Post-Traumatic Stress Symptoms in Head and Neck Cancer Patients: The Impact of the COVID-19 Pandemic and Gene-Environment Interaction

Daniel Paixão Pequeno; Juliana Carron; Karla Cristina Gaspar; Carmen Silvia Passos Lima; Clarissa Rosalmeida de Dantas; Gustavo Jacob Lourenço

doi:10.1002/hed.28026

Post-Traumatic Stress Symptoms in Head and Neck Cancer Patients: The Impact of the COVID-19 Pandemic and Gene-Environment Interaction

Head Neck. 2024 Dec 9. doi: 10.1002/hed.28026. Online ahead of print.

Authors

Daniel Paixão Pequeno^{1

2}, Juliana Carron¹, Karla Cristina Gaspar², Carmen Silvia Passos Lima^{1

2}, Clarissa Rosalmeida de Dantas³, Gustavo Jacob Lourenço¹

Affiliations

¹ Laboratory of Cancer Genetics, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
² Department of Anesthesiology, Oncology, and Radiology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
³ Department of Psychiatry, School of Medical Sciences, University of Campinas, São Paulo, Brazil.

PMID: 39648899
DOI: 10.1002/hed.28026

Abstract

Background: This study aimed to assess the occurrence of post-traumatic stress symptoms (PTSS) in head and neck cancer (HNC) patients. The goal also was to explore potential associations between PTSS, demographic factors, psychological variables, and specific genetic variants.

Methods: This study included a total of 155 HNC patients, divided into pre-pandemic (n = 76) and COVID-19 pandemic (n = 79) groups. PTSS assessments were conducted using a standardized questionnaire. The assessment of adverse childhood experiences (ACEs) involved specific questionnaire items. Genetic variants were identified via RT-PCR. Statistical analysis employed linear multivariate regression, while mediation analysis examined gene-environment interactions.

Results: In the pre-pandemic, higher PTSS scores were found to be associated with younger age (p = 0.02) and a history of cumulative ACEs (p = 0.001). Mediation analysis revealed that ACEs had a direct impact on PTSS scores, with the FKBP5 CC genotype (rs1360780, C>T) mediating this association by 29%. In the pandemic, elevated PTSS scores were correlated with a history of depression (p = 0.001), the negative impact of the pandemic (p = 0.007), and undergoing palliative treatment (p = 0.02).

Conclusions: Our findings provide insights into the psychosocial and genetic factors contributing to PTSS in HNC patients, considering the additional stressors introduced by the COVID-19 pandemic.

Keywords: COVID‐19 pandemic; adverse childhood experience; gene–environment interaction; head and neck cancer; post‐traumatic symptom.