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Table of Contents Introduction
Overview
Diagnosis and Symptoms
Risk Factors, Protective Factors, and the Development of PTSD
Assessment
Treatment
Get More Information From NCI
Changes to This Summary (07/16/2007)
Questions or Comments About This Summary
About PDQ
Introduction
This patient summary on posttraumatic stress disorder is adapted from the
summary written for health professionals by cancer experts. This and other
credible information about cancer treatment, screening, prevention, supportive
care, and ongoing clinical trials, is available from the National Cancer
Institute. Better treatment of many cancers has resulted in more patients
experiencing longer periods of disease-free survival. This has also led to
more patients experiencing psychological problems, which are collectively
called posttraumatic stress disorder. This brief summary describes
posttraumatic stress disorder, its symptoms, and its treatment.
Back to Top Overview
Some survivors of cancer experience trauma-related symptoms similar to symptoms experienced by people who have survived
highly stressful situations, such as military combat, natural disasters, violent personal attack (such as rape), or other
life-threatening events. This group of symptoms is called posttraumatic
stress disorder (PTSD) and includes avoiding situations related to the trauma, continuously thinking of the trauma, and being overexcited.
People with histories of cancer are considered to be at risk for PTSD. The
physical and mental shock of having a life-threatening disease, of receiving
treatment for cancer, and living with repeated threats to one's body and life
are traumatic experiences for many cancer patients.
Back to Top Diagnosis and Symptoms
Posttraumatic stress disorder (PTSD) is defined as the development of certain symptoms following a mentally
stressful event that involved actual death or the threat of death, serious
injury, or a threat to oneself or others. For the person who has experienced a diagnosis of cancer, the specific trauma that triggers PTSD is unclear. It may be the actual diagnosis of a life-threatening illness, aspects of the treatment process, test results, information given about recurrence, or some other aspect of the cancer experience. Learning that one's child has cancer is traumatic for many parents. Because the cancer
experience involves so many upsetting events, it is much more difficult to
single out one event as a cause of stress than it is for other traumas, such as
natural disasters or rape. The traumatic event may cause responses of extreme fear,
helplessness, or horror and may trigger PTSD symptoms.
PTSD in cancer survivors may be expressed in these specific behaviors:
- Reliving the cancer experience in nightmares or flashbacks and by continuously thinking about it.
- Avoiding places, events, and people connected to the cancer experience.
- Being continuously overexcited, fearful, irritable, and unable to sleep.
To be diagnosed as PTSD, these symptoms must last for at least one month and cause significant problems in the patient's personal relationships, employment, or other important areas of daily life. Patients who have these symptoms for less than one month often develop PTSD later.
Back to Top Risk Factors, Protective Factors, and the Development of PTSD
As many as one third of people who experience an extremely upsetting event, including cancer, develop posttraumatic stress disorder (PTSD). The event alone does not explain why some people get PTSD and others don't. Although there is no clear answer as to which cancer survivors are at increased risk of developing PTSD, certain mental, physical, or social factors may make some people more likely to experience it.
Individual and social factors
Individual and social factors that have been associated with a higher incidence of PTSD include younger age, fewer years of formal education, and lower income.
Disease-related factors
Certain disease-related factors are associated with PTSD:
- In patients who received a bone marrow transplant, PTSD occurs more often when there is advanced disease and a longer hospital stay.
- In adult survivors of bone cancer and Hodgkin lymphoma, people for whom more time has passed since diagnosis and treatment tended to show fewer symptoms.
- In survivors of childhood cancer, symptoms of PTSD occur more often when there was a longer treatment time.
- Interfering thoughts occur more often in patients who experienced pain and other physical symptoms.
- Cancer that has returned has been shown to increase stress symptoms in patients.
Mental factors
Mental factors may affect the development of PTSD in some patients:
- Previous trauma.
- Previous psychological problems.
- High level of general stress.
- Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.
- The amount of social support available.
- Threat to life and body.
