Study highlights need for early identification, treatment of PTSD in cancer survivors

A recent study showed approximately one-fifth of patients with cancer experienced post-traumatic stress disorder (PTSD) several months after diagnosis, and many of these patients continued to live with PTSD years later. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings highlight the need for early identification, careful monitoring, and treatment of PTSD in cancer survivors.

Although PTSD is primarily known to develop in individuals following a traumatic event such as a serious accident or natural disaster, it can also occur in patients diagnosed with cancer. Because PTSD in cancer has not been explored thoroughly, Caryn Mei Hsien Chan, PhD, of the National University of Malaysia, and her colleagues studied 469 adults with various cancer types within one month of diagnosis at a single oncology referral center. Patients underwent additional testing after six months and again after four years.

Clinical evaluations revealed a PTSD incidence of 21.7% at 6-months follow-up, with rates dropping to 6.1% at 4-years follow-up. Although overall rates of PTSD decreased with time, roughly one-third of patients initially diagnosed with PTSD were found to have persistent or worsening symptoms four years later.

"Many cancer patients believe they need to adopt a 'warrior mentality', and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer. To these patients, seeking help for the emotional issues they face is akin to admitting weakness," said Dr. Chan. "There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval--particularly depression, anxiety, and PTSD--post-cancer."

Dr. Chan also stressed that many patients live in fear that their cancer may come back, and they may think cancer has returned with every lump or bump, pain or ache, fatigue or fever. In addition, survivors might skip visits to their oncologists or other physicians to avoid triggering memories of their past cancer experience. This can lead to delays in seeking help for new symptoms or even refusal of treatment for unrelated conditions.

The researchers' study also found that, compared with patients with other cancer types, patients with breast cancer were 3.7 times less likely to develop PTSD at six months, but not at four years. This may be because, at the referral center studied, there is a dedicated program that provides support and counseling, focusing mostly on breast cancer patients within the first year of cancer diagnosis.

"We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follows-up because psychological well-being and mental health--and by extension, quality of life--are just as important as physical health," said Dr. Chan.