Post-traumatic stress disorder (PTSD) is often associated with survivors of military combat or natural disaster, such as refugees or veterans. However, patients with a current or past cancer diagnosis, and their loved ones, are at risk for developing cancer-related PTSD (CR-PTSD).
PTSD develops over time as the brain associates certain senses with a traumatic event. Cancer diagnoses expose patients and families to a series of life-altering, traumatic experiences: initial diagnosis, treatment, and acute and long-term physical reactions such as hair loss, body image changes, pain, and fatigue. Even after remission, survivors could develop CR-PTSD from a fear of their cancer recurring.
Symptoms and Screening
CR-PTSD is an anxiety disorder than can interfere with living a normal life. Although its symptoms are usually less severe and don’t last as long as PTSD from some other causes, their general nature often causes the condition to go undiagnosed. Typical symptoms, such as sadness or emotional response, are expected following a life-altering cancer diagnosis.
The condition can manifest in patients with cancer in the form of flashbacks or nightmares, insomnia, or skipping appointments, among others.
Patients can develop CR-PTSD at any point on the cancer care continuum. Smells, sounds, or sights related to aspects of their treatment, such as chemotherapy, can trigger CR-PTSD years after treatment. However, CR-PTSD symptoms usually appear within three months of the diagnosis or traumatic experience.
Factors that increase the risk for developing CR-PTSD include women in minority groups, poverty, less formal education, and substance misuse. Additional factors include previous trauma, lack of social support, or high-stress lifestyles.
Nearly 25% of women recently diagnosed with breast cancer and nearly 20% of infants and preschool-aged children diagnosed with cancer experienced CR-PTSD. Additionally, parents of patients with pediatric cancer have higher rates of anxiety, depression, and PTSD compared to parents of healthy children.
Prevention and Management
Oncology nurses should take a comprehensive history of a patient’s mental and emotional health. Implementing relaxation exercises into treatment routines and encouraging patients to discuss their emotions or attend counseling sessions and support groups may also be helpful.
Evidence on CR-PTSD treatment is limited, so current management strategies are similar to traditional PTSD: cancer survivors and their families need long-term monitoring through in-depth follow-up and repeated mental health screening. Patients with severe CR-PTSD can take antidepressant or antianxiety medications.
ONS’s symptom management guidelines identified cognitive-behavioral approaches, mindfulness-based stress reduction, music therapy, psychoeducation, and yoga as recommended treatment strategies for cancer-related anxiety. Integrated or collaborative behavioral healthcare models is added to the same list for depression.
CancerCare provides a list of online, phone, and in-person support groups, led by oncology social workers.