Deconstructing the complexity of PTSD in cancer.
Deconstructing the complexity of PTSD in cancer.
复制标题
解构癌症中 PTSD 的复杂性。
DOI：
10.1038/nrclinonc.2013.49-c2
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Koopman,Cheryl
中科院分区：
文献类型：
--
作者：
Palesh,Oxana;Koopman,Cheryl
Oxana Palesh and Cheryl Koopman article when it is published on the cultural and individual differences in supportive care needs during cancer.[Editor’s note: since the time of writing, the article in question has been published. See: Attributing variance in supportive care needs during cancer: culture-service and individual differences before clinical factors. PLoS ONE 8, e65099 (2013).] Within the context of a ‘melting pot’such as the USA, comparing Asian patients with patients of other racial or ethnic backgrounds can be a starting point to understand the cultural differences in patients’ needs for supportive care. At the same time, we agree that examining subgroup differences—such as country of origin or residence—is better than leaving these factors out of the analyses when the data allow for such comparisons. We also concur that the lack of differentiation should be kept in mind when categorizing subgroups within the term Asian. As research progresses, subgroup cultural differences should become considerably more nuanced to understand the needs for supportive care in patients with cancer. For example, when considering ethnic differences among immigrants, the degree of acculturation is also relevant. 6 We would like to move away from debating the complexity of screening and diagnosing PTSD and instead draw further attention to the importance of identifying the important minority of women with breast cancer whose trauma symptoms seem to be considerable enough that further evaluation is warranted. Fielding and Lam2 did not discuss the high societal and personal burdens associated with untreated PTSD symptoms among women whose symptom course is neither mild nor transient. As we previously noted, 1 many patients living with PTSD experience worse health outcomes than those without PTSD via multiple pathways that can lead to greater morbidity and shorter survival. 7, 8 Thus, the costs of screening, evaluating and treating PTSD (when warranted) must be weighed against the allevi ation of the societal and personal burdens of untreated PTSD.Of course, we agree with Fielding and Lam2 that not all women with breast cancer who screen positive for PTSD symptoms require treatment. However, when screening procedures are not in place, women with clinically significant levels of distress would likely be missed. That is, the risks associated with overtreating PTSD must be balanced with the risks of undertreatment. To address Fielding and Lam’s question about who should be treated and when, focusing on women who are most disabled by their symptoms seems most sensible. 9 This approach would require that the symptoms be screened for in the first place and that impairment in social, occupational or other important areas of functioning also be investigated. A screening measure for PTSD can be brief, such as the seven-item screening scale of Breslau et al. 10 that has been demonstrated as having strong reliability and validity when used to assess PTSD in the primary care setting. 11 The implications of our commentary on the study by vin-Raviv et al. 3 would not necessitate constant screening across all women with breast cancer. Instead, we think that improving the screening at any problematic junction—such as following diagnosis, during treatment or at the end of treatment—could identify women who would benefit from further evaluation.
