We would like to thank Dr. Yang for the interesting remarks on our recently published paper titled “Post-traumatic stress in head and neck cancer survivors and their partners.”
Dr. Yang raises the question of whether treatment of head and neck cancer (HNC) has an effect on patients’ psychological state. Our results showed that treatment type and time since treatment were not statistically significantly associated with self-reported levels of post-traumatic stress. Research has shown that illness-related variables including the type of cancer treatment received are rarely associated with cancer survivors’ psychological wellbeing and overall quality of life [1, 2]. These findings indicate that patients’ emotional response to cancer may not be directly associated with the severity of cancer and its treatment  but with other risk factors such as social support and indices of distress . Dr. Yang makes the point that treatment of HNC might have a more beneficial effect on patients’ well-being than treating anxiety and depression. Ideally, we would recommend both approaches and longitudinal data are needed in order to accurately assess which of these treatments for HNC improves outcomes.
With regard to whether screening for cancer-related post-traumatic stress might be helpful, a stepped approach to patients’ care might be an effective way forward. More specifically, this would involve preparing all patients with information regarding the possible effects of being diagnosed with and treated for cancer, screening for those vulnerable to adverse outcomes such as the development of a psychiatric disorder, and providing treatment as clinically required. Further research is needed in order to identify the most effective model of care, one that is not resource-intensive, is ethically acceptable, and provides for patients’ needs.
We agree with Dr. Yang that one of the roles of clinical research is to inform clinical practice. Indeed the healthcare team should be alert to patients’ psychological reaction to cancer including the potential for the development of cancer-related post-traumatic stress symptoms. More research is needed in order to understand better the mechanisms behind the development of those symptoms, who may be at increased risk and how to best treat cancer-related post-traumatic stress.
Hahn EE, Hays RD, Kahn KL, Litzwin MS, Ganz PA (2016) Post-traumatic stress symptoms in cancer survivors: relationship to the impact of cancer scale and other associated risk factors. Psycho-Oncology 24:643–652
Korszun A, Sarker SJ, Chowdhury K, Clark C, Greaves P, Johnson R, Kingston J, Levitt G, Matthews J, White P, Lister A, Gribben J (2013) Psychosocial factors associated with impact of cancer in long-term haematological cancer survivors. Br J Haematol 164:790–803
Shand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA (2015) Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology 24:624–634
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Moschopoulou, E., Hutchison, I., Bhui, K. et al. Response to the letter to the editor: Post-traumatic stress in head and neck cancer survivors and their partners. Support Care Cancer 27, 719 (2019). https://doi.org/10.1007/s00520-018-4621-3