The shock of a cancer diagnosis is a life-changing, frightening experience, and not surprisingly, researchers reported symptoms of post-traumatic stress disorder (PTSD) in as many as 20% of patients with cancer. The condition often lasts for a number of years in these patients. Caryn Mei Hsien Chan, PhD, and her colleagues at the National University of Malaysia, along with researchers in Boston at Harvard Medical School and Dana-Farber Cancer Institute, researched the condition.
The researchers sought to evaluate prospectively the course of PTSD in patients with cancer from diagnosis and treatment via follow-up assessments over 4 years. Their hypothesis was that signs of psychological distress at diagnosis and in the posttreatment period indicate the presence of PTSD. In addition, they thought that the PTSD would endure over the long term in some patients, possibly affecting their treatment.
All the participants were treated at one academic medical center where they were recruited within a month of receiving their cancer diagnosis. Inclusion criteria were having any type of cancer and the ability to complete the required interviews and questionnaires, understand the study’s objective, and give informed consent.
A total of 469 patients older than 18 years were included in the prospective study. The investigators used 2 techniques for their evaluations: the Hospital Anxiety and Depression Scale (HADS) and structured clinical interviews based on the DSM-IV-TR for assessing for PTSD. A cancer diagnosis was the potentially traumatic event discussed in the structured clinical interview used to evaluate for presence of PTSD. Researchers administered the assessments at baseline (4 to 6 weeks after patient’s initial diagnosis), at 6 months, at a 1-year follow-up, and at a 4-year follow-up. Participants who could not attend or complete their sessions were interviewed by telephone.
PTSD in these participants were classified as: full PTSD, subsyndromal PTSD, no PTSD, and nonprobable PTSD. Those classified as no PTSD were a group of patients who did not qualify for even a subsyndromal PTSD diagnosis. Two hundred and three patients with elevated HADS scores sat for the structured clinical interview at the 6-month follow-up. At that time, interviewers determined that 27 patients (13%) had full PTSD, 17 (8%) had subsyndromal PTSD, 159 had no PTSD, and 236 had nonprobable PTSD. When combined, incidence of full and subsyndromal PTSD was 21% at 6 months. Of 245 patients at the 4-year follow-up, 10 (4%) had full PTSD whereas 5 (2%) had subsyndromal PTSD.