Post-traumatic stress disorder and cancer

Abstract

Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.

Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial

“…Studies have shown that the anxiety experienced during a traumatic event can play a critical role in the risk of developing PTSD in the future. 39,40 Because the palliative care intervention improved anxiety symptoms during hospitalization, the intervention may mitigate the trauma and thereby lead to fewer PTSD symptoms in the future. However, patient symptom burden and anxiety during hospitalization only accounted for 30% to 45% of the effect of the intervention on post-transplant outcomes.…”

Posttraumatic stress disorder among cancer patients—Findings from a large and representative interview‐based study in Germany

“…In DSM‐5, AD is even explicitly considered the major psychological response to a medical disease: Therefore, it is to expect that AD will gain diagnostic importance in characterizing stressor‐related symptomatology in oncological settings . To empirically investigate this assumption, future epidemiological studies are needed that assess both PTSD and AD …”

Course and predictors of post‐traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4‐year follow‐up study

“…[10][11][12] There are several possible explanations for this. Approximately 1 in 5 patients (21.7%) with cancer at the 6-month follow-up had PTSD.…”

“…[10][11][12] Only 6 existing studies of 100 or more patients, mainly conducted among women with breast and gynecologic cancers [12][13][14][15][16] but also among bone marrow transplantation recipients 17 (range, 102-506 patients), have reported the prevalence of PTSD using a validated diagnostic interview. [10][11][12] Only 6 existing studies of 100 or more patients, mainly conducted among women with breast and gynecologic cancers [12][13][14][15][16] but also among bone marrow transplantation recipients 17 (range, 102-506 patients), have reported the prevalence of PTSD using a validated diagnostic interview.…”