Child's PTSD risk not increased by cancer diagnosis

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Despite being diagnosed with life-threatening illnesses, childhood cancer patients are no more likely than their healthy peers to develop post-traumatic stress disorder (PTSD).

According to the a study from carried out at St. Jude Children's Research Hospital in Memphis, Tennessee, young cancer patients were also more likely than children who experience other stressful events to report having benefited from the experience. Reported benefits included developing greater empathy and growing closer to family and friends. The research appears in the Journal of Clinical Oncology (2014; doi:10.1200/JCO.2013.49.8212).

The study included 255 St. Jude patients who were between ages 8 to and 17 years when their cancer was diagnosed. Based on self-reported patient symptoms, researchers concluded that 2.8%, or seven7 patients (2.8%), met the criteria for a diagnosis of PTSD either when the study was conducted or in the prior to the study timeframeast. The PTSD was cancer-related in two 2 patients. In the other five 5 patients, the anxiety disorder was linked to a drive-by shooting, Hurricane Katrina, or other stressful events.

This incidence of PTSD was comparable to with rates reported in community samples of children without cancer and a similar group of 101 healthy peers recruited for the study. The prevalence, however, contrasts sharply with previous reports from other investigators who identified cancer-related PTSD as a widespread problem. Those estimates suggested that 20% to 35% of childhood cancer patients would develop PTSD.

"These results should be very reassuring to childhood cancer patients and their families," said the study's first and correspondinglead author Sean Phipps, PhD, chair of the Department of Psychology at St. Jude Department of Psychology chair. "A cancer diagnosis is a highly significant and challenging event, but this study highlights the impressive capacity of children to adjust to changes in their lives and in most cases do just fine or even thrive emotionally as a result."

For this study, researchers used three established methods to screen pediatric cancer patients and their healthy peers for PTSD. Those included a symptom check list and a structured diagnostic interview about the event that each child identified as the most traumatic. Parents were also interviewed about PTSD symptoms in themselves and their children. The study is part of a long-term project to track adjustment and predictors of adjustment in pediatric cancer patients.

Unlike many previous studies of PTSD in cancer patients, researchers initially refrained from asking patients specifically about their diagnosis. Investigators wanted to avoid suggesting to patients that their cancer diagnoses were traumatic, Dr. Phipps explained. "We know such suggestions, called ‘focusing illusions', prime individuals to think about their cancer experience as traumatic, and leaves them prone to exaggerating its impact in subjective reports," he said.

More than half of the patients identified their cancer as the most stressful event they had experienced. Of those who were long-term survivors, however, less than 25% cited cancer as their most traumatic experience. The study included patients whose cancer had been diagnosed between 1 month and more than 5 years earlier.

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