Cancer patients suffer PTSD years after diagnosis

The study, led by Sophia Smith from the Duke Cancer Institute in Durham, looked at 566 patients with non-Hodgkin’s lymphoma. These patients had been surveyed years ago by Smith and her team for signs and symptoms of PTSD and it was estimates that one in 12 suffered from full-blown symptoms of PTSD.

When comparing the numbers from the previous study to this new one, Smith reports that half of the patients had no signs of PTSD 13 years after diagnosis, the symptoms no longer remained in 12 percent, but 37 percent saw symptoms that had continued or worsened.
In this new study, Smith looked back at these same patients and discovered that nearly four out of 10 still suffered from PTSD symptoms. They symptoms include feeling emotionally numb towards friends or family members, disturbing thoughts about their cancer and treatment and anxiety.

Smith also discovered that one in 10 patients avoided thoughts of their cancer and one in 20 did everything they could to avoid situations that reminded them of cancer. As Smith points out, these facts should be disturbing to physicians. She worries that because of this many patients may be avoiding medical care and not getting the proper follow-ups needed.

Smith stresses that PTSD only affects a small minority of cancer patients and that depression is more common. However, physicians need to be aware and learn to recognize signs of PTSD in their patients. This is especially true in low-income patients as this study showed they are more vulnerable to PTSD. She advises that physicians ask not only about pain and routine cancer treatment questions, but also ask their patients about their stress levels.

Many therapies exist for PTSD, such as talk therapy and trauma counseling, and she advises cancer patients take advantage of these services.

More information: Post-Traumatic Stress Symptoms in Long-Term Non-Hodgkin's Lymphoma Survivors: Does Time Heal? Published online before print October 11, 2011, doi:10.1200/JCO.2011.37.2631

Abstract
Purpose Little is known about the trajectory of post-traumatic stress disorder (PTSD) symptoms in cancer survivors, despite the fact that such knowledge can guide treatment. Therefore, this study examined changes in PTSD symptoms among long-term survivors of non-Hodgkin's lymphoma (NHL) and identified demographic, clinical, and psychosocial predictors and correlates of PTSD symptomatology.
Patients and Methods. Surveys were mailed to 682 NHL survivors who participated in an earlier survey and now were at least 7 years postdiagnosis. Information was obtained regarding PTSD symptoms, positive and negative perceptions of the cancer experience (ie, impact of cancer), and other potential correlates of PTSD.
Results. A total of 566 individuals participated (83% response rate) with a median of 12.9 years since diagnosis; respondents were 52% female and 87% white. Although half (51%) of the respondents reported no PTSD symptoms and 12% reported a resolution of symptoms, more than one-third (37%) reported persistence or worsening of symptoms over 5 years. Survivors who reported a low income, stage ≥ 2 at diagnosis, aggressive lymphoma, having received chemotherapy, and greater impact of cancer (both positive and negative) at the initial survey had more PTSD symptoms at follow-up. In multivariable analysis, income and negative impacts of cancer were independent predictors of PTSD symptoms.
Conclusion. More than one-third of long-term NHL survivors experience persisting or worsening PTSD symptoms. Providers should be aware of enduring risk; early identification of those at prolonged risk with standardized measures and treatments that target perceptions of the cancer experience might improve long-term outcomes.

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