Knowledge and Anxiety Related to Hereditary Ovarian Cancer in Serous Ovarian Cancer Patients

Sang Hee Lee; Hyangkyu Lee; Myong Cheol Lim; Sue Kim

doi:10.4069/kjwhn.2019.25.4.365

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Lee, Lee, Lim, and Kim: Knowledge and Anxiety Related to Hereditary Ovarian Cancer in Serous Ovarian Cancer Patients

Original Article

Korean J Women Health Nurs 2019;25(4):365-378.

Published online: 19 December 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.4.365

Knowledge and Anxiety Related to Hereditary Ovarian Cancer in Serous Ovarian Cancer Patients

Sang Hee Lee^1,², Hyangkyu Lee³, Myong Cheol Lim⁴, Sue Kim³

¹Student, College of Nursing, Yonsei University, Seoul, Korea

²Nurse, Uterine Ovarian Cancer Center, National Cancer Center, Goyang, Korea

³Professor, College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea

⁴Professor, Uterine Ovarian Cancer Center, National Cancer Center, Goyang, Korea

Corresponding author: Sue Kim College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2228-3276 Fax: +82-2227-8303 E-mail: suekim@yuhs.ac

Received 8 August 201922 November 2019 Accepted 25 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The awareness of hereditary breast and ovarian cancer (HBOC) and BRCA testing is increasing in Korea. Compared to the sizable research on HBOC knowledge among breast cancer women, studies in the ovarian cancer population are limited. This paper aimed to investigate the level of knowledge of hereditary ovarian cancer and anxiety in women diagnosed with serous ovarian cancer in Korea and determine differences in the knowledge and anxiety according to whether genetic testing was undertaken and whether BRCA1 or BRCA2 mutations were present.

Methods

Using a descriptive research design, a cross-sectional survey was conducted on 100 women diagnosed with serous ovarian cancer at N hospital in Gyeonggi-do, Korea, from July to November 2018. The collected data were analyzed by descriptive statistics, independent t-tests, one-way analysis of variance, and Pearson’s correlation coefficient using the SPSS 21.0 program.

Results

The hereditary ovarian cancer-related knowledge score was mid-level (mean score 8.90±3.29 out of a total of 17), as was the state anxiety level was mid-level (mean score 47.96±3.26 out of possible score range of 20–80). Genetic knowledge of hereditary ovarian cancer was associated with age, education, occupation, genetic counseling, and BRCA mutations. There were no statistically significant factors related to anxiety and there were no statistically significant correlations between knowledge level and anxiety.

Conclusion

More comprehensive education on gene-related cancer is needed for ovarian cancer patients, especially for items with low knowledge scores. A genetic counseling protocol should be developed to allow more patients to alleviate their anxiety through genetic counseling.

Keywords: Hereditary breast and ovarian cancer syndrome, Ovarian cancer, Genetic testing, Knowledge, Anxiety

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Table 1.

Participant Characteristics (N=100)