- Having PTSD before being diagnosed with cancer.
- The use of avoidance to cope with stress.
Protective factors
Certain factors may decrease a person's chance of developing PTSD. These include increased social support, accurate information about the stage of the cancer, and a satisfactory relationship with the medical staff.
How PTSD may develop
PTSD symptoms develop by both conditioning and learning. Conditioning explains the fear responses caused by certain triggers that were first associated with the upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended. Once established, PTSD symptoms are continued through learning. The patient learns that avoiding the triggers prevents unpleasant feelings and thoughts, so coping by avoidance continues.
Although conditioning and learning are part of the process, many factors may explain why one person develops PTSD and another does not.
Back to Top Assessment
It is important that cancer patients undergo a careful assessment for posttraumatic stress disorder (PTSD) so that early symptoms may be identified and treated. The timing of this assessment will vary with the individual patient. Cancer is an experience of repeated traumas and
undetermined length. The patient may experience stress symptoms anytime from diagnosis through completion of treatment and cancer recurrence. In patients
who have a history of victimization (such as Holocaust survivors) and who have
PTSD or its symptoms from these experiences, symptoms can be started again by
certain triggers experienced during their cancer treatment (for example, clinical procedures such as being inside MRI or CT scanners). While these
patients may have problems adjusting to cancer and cancer treatment, their PTSD
symptoms may vary, depending on other factors. The symptoms may become more or
less prevalent during and after the cancer treatment.
Symptoms of PTSD usually begin within the first 3 months after the trauma, but
sometimes they do not appear for months or even years afterwards. Therefore,
cancer survivors and their families should be involved in long-term monitoring.
Some people who have experienced an upsetting event may show early symptoms
without meeting the full diagnosis of PTSD. However, these early symptoms
predict that PTSD may develop later. Early symptoms also indicate the need for
repeated and long-term follow-up of cancer survivors and their families.
Diagnosing PTSD can be difficult since many of the symptoms are similar to
other psychiatric problems. For example, irritability, poor concentration,
increased defensiveness, excessive fear, and disturbed sleep are symptoms of
both PTSD and anxiety disorder. Other symptoms are common to PTSD, phobias,
and panic disorder. Some symptoms, such as loss of interest, a sense of having
no future, avoidance of other people, and sleep problems may indicate the
patient has PTSD or depression. Even without PTSD or other problems, normal
reactions to the cancer diagnosis and treatment of a life-threatening disease
can include interfering thoughts, separating from people and the world, sleep
problems, and over-excitability.
Questionnaires and interviews are used by health care providers to assess if
the patient has symptoms of stress and to determine the diagnosis.
Other problems may also exist in addition to PTSD. These problems can include
substance abuse, emotional problems, and other anxiety disorders, including
major depression, alcohol dependence, drug dependence, social fears, and/or
obsessive-compulsive disorder.
Back to Top Treatment
Effects of posttraumatic stress disorder (PTSD) are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may interfere with personal relationships, education, and employment. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment. It is important that cancer survivors receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD. Therapies used to treat PTSD are those used for other
trauma victims. Treatment may involve more than one type of therapy.
The crisis intervention method tries to lessen the symptoms and return the patient
to a normal level of functioning. The therapist focuses on solving
problems, teaching coping skills, and providing a supportive setting for the
patient.
Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods
include helping the patient understand symptoms, teaching coping and stress
management skills (such as relaxation training), teaching the patient to reword upsetting thoughts, and
helping the patient become less sensitive to upsetting triggers. Behavior therapy is
used when the symptoms are avoidance of sexual activity and intimate
situations.
Support groups may also help people who experience posttraumatic stress
symptoms. In the group setting, patients can receive emotional support, meet
others with similar experiences and symptoms, and learn coping and management
skills.
For patients with severe symptoms, medications may be used. These include antidepressants, antianxiety medications, and when necessary, antipsychotic
medications.
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (07/16/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Back to Top Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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