Treatment of PTSS/PTSD

Evidence-based treatments for PTSD include psychotherapeutic approaches such as cognitive behavior therapy (CBT), as well as pharmacotherapy.74 In adults, the treatment literature indicates that effective PTSD interventions involve short-term and cognitive behavioral models.75,76


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Despite a growing literature base supporting the efficacy of these treatments for PTSD in noncancer populations, a limited number of studies have investigated treatment of PTSS in adolescent survivors of childhood cancer.

Stemming from a model that conceptualizes the diagnosis of childhood cancer as a potentially traumatic event, Kazak et al77 developed the Surviving Cancer Competently Intervention Program (SCCIP) for adolescent survivors of childhood cancer and their families. SCCIP, a 1-day, four-session, manualized intervention, uses CBT and family therapy principles to reduce distress symptoms in survivors.

The first two sessions are held separately for survivors, mothers, fathers, and siblings. These sessions provide family members with the opportunity to discuss cancer-related traumatic events, and they utilize cognitive behavioral principles to teach individual coping skills.

The third session utilizes multiple family discussion groups to apply information from the first two sessions to the family context. A final session focuses on the application and translation of techniques to the home. Results from a randomized clinical trial of 150 adolescent survivors, their mothers, fathers, and adolescent siblings indicated significant reductions in intrusive thoughts among fathers and arousal symptoms among survivors.78

More recently, a pilot study of an Internet-based CBT intervention, Onco-STEP,79 resulted in a significant reduction in PTSS and anxiety symptoms among 20 young adult survivors of childhood cancer. The online modules that comprise Onco-STEP utilize an expressive writing technique.

A primary aim of this intervention involves reprocessing the traumatic cancer-related event (by writing about the experience), followed by developing coping strategies designed to combat cancer-related fears. Despite the potential promise of these two intervention programs, few empirically supported treatments designed to meet the unique needs of AYA survivors are available.

The concept of posttraumatic growth (PTG) provides an alternate framework for understanding responses to stress that might further inform intervention approaches. PTG, defined as the positive changes or influences resulting from a struggle with a traumatic event, has been reported in some cancer survivors who experience personal growth following the cancer experience.80,81

The nature of the relationship between PTG and PTSS has been questioned; one study using a large cohort study suggested a weak but positive relationship between the two constructs.82

Further examination of resilience, personal growth, and/or positive change in AYA cancer survivors is critical to understanding the scope of potential trauma responses and how interventions may promote positive outcomes. 

CONCLUSION

In sum, AYA cancer survivors appear to be at risk of developing symptoms of posttraumatic stress; however, our ability to quantify the magnitude of this risk is limited by a number of methodological issues present in the current literature.

Specifically, prevalence estimates of PTSS/PTSD differ by the assessment measures utilized, the timing of assessment relative to diagnosis, the definition of the outcome, and identification of the precipitating traumatic event.

Despite methodological inconsistencies across studies, several static and dynamic risk factors of PTSS have been identified. Empirically supported interventions targeting potentially modifiable risk factors are limited, though CBT approaches have garnered the most support for the treatment of PTSS in AYA survivors of pediatric cancer. 

Future research is needed to further evaluate existing and forthcoming treatment programs, as well as the applicability of DSM-5 PTSD symptom criteria, to AYA cancer survivors.

DISCLOSURE

The authors report no conflicts of interest in this work.