J.-L. PUJOL ET AL.
noted that over 80% of patients with lung cancer are affected by
at least three symptoms (including the most common such as
pain, dyspnea and fatigue). This explains the patient’s social
function impairment. Therapeutic weight by itself also contrib-
utes to this impairment and consequently increases the impact
in the significant other’s life, with possible changes in family
and social status. Caught between the social representations of
illness and the burden of patient support, the significant other’s
room for expression is restricted during or subsequent to the
diagnosis.
From the significant other’s point of view, the herein study
suggests that the trauma is equivalent to that affecting the pa-
tients, as long as the IES total scores and IES intrusion subscale
scores are considered. Here again, internal consistency coeffi-
cients of all items of the IES scale and subscales together with
the correlation of the IES scores and quality of life GHQ-28
scores attest the reality of the observation (Ganz et al., 1991;
Dancey et al., 1997). Therefore, this study suggests that the
diagnosis-induced trauma had as much impact (and maybe nu-
merically more) on the significant other’s experience as on the
patient’s, and that the GHQ-28 is essentially a health-related
quality of life instrument. Considering the intrusion subscale
score, the high median value in asymptomatic significant others
and the low median value in COPD patients (although suffering
from symptoms requiring daily treatment) demonstrated that
there was no link between clinical burden and a high IES.
The intrusive re-experiences are more important than the
avoidance cognitions after the specific event of lung cancer
diagnosis. We hypothesize that avoidance type behaviors are
inhibited because of the current circumstances of diagnosis and
treatment of lung cancer. Indeed, the majority of patients who
participated in this survey-study were then supported by ther-
apy, mainly with chemotherapy regimens given every three
weeks. The repetitive admissions did not allow favorable con-
ditions for avoidance cognitions. As a matter of fact, several
studies having evaluated PTSD prevalence in various malignant
diseases, suggested that avoidance behavior is difficult to de-
fine in cancer patients insofar as therapy imply a continuous
confrontation with putative stressors (Mehnert & Koch, 2007).
Intrusive re-experiences are high (some patients’ questionnaires
having indicated the 35 maximum subscale score); this could be
interpreted as an indicator of a particularly intense break at the
time of the diagnosis. This study has two main limitations: the
follow up is not sufficiently long to assess possible change
along time of the PTSD level. Comparison with other cancers
that are not linked with self-inflicted social representations
should be useful. However, the herein reported results deserve
further researches.
Psychological intervention should be considered in any pa-
tient with an IES score equal to or greater than 35 and/or a high
level of intrusive re-experiences. A similar intervention should
also be offered to significant others as they experience the same
type of PTSD.
Acknowledgements
Authors thank Mrs. Sylvia Motsch and Mrs. Odile Flohic for
technical assistance. Pr Gregory Ninot; Pr Claude Guy Bruère
Dawson for helpful discussions. Study supported by grants
from the French League against Cancer (national and Hérault
committee), from Roche Company and from Chugaï Company.
REFERENCES
Bell, K., Salmon, A., Bowers, M., Bell, J., & McCullough, L. (2010).
Smoking, stigma and tobacco “denormalization”: Further reflections
on the use of stigma as a public health tool. Social Science & Medi-
cine’s Stigma, Prejudice, Discrimination and Health, 70, 795-799.
doi:10.1016/j.socscimed.2009.09.060
Bolognini, M., Bettschart, W., Zehndergubler, M., & Rossier, L. (1989).
The validity of the french version of the GHQ-28 and psydis in a
community sample of 20 years olds in Switzerland. European Ar-
chives of Psychiatry and Neurol o g i cal Sciences, 2 3 8 , 161-168.
doi:10.1007/BF00451005
Burris, S. (2006). Stigma and the law. Lancet, 367, 529-531.
doi:10.1016/S0140-6736(06)68185-3
Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame,
and blame experienced by patients with lung cancer: Qualitative
study. British Medical Jour nal, 328, 1470.
doi:10.1136/bmj.38111.639734.7C
Dancey, J., Zee, B., & Osoba, D. (1997). Quality of life scores: An
independent prognostic variable in a general population of cancer pa-
tients receiving chemotherapy. The National Cancer Institute of Ca-
nada Clinical Trials Group. Quality of Life Research, 6, 151-158.
doi:10.1023/A:1026442201191
Ganz, P. A., Lee, J. J., & Siau, J. (1991). Quality of life assessment. An
independent prognostic variable for survival in lung cancer. Cancer,
67, 3131-3135.
doi:10.1002/1097-0142(19910615)67:12<3131::AID-CNCR2820671
232>3.0.CO;2-4
Gaugler, J. E., Given, W. C., Linder, J., Kararia, R., Tucker, G., &
Regine, W. F. (2008). Work gender and stress in family cancer care-
giving. Support Care Cancer, 16, 347-357.
doi:10.1007/s00520-007-0331-y
Goldberg, D. P., & Hillier, V. F. (1979). A scale version of the General
Health Questionnaire. Psychological Medicine, 9, 139-145.
doi:10.1017/S0033291700021644
Gralla, R. J., & Thatcher, N. (2004). Quality-of-life assessment in ad-
vanced lung cancer: Considerations for evaluation in patients receiv-
ing chemotherapy. Lung Cancer, 46, S41-S47.
doi:10.1016/S0169-5002(04)80040-0
Gralla, R. J. (2012). Coming of age for monitoring quality of life and
patient-reported outcomes. Journal of Thoracic Onc ol ogy, 7, 8-9.
doi:10.1097/JTO.0b013e31823f12a3
Haagsma, J. A., Polinder, S., Olff, M., Toet, H., Bonsel, G. J., & Van
Beeck, E. F. (2012). Postraumatic stress symptoms and health-related
quality of life: A two year follow up study of injury treated at the
mergency department. BMC Psychiatry, 12, 1.
doi:10.1186/1471-244X-12-1
Horowitz, M. J., Wilner, N. R., & Alvarez, W. (1979). Impact of event
scale: A measure of subjective stress. Psychosomatic Medicine, 41,
209-218.
Jacobsen, P. B., & Holland, J. C. (1991). The stress of cancer: Psycho-
logical responses to diagnosis and treatment. In: C. I. Cooper, & M.
Watson (Eds.), Cancer and stress: Psychological, biological and
coping studies (pp. 147-169). Chichester: Wiley.
Kaasa, S., Malt, U., Hagen, S., Wist, E., Moum, T., & Kvikstad, A.
(1993). Psychological distress in cancer patients with advanced dis-
ease. Radiotherapy & Oncology, 27, 193-197.
doi:10.1016/0167-8140(93)90073-H
Koopman, C., Classen, C., & Spiegel, D. (1994). Predictors of post-
traumatic stress symptoms among survivors of the Oakland/Berkeley,
Calif., firestorm. American Journal of Psychiatr y, 151, 888-894.
Lloyd, S., Watson, M., Waites, B., Meyer, L., Eeles, R., Ebbs, S., &
Tylee, A. (1996). Familial breast cancer: A controlled study of risk
perception, psychological morbidity and health beliefs in women at-
tending for genetic counseling. British Journal of Cancer, 74, 482-
487. doi:10.1038/bjc.1996.387
LoConte, N. K., Else-Quest, N. M., Eickhoff, J., Hyde, J., & Schiller, J.
H. (2008). Assessment of guilt and shame in patients with non-small-
cell lung cancer compared with patients with breast and prostate
cancer. Clinical Lung Cancer, 9, 171-178.
doi:10.3816/CLC.2008.n.026
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