk of chronic stress, which may be an important consideration for manifestations of illness in this cancer-vulnerable population.