Variable	Categories	Total (n=100)	BRCA positive (n=36)	BRCA negative (n=36)	Not tested (n=28)
		M±SD or n(%)	M±SD or n(%)	M±SD or n(%)	M±SD or n(%)
Age (year)	Range: 27–77	54.60±10.94
	<50	32 (32.0)	18 (50.0)	6 (16.7)	8 (28.6)
	50–59	36 (36.0)	11 (30.6)	16 (44.4)	9 (32.1)
	≥60	32 (32.0)	7 (19.4)	14 (38.9)	11 (39.3)
Education	≤Middle school	15 (15.0)	4 (11.1)	4 (11.1)	7 (25.0)
	High school	41 (41.0)	14 (38.9)	17 (47.2)	10 (35.7)
	≥College	44 (44.0)	18 (50.0)	15 (41.7)	11 (39.3)
Occupation	Yes	73 (73.0)	24 (66.7)	30 (83.3)	19 (67.9)
	No	27 (27.0)	12 (33.3)	6 (16.7)	9 (32.1)
Marital status	Married	76 (76.0)	28 (77.8)	27 (75.0)	21 (75.0)
	Unmarried & other	24 (24.0)	8 (22.2)	9 (25.0)	7 (25.0)
Monthly family income (10,000 won)	<200	33 (33.0)	12 (33.3)	10 (27.8)	11 (39.3)
	200–399	35 (35.0)	8 (22.2)	16 (44.4)	11 (39.3)
	≥400	32 (32.0)	16 (44.4)	10 (27.8)	6 (21.4)
Seeking disease-related information^†	Internet	53 (53.0)	19 (52.8)	20 (55.6)	14 (50.0)
	TV, radio	26 (26.0)	11 (30.6)	6 (16.7)	9 (32.1)
	Book	5 (5.0)	2 (5.6)	1 (2.8)	2 (7.1)
	Other patients	14 (14.0)	5 (13.9)	5 (13.9	4 (14.3)
	Medical staff	32 (32.0)	12 (33.3)	11 (36.0)	9 (32.1)
Sharing disease-related information^†	Spouse	66 (66.0)	25 (69.4)	23 (63.9)	18 (64.3)
	Sibling	44 (44.0)	17 (47.2)	17 (47.2)	10 (35.7)
	Parents	16 (16.0)	8 (22.2)	5 (13.9)	3 (10.7)
	Children	49 (49.0)	15 (41.7)	24 (66.7)	10 (35.7)
	Cousin	7 (7.0)	3 (8.3)	1 (2.8)	3 (10.7)
	No	1 (1.0)	1 (2.8)	0 (0.0)	0 (0.0)
Sharing genetic test results^†	Spouse	39 (39.0)	21 (55.6)	18 (50.0)
	Sibling	34 (34.0)	19 (52.8)	15 (41.7)
	Parents	11 (11.0)	7 (19.4)	4 (11.1)
	Children	42 (42.0)	17 (44.4)	25 (69.4)
	Cousin	4 (4.0)	4 (11.1)	0 (0.0)
	No	4 (4.0)	3 (8.3)	1 (2.8)
Received genetic counseling	Yes	19 (19.0)	16 (44.4)	3 (8.3)	0 (0.0)
	No	81 (81.0)	20 (55.6)	33 (91.7)	28 (100)
Secondary cancer screening^†	Breast self-examination	11 (11.0)	5 (13.9)	3 (8.3)	3 (11.1)
	Clinical breast examination	20 (20.0)	11 (30.6)	4 (11.1)	5 (18.5)
	Mammography or MRI	19 (19.0)	9 (25.0)	6 (16.7)	4 (14.8)
	EGD	22 (22.0)	6 (16.7)	9 (25.0)	7 (25.9)
	Colonoscopy	19 (19.0)	5 (13.9)	8 (22.2)	6 (22.2)
	No	54 (54.0)	17 (47.2)	21 (58.3)	16 (59.3)
Current chemo status	Yes	86 (86.0)	33 (89.2)	29 (78.4)	24 (64.9)
	No	14 (14.0)	3 (8.1)	7 (18.9)	4 (10.8)
Time from diagnosis (year)	Range: 0.08–10.5	1.00±1.58
	<1	56 (56.0)	24 (66.7)	26 (72.2)	16 (44.4)
	1–2	20 (20.0)	7 (19.4)	7 (19.4)	6 (16.7)
	>2	14 (14.0)	5 (13.9)	3 (8.3)	6 (16.7)
Disease stage	During 1st therapy	61 (61.0)	15 (41.7)	21 (58.3)	25 (89.3)
	NED	6 (6.0)	0 (0.0)	5 (13.9)	1 (3.6)
	AWD	33 (33.0)	32 (58.3)	10 (27.8)	2 (7.1)
Cancer staging	I	6 (6.0)	0 (0.0)	4 (11.1)	2 (7.1)
	II	10 (10.0)	2 (5.6)	3 (8.3)	5 (17.9)
	III	60 (60.0)	24 (66.7)	21 (58.3)	15 (53.6)
	IV	24 (24.0)	10 (27.8)	8 (22.2)	6 (21.4)

BRCA=breast cancer susceptibility gene; NED=no evidence of disease; AWD=alive with disease, MRI=magnetic resonance imaging; EGD=esophagogastroduodenoscopy;.

M±SD=mean±standard deviation.

^† Multiple response.

Table 2.

Participants’ Genetic Ovarian Cancer Knowledge and Anxiety (N=100)

Variable	Categories	M±SD	Min	Max	F	p	Scheffé test
Genetic ovarian cancer knowledge	Total	8.90±3.29	0	16	4.63	.012	a>c
	BRCA positive^a	9.83±3.65	1	16
	BRCA negative^b	9.11±2.64	5	14
	Not tested^c	7.43±3.14	0	12
State anxiety	Total	47.96±3.26	41	58	0.00	.992
	BRCA positive	47.86±2.78	42	56
	BRCA negative	47.67±3.38	41	58
	Not tested	48.39±3.71	43	56

BRCA=breast cancer susceptibility gene; M±SD=mean±standard deviation.

Table 3.

Participants’ Genetic Ovarian Cancer Knowledge (N=100)

