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. 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, Dr Caryn Mei Hsien Chan, 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 centre. 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 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."
Chan also stressed that many patients live in fear that their cancer may come back, and they may think the 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 centre studied, there is a dedicated program that provides support and counselling, 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 Chan.
Abstract
Background: Scant evidence exists on the long-term course of cancer-related post-traumatic stress disorder (PTSD). This is among the few studies worldwide, and the first in the South-East Asian region, to prospectively evaluate PTSD in patients with cancer using gold-standard clinical interviews. The objective of the study was to assess the course and predictors of PTSD in adult patients with cancer in a South-East Asian population.
Methods: A prospective, longitudinal study was conducted in a cohort of 469 consecutively recruited patients (aged ≥18 years) with various cancer types within 1 month of diagnosis at a single oncology referral center. Only patients who had significant psychological distress (Hospital Anxiety and Depression Scale total cutoff score ≥16) underwent the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (SCID) at at 6-months follow-up. All patients completed the SCID at the 4-year follow-up assessment regardless of their initial Hospital Anxiety and Depression Scale score.
Results: In an analysis combining patients who had both full and subsyndromal PTSD, there was a 21.7% incidence of PTSD at the 6-month follow-up assessment (n = 44 of 203 SCID-interviewed patients), with rates dropping to 6.1% at the 4-year follow-up assessment (n = 15 of 245 SCID-interviewed patients). Patients with breast cancer (compared with those who had other types of cancer) were 3.68 times less likely to develop PTSD at 6-months, but not at 4-years follow-up.
Conclusions: The overall rates of PTSD decreased with time, but one-third of patients (34.1%) who were initially diagnosed had persistent or worsening PTSD 4 years later. There is a need for early identification of this subset of patients who have cancer with PTSD to design risk-targeted interventions.
Authors
Caryn Mei Hsien Chan, Chong Guan Ng, Nur Aishah Taib, Lei Hum Wee, Edward Krupat, Fremonta Meyer
[link url="https://www.sciencedaily.com/releases/2017/11/171120085442.htm"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1002/cncr.30980/abstract"]Cancer abstract[/link]