Reply to Do 1 in 5 Cancer Patients Develop Post-Traumatic Stress Disorder?

We recently read a BBC News article in the United Kingdom claiming that “a fifth of cancer patients experience PTSD [post-traumatic stress disorder], a Malaysian study has found.”1 On reviewing the full study, “Course and Predictors of Post-Traumatic Stress Disorder in a Cohort of Psychologically Distressed Patients With Cancer: A 4-Year Follow-Up Study” by Chan et al,2 we are concerned about the way in which the results are represented in the study and, subsequently, in the article. The study covered 469 eligible patients who had completed the Hospital and Anxiety Depression Scale at the baseline and at 4 to 6 weeks. For anyone scoring higher than 8 on either the anxiety or depression subscale or higher than 16 overall on this questionnaire, a full Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was performed by a clinical psychologist. After dropouts, 204 patients were grouped into categories according to the results of the SCID (no PTSD, subsyndromal PTSD, or full PTSD) in addition to 236 patients with nonprobable PTSD who did not undergo the SCID. In the Results section, it states that “at the 6-month follow-up, 27 of 203 patients (13.3%) met the full criteria for PTSD, and another 17 patients (8.4%) had subsyndromal PTSD symptoms. This yielded a 21.7% PTSD incidence when patients with both full and subsyndromal PTSD were aggregated.”2 However, because there were 439 patients, of whom 236 had nonprobable PTSD, we calculated an incidence of 6.2% for full PTSD (27 of 439 patients) and an incidence of 3.87% for subsyndromal PTSD (17 of 439). The study's Discussion section states that “approximately 1 in 5 patients (21.7%) with cancer at the 6-month follow-up had PTSD”2; this is significantly higher than prevalence estimates. However, we do not believe that this is correct. This 1-in-5 figure was derived only from the patients who had an elevated Hospital and Anxiety Depression Scale score. With the whole population, the value drops to 6.1% (or 10% if subsyndromal PTSD is included). We are concerned that this idea of 1 in 5 patients with cancer having PTSD is misleading and has been published within mainstream media across the world, including BBC News, the Huffington Post,3 and Times Now,4 and it has the potential to cause alarm in cancer sufferers and their relatives. We look forward to receiving a response from the authors. No specific funding was disclosed. The authors made no disclosures. Charlotte Turner, BMedSci, BMBS Psychiatry Southway Clinic Plymouth, United Kingdom Jason Hancock, MbChB (Hons), MRCPsych, MSc Psychiatry Southway Clinic Plymouth, United Kingdom University of Exeter Medical School Exeter, United Kingdom