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Long-Term Cancer Impact and PTSD
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By Alex Cukan
UPI Health Correspondent
ALBANY, N.Y., Feb. 6 (UPI) — Only recently has cancer been considered a trauma akin to combat or a terrorist attack – causing post-traumatic stress disorder in a small percentage.
I wrote a series of stories on PTSD after the attacks of Sept. 11, 2001, and it seemed to me that a sudden life-threatening cancer diagnosis and treatment qualified for PTSD.
The American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders outlines the criteria for PTSD as:
- A traumatic event occurred in which a person witnessed or experienced actual or threatened death or serious injury, and responded with intense fear, horror or helplessness.
- Memory cues causing the person to re-experience symptoms, like their recollections of fear or helplessness, nightmares, flashbacks or other psychological distress.
- The person avoids trauma-related stimuli and feels emotionally numb.
- The person is at a heightened state and can be more irritable or experience difficulty sleeping.
In the past few years there has been more of an acceptance that cancer has a toll emotionally on both the patient and his or her family, but studies have found a range of results: Anywhere from 0 percent to 52 percent of cancer patients experience PTSD. Part of the problem is that these studies used differing research methods, often had small samples, examined cancer patients at varying times during diagnosis and treatment and found other issues that make it hard to generalize from them, according to Barbara Andersen, a professor of psychology at Ohio State University.
Andersen was co-author of a study in 2002 that found patients who are most at risk for PTSD after cancer appear to be those who suffered from mood disorders, such as depression or anxiety, before they were diagnosed with cancer. The study found that 75 percent of breast-cancer patients with PTSD had previous mood disorders.
The study results suggest that doctors should be concerned about the mental health of people with cancer, Andersen said. But there doesn't need to be a particular focus on PTSD.
"For the vast majority of patients with breast cancer, the diagnosis and treatment of their disease won't trigger PTSD," Andersen said. "Only a small subset of patients seems to be at risk, and they can be best identified by screening for mood disorders. Our results suggest screening for mood disorders will capture three-quarters of the women most at risk for PTSD."
Fox Chase Cancer Center psychologist Sharon L. Manne found 10 percent of mothers whose children undergo bone-marrow transplants suffer from PTSD six months after the procedure.
"Regardless of the advancements in this area of treatment, this is a traumatic event for any parent," said Manne. "The lengthy hospitalization, numerous treatment side effects and long-term medical risks, and ongoing fear of a cancer relapse or recurrence can lead to difficulties with emotional adjustment after the transplant."
Optimization and treatment that can be debilitating and leaving survivors with unique health needs as well as the lifelong monitoring and screening can leave a toll emotionally – whether it reaches the level of PTSD or not.
Some say once a person gets a cancer diagnosis life is never the same because the patient and his or her family have to deal with death as a real possibility, not something to be dealt with in the distant future.
But there is a plus side as well. Cancer provides a level of maturity and an ability to ignore the petty politics of one's job or the annoying habits of one's neighbor's. You learn to do the important things first and not wait until tomorrow to do the things you want to do. You become grateful for every day, and any day not in the hospital can be considered a good day.
Last month a study by the Lombardi Comprehensive Cancer Center in Washington found a significant number of young survivors of childhood cancers smoke, are physically inactive and/or don't use sunscreen. Many in the very population that should reduce cancer risk factors were ignoring medical advice.
Some in healthcare were surprised by the study findings, but I was not, because cancer can turn your world upside down and there's an emotional component that is not readily recognized by many in healthcare.
Dr. Larry Lachman, a licensed clinical psychologist at Chapman University in Monterey, Calif., is a cancer survivor who treats cancer survivors and leads cancer support groups. He was diagnosed with prostate cancer at age 39, 10 years ago.
"Before being diagnosed, I was running 5 miles five times per week; weight training three times per week; eating a semi-vegetarian diet, etc., and I still got cancer!" Lachman told UPI's Caregiving.
"When that happened, I thought, 'Well if I am going to get it anyway, and I really can't control it, I might as well enjoy my food and fun, and I added meat back and throttled back from the intense exercise -- almost like a whiplash rebelling reaction out of being angry with the grief and shock reaction of the cancer diagnosis itself.
"After a few months, my reactive pendulum -- maybe not too unlike what's going on with the adolescents in the article -- began to swing back to the middle -- regaining balance away from either extreme: reckless disregard with cancer risk behaviors on one end or a life of an austere monk with overall deprivation and no fun on the other."
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Alex Cukan is an award-winning journalist, but she always has considered caregiving her real work. UPI welcomes comments and questions about this column. E-mail: consumer@upi.com
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