PTSD is something we often hear about with veterans, survivors of airplane crashes, or survivors of natural disasters. But PTSD is also seen in people with an unexpected illness, such as a new cancer diagnosis.
Psychosocial issues are common with those facing a new cancer diagnosis. I have a patient who was diagnosed more than 10 years ago with early-stage breast cancer and underwent treatment. She has no evidence of recurrence, but every time she comes into the office, she is a wreck. She believes every new pain or weird feeling is her breast cancer coming back. She has been to counselors, on antidepressants, etc., but these provocative thoughts still haunt her. We always take time to reassure her, but it just doesn't seem fair to her to still be suffering emotionally.
A recent study published in the Journal of Traumatic Stress found that more than half of people with PSTD also suffered from depression; the previous estimates were wide ranging, from 20 percent to 80 percent. The important point of this study is that both PTSD and depression need to be considered when screening or assessing patients, so that one or the other is not missed, especially in men.
The defining characteristics seen in a person experiencing PTSD are vividly remembering a traumatic event in the form of thoughts, images, and dreams with persistent internal (physiologic) or external (behavioral) avoidance of the reminders of the trauma; detachment from others; negative emotions; a sense of foreshortened future: and heightened sympathetic arousal.
Here are some interesting reported findings about PTSD in oncology patients:
Among patients who have experienced hematopoietic stem- ell transplants, 5-19 percent report PTSD symptoms.
Among early-stage breast cancer survivors, 15 percent report PTSD symptoms.
Among non-Hodgkin's lymphoma survivors, 39 percent report PTSD symptoms, and another 8 percent meet PTSD criteria.
Many oncology facilities now screen using a distress measurement tool to identify possible psychosocial issues. Using a distress measurement tool is supported and/or recommended by the Oncology Nursing Society, the National Comprehensive Cancer Network, and the American Society of Clinical Oncology. Surveying people with cancer has demonstrated that 20-40 percent of patients show a significant level of distress, such as depression, PTSD, or anxiety, at some point along the cancer trajectory.
Do you screen for, see, and treat for PTSD? Is this a regular occurrence in your cancer patient population? Do you feel is it often missed or underdiagnosed?
Gobel, B.H., Triest-Robertson, S. and Vogel, W.H. (2009). Advanced Oncology Nursing Certification Review and Resource Manual. Oncology Publishing Division of the Oncology Nursing Society, Pittsburgh, PA.
Kornblith AB, Herndon JE 2nd, Weiss RB, Zhang C, Zuckerman EL, Rosenberg S, Mertz M, Payne D, Jane Massie M, Holland JF, Wingate P, Norton L, Holland JC (2003). Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 2003; 98:679. Retrieved from UpToDate.
Preidt, R. (2013). Depression Common in Those With PTSD, Study Finds. Depressive disorder diagnosis often missed in men, researchers say. Health News.
Smith SK, Zimmerman S, Williams CS, Preisser JS, Clipp EC (2008). Post-traumatic stress outcomes in non-Hodgkin's lymphoma survivors. J Clin Oncol. 2008;26(6):934. Retrieved from UpToDate.
Taking Cancer Care to Heart Monica Key, APRN, CCRN, AOCNP, 2/12/2015 12 This month is abounding with hearts due to Valentine's Day -- and due to the American Heart Association having designated February American Heart Month. How are we, in oncology, ...