The Fear Factor
The negativity and fear associated with cancer are so strong that some people seem to believe the word itself has power, referring to cancer as “the big C” or “the C word.” Cancer is certainly powerful. Survivors suffer terribly and form associations with their illness that can be unforgiving. For example, researchers have described how the sight of pink ribbons triggered PTSD in a patient with breast cancer, so she avoids going into many places that actively support the campaign.1,2 This author had one friend who vomited every time she set foot in the doorway of the cancer center where she had been treated with a brutal chemotherapy agent.
The course of canceris filled with trauma-causing moments, from diagnosis through treatment and into survival. Patients undergo diagnostic tests followed by anxious and seemingly unending periods of waiting for results that are then followed by a terrible acknowledgment. Even then, there is no let-up of anxiety. Denial is impossible as it’s time to begin a treatment plan. The patient must now find the strength to bear the additional trauma of undergoing cancer treatment, because no one can do this for her. Along the way, further trauma is experienced as the patient deals with more testing, therapeutic interventions and their side effects, possible surgery, more testing, scans, and so on. If the patient gets through all of that and comes out the other side as a survivor, she has to gird herself against trauma every time she has a follow-up appointment or scan, every time she looks in the mirror, or feels a new possible symptom, or even when she hears that someone else has died of cancer. Acceptance of cancer-related PTSD as a diagnosis acknowledges that these experiences are part of cancer and need treatment.
Who Is Vulnerable?
Oncology nursing is an ideal role for helping the patient with cancer-related PTSD. Communication between nurses and patients provides an optimal opportunity to assess, comfort, inform, and assist patients. It provides guidance that helps the nurse identify those patients at risk, especially that some risk factors for developing PTSD are easy to spot, such as young age.
Another characteristic is the tendency to have rapid, strong emotional reactions to adverse events — a hallmark of neuroticism. Someone who has a history of substance use or dependency, a mood disorder, or who has a negative affect or a stress-prone personality may be more susceptible to developing PTSD. Interestingly, the researchers suggest that people who are less assertive may be more at risk of developing cancer-related PTSD because their tendency to feel somewhat powerless may keep them from expressing their emotional concerns to their nurse or others. 2
Of course, the waiting period between diagnostic testing and receiving the results is fraught with terrible anxiety for anyone. Nurses should watch patients who become particularly angry and frustrated at that time, since such anger could be a sign of intolerable anxiety that can lead to PTSD.
Another interesting fact is that some oncology patients who have undergone surgery followed by postoperative delirium may be at increased risk of developing PTSD as much as 3 months after their surgery. Those who were afraid they would die or experience a postsurgery cognitive decline are at highest risk for developing PTSD.2
The clinical signs of PTSD for nurses to watch for include the strong negative emotions described above. Patients may avoid stressful situations or procedures so often that they become socially withdrawn. They may also have unusually strong negative reactions to clinical situations, have difficulty making treatment decisions because they are afraid of making the wrong decision, or may ruminate excessively, which can lead to depression. Patients who witnessed someone close to them endure the difficult side effects of conventional cancer treatments may choose alternative treatments for themselves.2
The Advantages of a Good Relationship
The frequency with which nurses see their patients often facilitates a close relationship. Patients feel comfortable discussing their concerns with the nurse who cares for them, and this presents an opportunity for the nurse to assess the patient psychosocially and intervene as she or he sees fit. For example, a nurse could correct patients’ negative thinking by gradually steering patients who think “I am worthless and a burden” toward more positive thoughts such as “I am lucky that I have a supportive family by my side ….”2
Other ways nurses can help their patients with PTSD include staying in touch with their patients while encouraging them to take an active role in their treatment. A valuable skill nurses can develop is focused therapeutic communication, which can help them recognize and validate their patients’ concerns and improve their ability to explain to patients and their loved ones that traumatic events may cause distress but can be lessened instead of exacerbated. Meditation and deep breathing exercises are also important practices nurses can teach their oncology patients. Of course, nurses should discuss the option of professional help with patients whose PTSD is becoming difficult to manage.