White, V.M., Young, M., Farrelly, A., Meiser, B., Jefford, M., Williamson, E., . . . Winship, I. (2014). Randomized controlled trial of a telephone-based peer-support program for women carrying a BRCA1 or BRCA2 mutation: Impact on psychological distress. Journal of Clinical Oncology, 32, 4073–4080.

To determine if peer telephone intervention would reduce distress among women with BRCA1/2.

Recruitment through familial cancer clinics; baseline questionnaire completed and then those who indicated interest in talking with a peer were randomly assigned to the intervention group (IG) or usual care group. Those in the IG received surveys four and six months after baseline. IG matched with peer to support. Peers were recruited and received a program manual and three days of training. Contact between peer and participant was to occur six times in a four-month period.

• N = 174
• MEAN AGE: 43.56 for the IG and 43.18 for controls
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Women; BCRA1/2 mutation carriers; received genetic counseling
• OTHER KEY SAMPLE CHARACTERISTICS: No advanced cancer; within five years of knowing genetic status; older than age 18 years

• SITE: Multi-site    
• SETTING TYPE: Outpatient    
• LOCATION: Australia

• PHASE OF CARE: Multiple phases of care

• Single blind randomized, controlled trial

Baseline questionnaires for socioeconomic information, cancer history and treatment, family history of cancer, age when notified of mutation status, BRCA1/2 mutation status of female relatives, risk-reducing surgeries, screening behaviors, and supportive care services used. At time 2, peer satisfaction was asked; Impact of Event Scale (IES) measuring distress; a single item question for anxiety; 16-item scale to measure unmet needs. 10-item cognitive appraisals about genetic testing scale.

There was little change in the mean scores on most outcome measures during the three time points. Unmet needs was the only outcome measure that decreased consistently over time. Breast cancer distress (IES) showed a significantly lower level of stress in the IG (p < 0.01). Anxiousness and stress were  lower in the IG at the first two time points (p < 0.03), but there was no difference after that. Telephone based intervention reduced distress and unmet information needs for this group. Percent of patients contacted continued to decline over time, and by the sixth phone call less than 25% had any contact.

Peer support programs may be effective at reducing distress and anxiety in those who are BRCA1/2 carriers.

• Risk of bias (no appropriate attentional control condition)
• Measurement validity/reliability questionable
• Intervention expensive, impractical, or training needs
• Subject withdrawals of 10% or greater 
• Other limitations/explanation: Usual care is not well defined; family members in the IG were not assigned to the same peer. A high percentage of the intervention group did not have actual contact after the third call, suggesting that the duration of the intervention was not practical or accepted. Those who dropped out had higher baseline stress scores. A single-item scale was used for measurement of anxiety.

Peer support among women with genetic mutations may prove to reduce distress. This type of support may be beneficial for other patient populations. Findings from this study suggest that the greatest needs and efficacy may be in the short term, since many patients did not have contact after the third phone call. As anxiety tends to decline over time, it is unclear from this study what the actual efficacy was for anxiety.