Many cancer survivors struggle with PTSD symptoms

A cancer diagnosis can leave lasting psychological scars akin to those inflicted by war, according to a new survey.

More than decade after being told they had the disease, nearly 40% of cancer survivors said they were still plagued by symptoms of post-traumatic stress disorder (PTSD).

10% also said they avoided thinking about their cancer and 5% said they steered clear of situations or activities that reminded them of the disease.

That could amount to a medical problem, in addition to the psychological toll, said lead researcher Dr Sophia Smith from the Duke Cancer Institute in Durham, North Carolina.

"You worry if the patient is avoiding medical care, you worry they might not be getting follow-ups," she said. "We don't have data to support that, but we worry about it."

Non-Hodgkin's lymphoma

The survey is based on 566 patients with non-Hodgkin's lymphoma. Dr Smith's team had surveyed these patients for PTSD symptoms once before, estimating that about 8% had full-blown PTSD, involving avoidance, arousal and flashbacks.

Many more had one or more PTSD symptoms, however. And the new survey, published  in the Journal of Clinical Oncology, shows the symptoms often persist.

Overall, half of the patients had no PTSD symptoms 13 years after their diagnosis. The problems had disappeared in 12%, but had remained or worsened in 37%.

"This study found that people seemed to have worse PTSD later on," said Dr Bonnie L. Green, a trauma expert who pioneered the study of PTSD in breast cancer survivors but was not linked to the new work.

"It's just very stressful for people to be told that they have cancer," Dr Green, of Georgetown University in Washington, D.C., said. "You can't just assume that they feel bad now, but that it will go away."

She stressed that it's only a minority of patients who develop full-blown PTSD, but added that depression is common after a cancer diagnosis.

Low-income people vulnerable

The new survey shows that low-income people are particularly vulnerable to the psychological impact of living with cancer. "I am particularly concerned about the patients who are poor or have fewer resources," said Dr Smith.

She said doctors need to be better at recognising distress in patients and improving patients' experience when they get the diagnosis.

"Each time they come in you are asking not only if they're having pain, but also if they are having stress," Dr Smith said. "There are wonderful therapies out there."

Those treatments include trauma counselling and talk therapy, which have been proved effective in several studies. Dr Smith recommended the website for people interested in more information about PTSD.

(Reuters Health, Frederik Joelving, October 2011)

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