A Systematic Literature Review Exploring the Prevalence of Post-traumatic Stress Disorder and the Role Played by Stress and Traumatic Stress in Breast Cancer Diagnosis and Trajectory
Breast Cancer: Targets and Therapy
Abstract: Stress has been extensively studied as a psychosomatic factor associated with breast cancer. This study aims to review the prevalence of post-traumatic stress disorder (PTSD), its associated risk factors, the role of predicting factors for its early diagnosis/prevention, the implications for co-treatment, and the potential links by which stress could impact cancer risk, by closely examining the literature on breast cancer survivors. The authors systematically reviewed studies published from 2002 to 2016 pertaining to PTSD, breast cancer and PTSD, and breast cancer and stress. The prevalence of PTSD varies between 0% and 32.3% mainly as regards the disease phase, the stage of disease, and the instruments adopted to detect prevalence. Higher percentages were observed when the Clinician Administered PTSD Scale was administered. In regard to PTSD-associated risk factors, no consensus has been reached to date; younger age, geographic provenance with higher prevalence in the Middle East, and the presence of previous cancer diagnosis in the family or relational background emerged as the only variables that were unanimously found to be associated with higher PTSD prevalence. Type C personality can be considered a risk factor, together with low social support. In light of the impact of PTSD on cognitive, social, work-related, and physical functioning, co-treatment of cancer and PTSD is warranted and a multidisciplinary perspective including specific training for health care professionals in communication and relational issues with PTSD patients is mandatory. However, even though a significant correlation was found between stressful life events and breast cancer incidence, an unequivocal implication of distress in breast cancer is hard to demonstrate. For the future, overcoming the methodological heterogeneity represents one main focus. Efficacy studies could help when evaluating the effect of co-treating breast cancer and post-traumatic stress symptoms, even if all the criteria for a Diagnostic and Statistical Manual of Mental Disorders diagnosis are not fulfilled.
Keywords: PTSD, post-traumatic stress disorder, breast cancer, disease management
When women affected by breast cancer are asked to recall the very moment of their diagnosis and cancer experience, a series of symptoms may appear including hyperarousal, emotional numbness, the sensation of the situation happening to a person other than self, and intrusive thinking together with nightmares and flashbacks that guide the clinician to understand how traumatic the cancer diagnosis was across the life span.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) version IV recognized that it is possible for a person to receive a diagnosis of post-traumatic stress disorder (PTSD) as a consequence of life-threatening disease.1 In the newer DSM-V, a medical disease such as cancer is considered a traumatic event only when it is sudden and “catastrophic”.2
The prevalence of PTSD diagnosis in breast cancer is higher than that in colorectal, head and neck, and prostate cancers but lower than that in brain, gynecological, and hematological cancers.3
It is important that such a psychological disorder is detected in order to implement appropriate short- and long-term health care policies and to sustain adherence and compliance in patients whose psychological symptoms cause defects in information processing, problem-solving abilities, decision-making processes, and in communication, relational, and social issues.3,4
The prevalence of PTSD symptoms varies hugely on the basis of diagnostic criteria considered, psychological instruments applied in research studies, disease phase, and stage in which the prevalence study is conducted.4,5
This paper aims to investigate the literature regarding the prevalence of PTSD in breast cancer patients considering the associated sociodemographic and comorbidity risk factors. In addition, it summarizes the potential links and proposed mechanisms by which stress impacts cancer risk, the implication for co-treatment of cancer and related PTS symptomatology, and the role played by predictive factors for early diagnosis and prevention.