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Preferences for outcomes associated with decisions to undergo or forgo genetic testing for Lynch syndrome
Article first published online: 11 JUL 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 1, pages 215–225, 1 January 2013
How to Cite
Kuppermann, M., Wang, G., Wong, S., Blanco, A., Conrad, P., Nakagawa, S., Terdiman, J. and Ladabaum, U. (2013), Preferences for outcomes associated with decisions to undergo or forgo genetic testing for Lynch syndrome. Cancer, 119: 215–225. doi: 10.1002/cncr.27634
- Issue published online: 17 DEC 2012
- Article first published online: 11 JUL 2012
- Manuscript Accepted: 11 APR 2012
- Manuscript Revised: 24 FEB 2012
- Manuscript Received: 23 DEC 2011
- Lynch syndrome;
- hereditary nonpolyposis colorectal cancer;
- genetic testing;
- quality of life;
- decision making
Current guidelines recommend offering genetic testing for Lynch syndrome to individuals whose tumors suggest this condition and to relatives of affected individuals. Little is known, however, regarding how patients view the prospect of such testing. In addition, data on preferences (utilities) for the potential outcomes of testing decisions for use in cost-effectiveness analyses are lacking.
Time tradeoff utilities were elicited for 10 potential outcomes of Lynch syndrome testing decisions and 3 associated cancers from 70 participants, representing a range of knowledge about and experiences with Lynch syndrome.
Highest mean utilities were assigned to scenarios in which only the assessor's sibling had Lynch-associated colorectal cancer (ranging from 0.669 ± 0.231 to 0.760 ± 0.220). Utilities assigned to scenarios in which the assessor had Lynch-associated colorectal cancer ranged from 0.605 ± 0.252 to 0.682 ± 0.246, whereas the lowest mean utilities were assigned to 2 of the general cancer states (0.601 ± 0.238 and 0.593 ± 0.272 for colorectal and ovarian cancer respectively). Only 43% of the sample assigned higher values to undergoing Lynch testing and receiving negative results versus forgoing Lynch testing, whereas 50% assigned higher values to undergoing rather than forgoing surgery to prevent a subsequent cancer.
Genetic testing for Lynch syndrome, regardless of results, can have profound effects on quality of life; the utilities we collected can be used to incorporate these effects into cost-effectiveness analyses. Importantly, preferences for the potential outcomes of testing vary substantially, calling into question the extent to which patients would avail themselves of such testing if it were offered to them. Cancer 2013. © 2012 American Cancer Society