PTSD in Patients Who Undergo Head and Neck Cancer Treatment: A Systematic Review

Background/Objectives: Post-traumatic stress disorder (PTSD) can develop after exposure to real or perceived threats to life and is characterized by symptoms including intrusive thoughts, hyperarousal, and emotional numbness. While PTSD is well-studied in populations affected by disasters and combat, the impact of serious medical conditions like cancer and its treatments remain under-researched. Due to the aggressive nature of the disease, fear of recurrence, and disfiguring nature of treatments, patients with head and neck cancer (HNC) may experience a real or perceived risk of death. This systematic review synthesizes current knowledge on PTSD in patients with HNC. Methods: A systematic review was conducted per PRISMA guidelines. Five databases (PubMed, EMBASE, SCOPUS, CINAHL, and COCHRANE) were searched for studies describing PTSD in patients with and survivors of HNC. Studies with PTSD diagnosis and/or symptom data specific to patients with HNC were included. Results: Of 80 studies, 14 met the inclusion criteria. The most commonly used scale was the PTSD Checklist-Civilian Version. The prevalence of PTSD ranged from 8% to 41% across the studies. No significant differences were found with regards to PTSD prevalence by HNC tumor site, disease stage, or treatment modality. Two studies identified significant associations between PTSD after treatment and depression at the time of diagnosis. Patients with PTSD who received cognitive behavioral therapy showed improvement in their PTSD symptoms compared to those who did not. Conclusions: PTSD is common in individuals with HNC; however, the lack of a standardized approach to diagnosing PTSD in patients with and survivors of HNC creates challenges in identifying patients who may benefit from treatment. Given that HNC is the seventh most common cancer worldwide, with increasing incidence, there is a need to better understand the relationship between HNC and PTSD to allow for better PTSD screening, identification, and treatment to improve patients' health-related quality of life and provide optimal patient care.