Roughly 1 in 5 cancer patients developed post-traumatic stress disorder within six months of their diagnosis — and a small percentage still experienced trauma-related symptoms six years later, according to new research.
Cancer patients and psychologists have long known a cancer diagnosis can lead to post-traumatic stress disorder, even when patients manage to drive their disease into remission.
A new study, published Monday in the journal Cancer, underlined the pervasiveness — and in some cases, the persistence — of that emotional trauma.
Scientists in Malaysia and Boston analyzed 245 patients over four years, and found that nearly 22 percent had developed PTSD within six months of their diagnosis. Four years later, more than 6 percent still experienced symptoms like psychological distress and cognitive problems.
Such problems can undermine a person’s recovery, because those with PTSD are less likely to show up for appointments or stay with treatment, among other things.
“This underscores the importance of building better programs for longer-term support for cancer patients, said Dr. Fremonta Meyer, a psychiatrist at the Dana-Farber Cancer Institute and co-author of the study. Otherwise, she said, “we’ll miss people who are really continuing to suffer emotionally.”
The study’s authors point out that one potentially significant limitation is that they examined only patients in Kuala Lumpur. Dr. Gary H. Lyman, co-director of the Hutchinson Institute for Cancer Outcomes Research, who was not involved with the study, said cultural differences could play a role in how patient emotionally respond to a cancer diagnosis. “But I wouldn’t be willing to dismiss this as something that may not apply to other settings, including other racial, ethnic, and social settings in the U.S.”
“I think this is a solid study, and one that’s going to get a fair amount of attention,” Lyman added.
Dr. Alan Valentine, chairman of the department of psychiatry at the University of Texas MD Anderson Cancer Center, in Houston, and who was also not involved in the study, said he was not surprised by the results.
“Do we do as well as we should in following up on anxiety and depression? Probably not,” he said. He said he would like to see the study replicated and the results compared with the number of cancer patients who are being tracked for long-term PTSD. “We’re probably missing a bunch of people.”
Lyman agreed. “We have just presumed that once the patient passes that acute phase, which may go for six months on average, that their symptoms will abate,” he said. “So we stop asking the question.”
Meyer said the research was unusual in that it analyzed a more heterogeneous patient population than other studies. “A lot of others have looked only at a few cancer types — like breast cancer, which tends to have more support services,” she said. “Ours enabled us to capture a wide variety of cancer types, including rare cancers, and those where there isn’t as much social acceptance and support.”
“In terms of the consequences of this – and how it might affect one’s cancer treatment, one of the cardinal symptoms of PTSD is avoidance,” she added. “Patients who are experiencing PTSD may actually avoid having scans, going to oncology appointments, things that might remind them of the traumatic experience they had.”
Dan Duffy, a St. Louis-based video producer, who was diagnosed with stage 3 testicular cancer in 2002, said that after what seemed to be a successful initial treatment, his oncologist had him undergo a scan that also involved a painful catheterization. When the results were inconclusive, he said the doctor asked to repeat the procedure.
Duffy said he initially refused. “One of most insidious things about cancer is when you realize treatment is working and you’re not going to die, but the treatment is so overwhelming that you don’t care if you do,” he said. “It happens to a lot of people. It happened to me.”
How much did his oncologist evaluate and treat Duffy’s emotional trauma?
“Oh, zero,” he said. “And my doc had a great bedside manner. I loved him.”