Post-Traumatic Stress Disorder after Cancer

It’s normal to feel anxious, scared or depressed when diagnosed with cancer. But prolonged and severe anxiety symptoms that interfere with daily activities, work and relationships might indicate a more serious problem known as posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after an extremely frightening or life-threatening experience.

Causes > The exact triggers for PTSD in cancer survivors are unclear, but a number of areas might be the cause: the diagnosis, aspects of treatment, test results, details about recurrence, pain, hospitalization or other experiences.

Incidence in cancer patients > Studies show that the full diagnostic criteria for PTSD are seen in 3 to 4 percent of newly diagnosed, early-stage cancer patients and in up to 35 percent who have completed treatment. The incidence of those who experience some but not all of the symptoms, however, is higher, ranging from 20 percent in people with early-stage cancer to 80 percent in those with recurrent cancer.

Symptoms > PTSD, characterized by feelings of horror and intense fear, can be identified by symptoms from three clusters: re-experiencing, avoidance and hyperarousal. Symptoms of reexperiencing include reliving an event through nightmares or flashbacks and thinking about it constantly with recurrent memories. Avoidance symptoms involve avoiding places, events and people that are reminders of the traumatic event. Feeling distant, displaying less interest in usual activities or thinking future plans won’t happen are also signs of avoidance. Hyperarousal symptoms can be expressed as trouble concentrating, jumpiness or irritation as well as having outbursts of anger and difficulty sleeping.

PTSD can be addressed with a number of approaches to fit the severity and specific symptoms of each person.

PTSD can have a negative impact on survivors’ quality of life in a number of areas. Survivors might avoid hospitals or doctors, which can interfere with treatment or follow-up.

Risk Factors > Certain mental, physical or social factors might make some people more likely to develop PTSD than others.

Individual and social factors associated with a higher incidence of PTSD include younger age at diagnosis, less formal education, low income, female gender, previous trauma, higher general stress level, little or no social support, maladaptive coping, negative perceptions of treatment intensity and a family or personal history of psychiatric disorders, such as anxiety and depression.

Disease-related risk factors for PTSD include treatment time, hospital stay, advanced disease, pain and other physical symptoms, and intensive cancer care.

Management > PTSD can be addressed with a number of approaches to fit the severity and specific symptoms of each person. These might include psychotherapy (“talk therapy”), support groups, cognitive-behavioral therapy, medications or a combination of these.

Psychotherapy focuses on talking through problem-solving and coping skills in a safe and supportive environment with a mental health professional, either one-on-one or in a group setting. Cognitive-behavioral therapy helps patients change their behaviors by changing their thinking patterns, such as understanding PTSD symptoms, learning coping skills, stress management strategies and cognitive restructuring.

Two antidepressants are FDA-approved to treat PTSD: sertraline and Paxil (paroxetine), both of which might help with symptoms such as sadness, worry and anger. Other antidepressants that might be used include fluoxetine and citalopram. Antianxiety medications, such as alprazolam or clonazepam, might help control hyperarousal symptoms and anxiety, and, in certain circumstances, antipsychotic medications might also help.