Abbreviated description of items	Correct rate (%)	Error rate (%)	Don’t know (%)
1. When a mother gets ovarian cancer, her daughter gets ovarian cancer.	34	35	31
2. A father can pass down the ovarian cancer gene mutation to his daughters.	28	21	51
3. The probability that a woman with ovarian cancer gene mutation will pass on this gene to her child is 50%.	47	15	38
4. If a mother or sister of a woman with ovarian cancer has ovarian cancer, it is hereditary ovarian cancer.	19	58	23
5. A woman with a family history of ovarian cancer should receive frequent ovarian cancer screening more often than normal, even if she does not have a genetic mutation.	7	86	7
6. If the mother has a genetic mutation, all her daughters will have mutations.	38	33	29
7. A mother can pass down the ovarian cancer gene mutation to her son.	35	19	46
8. All women who have the ovarian cancer gene mutation will get cancer.	45	29	26
9. If a mother has an ovarian cancer gene mutation, her child and other immediate family member will need ovarian cancer screening.	91	4	5
10. Mutations in ovarian cancer genes can increase the risk of developing cancer in other parts of the body.	69	8	23
11. About half of all ovarian cancers are hereditary.	37	25	38
12. A woman who does not have an ovarian cancer gene mutation can still get ovarian cancer.	84	2	14
13. A women with a ovarian cancer gene mutation has an increased risk of breast cancer.	64	6	30
14. If there is a genetic mutation of ovarian cancer, examinations for ovarian cancer should be done periodically.	95	1	4
15. If there is a genetic mutation of ovarian cancer, examinations for breast cancer should be done periodically.	72	5	23
16. Without the ovarian cancer gene mutation, there is no need to have regular ovarian cancer screening.	76	14	10
17. A man who carries the ovarian cancer gene mutation has an increased risk of prostate cancer and colorectal cancer.	49	5	46

Table 4.

Differences in Genetic Ovarian Cancer Knowledge and Anxiety according to Participants’ Characteristics (N=100)

Variable	Categories	Genetic ovarian cancer knowledge				State anxiety
Variable	Categories	M±SD	t or F	p	Scheffé	M±SD	t or F	p
Age (year)	<50^a	10.72±3.01	10.12	<.001	a>b,c	47.78±2.56	0.26	.770
	50–59^b	8.67±3.06				47.33±3.45
	≥60^c	7.34±2.99				48.84±3.57
Education	≤Middle school^a	7.13±3.70	3.65	.029	c>a	48.33±4.10	1.12	.330
	High school^b	8.71±3.05				48.41±3.28
	≥College^c	9.68±3.17				47.41±2.92
Occupation	Yes	9.32±2.90	−2.10	.068		48.21±3.42	−1.23	.219
	No	7.78±4.02				47.30±2.75
Marital status	Married	8.70±3.20	−1.09	.276		47.70±3.23	−1.43	.154
	Unmarried & others	9.54±3.56				48.79±3.31
Monthly family income (10,000 won)	<200	8.36±3.53	0.65	.520		48.33±3.47	0.35	.700
	200–399	9.11±3.10				47.89±2.96
	≥400	9.22±3.27				47.66±3.43
Received genetic counseling	Yes	10.53±3.67	−2.45	.016		47.74±1.99	0.32	.743
	No	8.52±3.09				48.01±3.50
Secondary cancer screening^†	Breast self-examination Yes	8.73±3.34	−0.13	.898		47.81±3.06	−0.13	.896
	No	8.87±3.34				47.96±3.30
	Clinical Breast examination Yes	10.45±3.87	2.46	.015		48.55±3.17	0.93	.352
	No	8.45±3.07				47.79±3.28
	Mammography or MRI Yes	9.84±3.13	1.45	.150		48.21±2.85	0.40	.690
	No	8.62±3.34				47.88±3.36
	EGD Yes	9.18±2.66	0.52	.599		47.95±3.24	0.02	.981
	No	8.76±3.50				47.94±3.28
	Colonoscopy Yes	9.37±3.11	0.75	.453		48.57±3.87	0.94	.345
	No	8.73±3.38				47.79±3.10
	At least one test	9.43±3.35	−1.63	.105		48.61±3.44	−1.91	.058
	Not all tests	8.35±3.25				47.37±3.01
Current chemo status	Yes	8.89±3.31	−0.33	.737		47.82±3.54	0.86	.387
	No	8.57±3.52				48.64±3.22
Time from diagnosis (year)	<1	9.15±3.11	0.86	.422		48.33±3.47	0.35	.700
	1–2	8.45±3.47				47.89±2.96
	>2	8.00±4.09				47.66±3.43
Disease stage	During 1st therapy	8.77±3.02	2.47	.090		47.65±3.22	1.22	.298
	NED	5.83±3.43				48.05±3.06
	AWD	8.52±3.14				49.14±3.63
Cancer staging	I	7.33±4.36	0.87	.459		45.51±3.50	0.44	.643
	II	9.80±4.18				44.33±3.61
	III	8.48±2.89				45.70±2.68
	IV	8.33±2.94				44.88±4.03
Genetic test & gene mutation state	BRCA positive^a	9.83±3.65	4.63	.012	a>c	47.92±2.81	4.79	.679
	BRCA negative^b	9.11±2.64				47.67±3.38
	Not tested^c	7.43±3.14				48.39±3.71

BRCA=breast cancer susceptibility gene; NED=no evidence of disease; AWD=alive with disease; MRI=magnetic resonance imaging;

EGD=esophagogastroduodenoscopy; M±SD=mean±standard deviation.

^† Multiple response.

Table 5.

Relationship between Genetic Knowledge and State Anxiety (N=100)

Variable	State anxiety
	r (p)
Genetic knowledge	−.31 (.091)

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