Very interested in demonstrated effectiveness of physical medicine and rehab, including neuropsychology, in the mediation of PTSD and depression, and is this age-specific or site of cancer-specific?
Dear Marilyn, there's a lot of work on psychological rehabilitation in cancer survivorship, but mostly on therapies for distress etc. The literature on this is somewhat mixed and suffers from a number of methodological issues, such as selective recruitment and dropout, indicating that while many patients may be distressed, many of these do not want or feel they need help to cope. Our own work indicates that, contrary to popular belief, most cancer patients are not distressed or depressed, and rates of depression and anxiety are little different from those seen in the general population. In people who are depressed, there is growing evidence that these people may have pre-existing vulnerabilities. There is also controversy about what constitutes PTSD in the context of cancer. Often the measures used to diagnose used tools not designed to detect PTSD or included a re-definition of what PTSD might be. David Speigel has good examples of both of these issues. His early work in the Lancet implying that group therapy increases survival of women with advanced breast cancer in fact reflected sampling bias, while a recent review in the Lancet Oncology sensible cautions about PTSD in cancer. Hope this is useful.
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