Pam Harrison

May 02, 2011

May 2, 2011 (Washington, DC) — Partners of patients with newly diagnosed head and neck cancer are significantly more likely to meet research criteria for post-traumatic stress disorder (PTSD) than patients themselves, according to a study presented here at the Society of Behavioral Medicine 32nd Annual Meeting and Scientific Sessions.

Donna Posluszny, PhD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and colleagues from there and from the University of Texas, Arlington, Texas, found that 8 of 20 partners of patients with head and neck cancer (20%) had a mean score on the PTSD Checklist (also known as the PCL) of 50 or higher, compared with only 2 of 40 patients (5%). Patients who score at least 50 on the PCL meet the criteria for PTSD.

"This is not a formal diagnosis of PTSD but for research purposes, a score of 50 or higher is meaningful," Dr. Posluszny told delegates. "And we were very surprised to find that partners of patients with newly diagnosed head and neck cancer experience greater amounts of traumatic stress than patients themselves do."

For the study, investigators recruited 40 dyads (2 individuals regarded as a pair) where the partner was considered to be a "romantic" partner. Some 78% of the patients were male, while most partners were female; all but a small minority were married.

Almost all were white, and, as a cohort, they were somewhat better educated and made more money than the majority of patients with head and neck cancer.

Sixty-five percent of them also had stage IV head and neck cancer, she added. At the time of assessment, 43% had undergone surgery; 7% surgery plus radiation; 15% surgery plus chemoradiation; and 35% chemoradiation. Patients had been diagnosed with cancer anywhere from the larynx on up, but none had distant metastases.

On the 17-item PCL, questions elicited whether patients or their partners were experiencing traumatic stress symptoms, whether patients or their partners found their own or their partner's diagnosis of cancer life-threatening, and whose fault the cancer might be.

Cancer Stage Not a Factor

"You would think that the presence of traumatic symptoms would be higher or at least as high in patients as in partners, but we found that partners reported more traumatic stress symptoms than patients, with a mean score of 35.9 for partners vs a mean score of 29.9 for patients, which was significant," Dr. Posluszny said. PCL scores were also higher among partners who perceived the diagnosis as a threat and who blamed tobacco and alcohol use as its cause.

In contrast, cancer stage did not predict PCL scores for patients or their partners. As Dr. Posluszny noted, it might be logical to think that because the majority of partners were women, women might be simply more susceptible to stress.

"But there were actually no gender differences [behind this]," she observed. In fact, male patients and male partners had similar PCL scores (in the 30s) but female patients had lower scores than male patients, "so for some reason, female patients were doing better," she said.

Patients and partners did agree on both how life-threatening their disease was, whose fault it was, and whether the cancer was due to tobacco and alcohol use.

Asked why partners of patients with head and neck cancer might be more distressed than the patient themselves, Dr. Posluszny told Medscape Medical News that the researchers really didn't know.

"It's not gender," she said, "but maybe it's because the partner needs to keep up with whatever the home situation is; maybe they need to keep working to keep the insurance, and on top of it, they are thinking, maybe I am going to lose my partner. So there are all sorts of things that could be affecting the partner. We just haven't tapped into what exactly it is yet."

Caregiver Burden?

Commenting on the study, session co-chair John Salsman, PhD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, told Medscape Medical News that investigators analyzed "reported distress" and a lot of males do not report high levels of distress, even if they are highly distressed.

Nevertheless, he also pointed out that when the National Cancer Institute developed their definition of a cancer survivor, "it's not just the individual patient but the family entity, the partners and the caregivers, that we have to think about." This study is therefore important, he added, because it looked at the psychosocial adjustment not only a patient has to make when newly diagnosed with head and neck cancer but partner adaptation to the diagnosis as well.

"The greater level of distress seen in partners of patients with head and neck cancer may also reflect the fact that partners are susceptible to caregiver burden, especially as the disease progresses or treatment continues. Inevitability, there is the challenge of additional symptoms and the level of support that partners are required to give to patients may be compromised," Dr. Salsman said.

The study was funded by the National Cancer Institute. Dr. Posluszny and Dr. Salsman have disclosed no relevant financial relationships.

Society of Behavioral Medicine 32nd Annual Meeting and Scientific Sessions. Abstract 2053. Presented April 28, 2011.


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