Childhood trauma in head and neck cancer patients: effects on the delay diagnosis, psychological stress, inflammatory mediators and disease prognosis

Abstract

Traumatic events in childhood may be associated with the occurrence of emotional disorders in cancer patients. Recent study from our team showed that occurrence of childhood trauma was predicted for higher alcohol consumption and advanced clinical staging in head and neck cancer (HNC) patients. However, until the moment there is no evidence that childhood trauma may affect the delay in diagnosis and the HNC progression. The goal of the present study is to evaluate the association between the occurrence of childhood trauma and its subtypes with delay in diagnosis, physiological and psychological stress levels, as well as their association with diasease prognosis in HNC patients. One hundred and fifty head and neck squamous cell carcinoma (HNSCC) patients, 80 patients with oral leukoplakia, 100 chronic smokers and alcoholics and 100 healthy volunteers will be submitted to the Childhood Trauma Questionnaire (CTQ) to assess the occurrence of childhood trauma. Blood samples from 100 HNSCC patients will used to evaluate the association of plasma levels of cortisol, ACTH and proinflammatory cytokines (TNF-apha, IL-6, and IL1-beta) with the CTQ measures. The Life Experience Survey (LES) and Perceived Stress Scale (PSS) questionnaires will be used to evaluate the psychological stress levels in HNSCC patients. A semi-structured interview will be performed to collect data about the patients' delay time to seek care after noting the first disease' sign or symptom. Logistic regression models will be used to assess whether the CTQ measures are associated with delay diagnosis, psychological stress levels, stress-related mediators and occurrence of recurrence and second primary tumor. The Kaplan-Meyer analysis will be performed to investigate whether the occurrence of childhood trauma and its subtypes are predictive for global and specific survival. We hope that the present study can help to uncover new predictive factors for psychological and neuroendocrine responses in HNC patients, as well as for disease prognosis. (AU)