The overall goal of this four-year competitive renewal application is to extend work on the characterization of psychosocial aspects of hereditary nonpolyposis colon cancer (HNPCC). In the current application, the investigators propose three interrelated phases of their research. In the first phase, they will extend the research undertaken during the initial grant period which consists of a prospective descriptive study of psychosocial aspects of molecular testing for HNPCC in colorectal cancer (CRC) cases, the first-degree relatives (FDRs) of CRC cases who are found to be carriers of an HNPCC mutation, and the spouses/partners (S/Ps) of the FDRs. In the second phase they will study psychosocial issues related to participation in a phase II randomized, controlled chemoprevention trial for HNPCC involving adherence to a Cox II inhibitor and periodic check-ups over a year period. In the third phase, the investigators will focus on the family as a unit for study of genetic testing and counseling. The investigators believe that a unifying theme in this research is the investigation of the psychological (e.g., distress, worry, coping style) and social and family processes (e.g., social support and family networks) that affect individuals' willingness to undergo medical tests and procedures that may be beneficial in the early detection and/or prevention of disease. The investigators indicate that their preliminary findings show that certain subgroups of individuals participating in genetic testing studies may be particularly distressed during this process and may need more intensive follow-up or interventions to facilitate adjustment following disclosure of the test results. The study population is comprised of cases of adenocarcinoma of the colon or rectum seen at The University of Texas M.D. Anderson Cancer Center, FDRs of CRC cases who are found to be carriers of an HNPCC mutation, and the S/Ps of the FDRs. Outcome measures for the proposed research include: (1) donation of a blood sample for genetic testing; (2) willingness to inform relatives about HNPCC status; (3) completion of genetic counseling for test results disclosure; (4) psychological status/well being; and (5) adherence of recommended surveillance procedures. The investigators believe that the significance of this research lies in the recently developed ability to identify, through molecular testing, those individuals carrying genetic mutations that place them at significantly increased risk for developing HNPCC. CRC is one of the few cancers for which there are effective early detection and prevention strategies. Through molecular testing, the investigators hope to indentify a subpopulation of individuals upon whom to focus early detection resources and to maximize their efforts to increase resources to adherence to surveillance.
