Familial communication patterns in a cohort of men with metastatic prostate cancer: A cross-sectional exploratory analysis using data from the GENTleMEN Study

Abstract

Background – A notable subset of men with metastatic prostate cancer (mPC) may carry an inherited germline mutation in a key cancer risk gene such as BRCA1 or BRCA2, predisposing them and their relatives who share the mutation to increased risk of certain types of cancer including breast, ovarian, and prostate cancer. Men with mPC could be the first members of their family to realize the presence of a cancer gene mutation and therefore have a responsibility to communicate information about hereditary cancer risk to male and female family members so that those that are carriers can participate in cancer risk management and prevention strategies. However, research thus far has not included men as central figures in the hereditary breast and ovarian cancer (HBOC) and hereditary prostate cancer risk communication process. Methods – We used a subset of responses to the initial survey of a large cohort study known as the GENTleMEN study (n = 584) to conduct a cross-sectional exploration of communication patterns of men with mPC. We looked at three communication outcomes including the number of mPC patients reporting: (1) frequent communication with related family members, (2) difficulty communicating with family about cancer risk, and (3) satisfaction with their familial risk communication. To assess the independent effects of a variety of demographic and personal characteristics on the three communication outcomes, we built multivariable models using multiple logistic regression. Results – 62.9% of mPC patients frequently communicated with their biological relatives about cancer, 74.9% of mPC patients did not find familial risk communication to be difficult, and 84.4% of mPC patients were satisfied with their current level of familial risk communication. In the multivariable models, frequent communication was positively associated with cancer worry (OR = 1.68; 95%CI = 1.07-2.70) and family satisfaction (OR = 2.20; 95%CI = 1.47-3.33); while it was negatively associated with older age (OR = 0.53; 95%CI = 0.29-0.93). Difficulty communicating with family about risk was positively associated with being of a minority race (OR = 2.71; 95%CI: 1.29-5.64) and having cancer-related distress (1.71; 95%CI = 1.31-2.24); difficulty was negatively associated with family satisfaction (0.51; 95%CI = 0.29-0.89). Lastly, having more satisfaction with familial risk communication was negatively associated with more formal education (OR = 0.58; 95%CI = 0.33-0.98) and depression (OR = 0.26; 95%CI = 0.10-0.72). Conclusion –mPC patients who are of older age and minority race, and who have underlying mental health comorbidities may have more challenges communicating to family members about cancer risk. These subgroups require more research attention and may ultimately need specialized interventions to increase familial cancer risk communication.