Most people conceptualize posttraumatic stress disorder (PTSD) as a condition rooted in horror on a grand scale: war, acts of terrorism, and cataclysmic natural disasters. Historically, when patients with cancer and other life-threatening diseases were plagued by intense distress about memories about their diagnosis or treatment, their symptoms didn't count.
Disease-related traumatic symptoms were explicitly excluded from the criteria for PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association.
By 1994, when the DSM-IV was published, it recognized that trauma associated with the diagnosis and treatment of a major illness could lead to unshakable symptoms of re-experiencing, avoidance, and increased arousal that are serious enough to impair one’s functioning.
Today, the "bible" of psychiatric diagnosis is undergoing yet another revision, soon to be unveiled as DSM-V. The proposed PTSD criteria are likely to allow for the diagnosis not only in individuals who have experienced exposure to "actual or threatened" death, serious injury, or sexual violation, but also in those who have witnessed or heard about such exposure, or been connected with extreme exposure to reminders of such an event. The DSM-V will also include expanded symptom criteria for diagnosing PTSD in children, including pediatric cancer patients.
The National Cancer Institute notes that unlike some time-limited traumatic events, cancer may expose patients to "repeated traumas of undetermined length," followed by endless concern over recurrence.
A recent overview from Baylor University researchers speaks to the need to recognize and treat cancer-related PTSD, which has been reported to have a lifetime incidence of 3% to 22% among survivors.
The group’s findings, published in the Journal of Psychiatric Practice (2011:4:270-276), summarize findings from a number of studies. The authors determined that three clusters of symptoms central to a PTSD diagnosis were commonly found in studies of cancer survivors. These are:
Frequent intrusive thoughts (including flashbacks and nightmares): 16%-28%
High levels of emotional numbness and avoidance: 15%-34%
A threshold of symptoms from these clusters is required for diagnosis of PTSD, but many cancer patients may experience significant, sub-threshold reminders of the trauma of their experience.
The Oncology Report
Comprehensive reports and expert commentary
on the latest advances in cancer treatment from
the world's major oncology meetings.
Past issues, click here »
|May 8 - 10|
|Breast International Group (BIG)/ European Society for Medical Oncology (ESMO): IMPAKT Breast Cancer Conference|
|May 14 - 17|
|American Society of Pediatric Hematology Oncology (ASPHO): Annual Meeting|
|May 22 - 23|
|European Musculo-Skeletal Oncology Society (EMSOS): Annual Meeting|
|May 30 - Jun 3|
|American Society of Clinical Oncology (ASCO): Annual Meeting|
|Jun 12 - 15|
|European Hematology Association (EHA): Annual Congress|
|Jun 23 - 24|
|Worldwide Innovative Networking (WIN) Consortium: WIN 2014 Symposium|
|Jun 25 - 28|
|European Society for Medical Oncology (ESMO) Conference: 16th World Congress on Gastrointestinal Cancer|
|Jun 26 - 27|
|European Institute of Oncology (IEO): 16th Milan Breast Cancer Conference|
|Jun 26 - 28|
|Multinational Association of Supportive Care in Cancer (MASCC)/ International Society of Oral Oncology (ISOO): International Symposium on Supportive Care in Cancer|
|Jul 5 - 8|
|23rd Biennial Congress of the European Association for Cancer Research|