PTSD Rates Among Patients With Cancer Are Three Times Above the General Population

When a person hears post-traumatic stress disorder (PTSD), they may think of a service man or woman who was deployed in a war zone or, perhaps, someone who was in a tragic car accident.

But, does a patient with cancer ever come to mind?

The disease is both physically and emotionally taxing. Now, a new study finds that more than 1 in 5 people diagnosed with cancer suffer from PTSD. Some even experience symptoms years later.

Defined by the National Institute of Mental Health as a disorder that develops in some people who have experienced a shocking, scary or dangerous event, PTSD can be experienced by anyone and at any age.

Researchers from Malaysia and Boston recruited 469 patients, 18 years or older, who had various cancer types including breast, gastrointestinal, gynecologic, head and neck, thyroid, skin, genitourinary and some rare cancers. All were recruited within one month of diagnosis.

“One strength of our study was that we examined PTSD across a spectrum of different cancer types, compared to most other studies which have examined only specific cancer types, such as breast cancer,” said senior investigator Fremonta Meyer, M.D., of Dana-Farber Cancer Institute in Boston, in an interview with CURE.

Using the Hospital Anxiety and Depression Scale (HADS) — a 14-item scale used to determine patient levels of anxiety and depression — the researchers studied which patients had significant psychological distress (a score greater than 16). Patients are scored from zero to 21, being ranked as normal (zero to seven), borderline (eight to 10) or abnormal (11 to 21).

In this study, patients who scored greater than 16 were asked to complete the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) at six months follow-up. All patients completed the SCID at the four-year follow-up assessment, regardless of their initial HADS score.

The researchers determined that there was a 21.7 percent incidence of PTSD at the six-month follow-up assessment. At the four-year follow-up, rates dropped to 6.1 percent.

“This is three times above the non-cancer, general U.S. population average of about 6.8 percent,” said Caryn Mei Hsien Chan, Ph.D., of the National University of Malaysia in Kuala Lumpur, regarding the rate of PTSD incidence at six months after diagnosis. “Although the rates dropped to a rate similar to individuals without cancer at 6.1 percent at four years follow-up, roughly one-third of patients were found to have persistent or worsening symptoms four years later.”

In addition, the researchers found that patients with breast cancer were 3.68 times less likely to develop PTSD at six months. However, that was not the case at four years follow-up. Chan explained that, oftentimes, there are more programs dedicated to helping patients with breast cancer during recovery compared with other cancer types. But these programs tend to diminish once patients complete treatment, even though the risk of PTSD is still present.

Another interesting finding of the study relates to cognitive impairment, which the majority of patients reported a high rate of, according to Chan. They experienced difficulties with memory and concentration.

“In the past, issues with cognition among patients with cancer used to be dubbed as ‘chemobrain’ and was often attributed as a side effect of chemotherapy,” said Chan. “We are still exploring as to whether this decline in cognitive functioning among so many of our patients may, in fact, be more likely related to PTSD than to be the result of treatment with cancer therapy.”

To further explore the subject, Chan would like to study PTSD in a larger population in the United States, and extend it to include caregivers, too.

Although there are many aspects of cancer that can trigger PTSD, such as diagnosis, nature of treatment, progression or fear of recurrence, health care professionals can help by just being aware.

“Taking the time to be supportive and sort of ‘debrief’ patients who are diagnosed with cancer from the start can make an immense difference to every individual patient being diagnosed and undergoing treatment,” said Chan.

Her advice to patients and survivors: don’t think you have to deal with this on your own.

“Keeping silent on the emotions you are going through doesn’t make you stronger,” said Chan. “In fact, it takes courage to talk to an expert. Many of the symptoms of PTSD, depression or anxiety can be managed and resolved far more quickly with therapy, than waiting months or years for these symptoms to go away on their own.”