Cancer and PTSD: What You Need to Know

Did you know that cancer survivors, particularly young adults, are at risk for Posttraumatic stress disorder, or PTSD?

Most cancer survivors are not aware of their risk for developing PTSD symptoms. Many who experience these symptoms feel that they are “going crazy” and that their loved ones don’t understand what they are going through. The most important thing that survivors can do is to discuss these symptoms with their healthcare provider (e.g., physician, nurse, social worker) so that they can be referred for further assessment and treatment, if needed.

Posttraumatic stress disorder results from exposure to a traumatic or terrifying event such as military combat, physical or sexual assault, or a life-threatening illness. Symptom clusters include intrusion (e.g., nightmares, flashbacks), avoidance (e.g., medical appointments), negative changes in mood and thoughts (e.g., guilt, blame), and arousal (e.g., difficulty sleeping and concentrating).

The most common events leading to the development of PTSD symptoms include combat exposure, childhood abuse, sexual and physical assault, and motor vehicle accidents. But while most people associate PTSD with violent events, a cancer diagnosis and treatment are often perceived as traumatic events and individuals who have experienced multiple traumas are at increased risk for PTSD.

“About 1 in 3 cancer survivors meet criteria for having at least one PTSD symptom cluster.”

It can be triggered by a single experience (e.g., a diagnosis), yet the cancer experience may be prolonged such as the case with related treatment (e.g., chemotherapy, radiation). In addition, cancer survivors may experience repeated stressful events such as a recurrence of their disease and follow-up appointments with further testing (e.g., “scanxiety”).

Rates of cancer-related PTSD are about twice that of the general population (roughly, 1 in 10 cancer survivors will develop full-blown PTSD or meeting criteria for all five symptom clusters). About 1 in 3 cancer survivors meet criteria for having at least one PTSD symptom cluster (e.g., avoidance, arousal).

Young adult survivors are at increased risk of PTSD as compared to their older counterparts. Additional risk factors include lower income, prior trauma, less social support, more intense treatment, and advanced stage or recurrence of disease.

Some of the most common PTSD-related symptoms reported by cancer survivors include: nightmares related to the cancer diagnosis and/or treatment

  • Avoiding medical appointments such as follow-up visits
  • Blaming oneself for the illness or experiencing “survivor guilt”
  • Difficulty sleeping and/or concentrating.

It’s important to treat PTSD as it is also associated with other mental health conditions such as depression (including suicidal thoughts and actions), anxiety, panic disorder, and substance abuse.

Cognitive behavioral and processing therapies have the highest level of evidence of efficacy in treating PTSD, followed by prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapies. Medications such as SSRIs and SNRIs can be prescribed alone or together with non-pharmacologic therapies.

“Because of the way prolonged or multiple traumas can exacerbate PTSD, it is important that PTSD symptoms are identified and treated early.”

Because of the way prolonged or multiple traumas can exacerbate PTSD, it is important that PTSD symptoms are identified and treated early. In addition, crisis intervention techniques that are delivered by licensed social workers can be effective. There are a growing number of online and mobile apps that are available to help lessen stress such as those that deliver mindfulness and breathing and relaxation exercises.

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At Duke University, we partnered with the National Center for PTSD to develop the Cancer Distress Coach app. It provides a PTSD assessment with feedback, educational content including a list of resources, and activities such as guided imageries and relaxation techniques. In a pilot study, app usage was associated with significant reductions in PTSD symptoms after four weeks (Smith et al., 2017).

We are now studying the app in a clinical trial and cancer survivors and caregivers are eligible to download iOS and Android apps from the AppStore or GooglePlay. Participation is voluntary and greatly appreciated! Interested individuals can learn more about it here.

Here are some additional resources:

Smith SK, Kuhn E, O’Donnell J, et al. Cancer distress coach: Pilot study of a mobile app for managing posttraumatic stress. Psycho‐Oncology. 2018;27:350–353. https://doi.org/10.1002/pon.4363

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