Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The diagnosis and treatment of head and neck cancer (HNC) is a psychosocial stressor that has been found to result in the development of Generalized Anxiety Disorder and depressive disorders. Physical discomfort, treatment side effects, body image concerns, communication challenges, financial burden, social isolation, and survivorship concerns are all major factors that may result in mental health challenges. Prior studies have illustrated an association between post-traumatic stress disorder (PTSD) in HNC survivors. The current study examines PTSD risk and quality of life in patients presenting with newly diagnosed HNC or recurrent HNC.
Methods: This is a retrospective cohort study of patients with HNC between November 2015 and September 2022. All patients with HNC are evaluated prior to starting treatment by psych-oncology, using a semistructured assessment including validated tools such as the FACT-HN and Primary Care PTSD Screen (PC-PTSD). The FACT-HN is a 27-item validated instrument that consists of five subscales: that assesses the patient's quality of life in the physical, social/family, emotional, functional domains, and HNC-specific domains. Risk of current PTSD diagnosis at the time of presentation was assessed with the PC-PTSD scale. The PC-PTSD consists of four questions with yes/no responses (yes=1; no=0). The scores are summed and a score of ≥3 was classified as a positive screen for PTSD. This study utilized five beta regression models to examine the association between positive PTSD screening and the five FACT-HN subscales. These models were adjusted for demographic covariates (age, gender, race, marital status), social factors (task and emotional support, alcohol, cigarette, and marijuana usage), and clinical factors (cancer type and stage, comorbidity score, surgery, radiation and systemic therapy). To estimate confidence intervals, bootstrap methods with bias correction were employed.
Results: The analysis included 309 patients, 7.5% had a positive screen for PTSD. Most were male (71.5%), white (79.9%), married (63.1%), had excellent/good task support (86.1%), and had excellent/good emotional support (73.1%). After adjusting for covariates, positive PTSD screening was found to be significantly associated with poorer emotional (β=-0.80; 95% CI=-1.17, -0.39), physical (β=-1.03; 95% CI=-1.37, -0.66), and functional wellbeing (β=-0.64; 95% CI=-1.07, -0.17). However, there was no statistically significant association between positive PTSD screening and social wellbeing or head and neck specific wellbeing in the cohort.
Conclusion: PTSD occurs in a small but significant portion of patients presenting with primary or recurrent HNC. Those who screened positive for PTSD using the PC-PTSD scale have poorer emotional, functional, and physical quality of life prior to the start of HNC treatment when compared to patients who screened negative. Utilizing the PC-PTSD scale in patients presenting with newly diagnosed HNC or new recurrent HNC prior to treatment can assist in identifying those who may have higher risk of experience poorer emotional, physical, and functional wellbeing prior to treatment. This may provide an opportunity to equip these patients and their social support networks with additional resources to mitigate the challenges that poorer emotional, physical, and functional wellbeing pose on the treatment of HNC.