PTSD common after cancer diagnosis
One-fifth of patients with cancer experienced PTSD within several months of diagnosis, according to results of a prospective study published in Cancer.
Further, one-third of these patients had persistent or worsening PTSD 4 years later.
“We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follow-ups because well-being and mental health — and by extension, quality of life — are just as important as physical health,” Caryn Mei Hsien Chan, PhD, from the department of medicine at National University of Malaysia, said in a press release.
Although depression and anxiety are known to be prevalent among patients with cancer, incidence of PTSD has not been well studied. Further, no studies have examined PTSD in patients with cancer using gold-standard clinical interviews with follow-up extending 4 years.
Therefore, Chan and colleagues sought to determine predictors of PTSD among adults in a Southeast Asian population over a 4-year period.
“We hypothesized that the presence of psychological distress at diagnosis and after treatment would predict PSD, and that PTSD would persist in the long-term for a small proportion of the sample,” the researchers wrote.
Researchers recruited 469 consecutive patients with various cancer types within 1 month of diagnosis. Patients completed the Hospital Anxiety and Depression Scale (HADS) at baseline, 4 to 6 weeks later, at 1-year follow-up assessment, and at 4-year follow-up assessment.
At 6-month follow-up, 203 of 222 patients with elevated HADS scores — or greater than 16 on a scale with a maximum total score for anxiety and depression of 42 — underwent the PTSD module from the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Researchers found 27 (13.3%) of these patients met the full criteria for PTSD, and 17 patients (8.4%) had subsyndromal PTSD for a total incidence of 21.7%. At 4-year follow-up, 10 of 245 (4.1%) interviewed patients had full PTSD and five (2%) had subsyndromal PTSD, for a 6.1% incidence.
Despite this decrease, approximately one-third of patients initially diagnosed with PTSD had persistent or worsening symptoms 4 years later. Among 27 patients diagnosed with full PTSD at 6 months, six had full PTSD at 4 years. Of the remaining patients, three had no PTSD, two had subsyndromal PTSD, one was lost to follow-up and 15 died.
Patients may think seeking help for mental health may be a sign of weakness, Chan said.
“There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval, particularly depression, anxiety and PTSD post-cancer,” Chan said.
Patients with breast cancer were 3.7 times less likely (OR = 0.27; 95% CI, 0.08-0.83) to develop PTSD at 6 months; however, researchers observed no significant predictors of PTSD at 4 years.
Because breast cancer is a common malignancy, there may be more readily available support programs for these patients, according to the researchers.
“It is possible that greater societal understanding and the wider availability of support programs tailored for breast cancer initially serve as protective factors against PTSD, but that this protective effect attenuates with distance from the original diagnosis,” the researchers wrote.
“A survivorship program that provides routine screening for PTSD, even during long-term follow-up, is recommended,” they added. – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.