A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder.

Abstract

Objective: Systematic reviews highlight a broad range of cancer-related post-traumatic stress disorder (CR-PTSD) prevalence estimates in cancer survivors. This meta-analysis was conducted to provide a prevalence estimate of significant CR-PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors. Methods: A systematic literature search was conducted for studies using samples of cancer survivors by using validated clinical interviews and questionnaires to assess the prevalence of CR-PTSD (k = 25, n = 4189). Prevalence estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects meta-regression and categorical analyses were used to investigate study-level moderator effects. Results: Studies using the PTSD Checklist-Civilian Version yielded lower event rates using cutoff [7.3%, 95% confidence intervals (CI) = 4.5-11.7, k = 10] than symptom cluster (11.2%, 95% CI = 8.7-14.4, k = 9). Studies using the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition (SCID), yielded low rates for lifetime (15.3%, 95% CI = 9.1-25, k = 5) and current CR-PTSD (5.1%, 95% CI = 2.8-8.9, k = 9). Between-study heterogeneity was substantial (I 2 = 54-87%). Studies with advanced-stage samples yielded significantly higher rates with PTSD Checklist-Civilian Version cluster scoring (p = 0.05), and when assessing current CR-PTSD on the SCID (p = 0.05). The effect of mean age on current PTSD prevalence met significance on the SCID (p = 0.05). SCID lifetime prevalence rates decreased with time post-treatment (R 2 = 0.56, p < 0.05). Discussion: The cancer experience is sufficiently traumatic to induce PTSD in a minority of cancer survivors. Post-hoc analyses suggest that those who are younger, are diagnosed with more advanced disease and recently completed treatment may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors.

Perceived diagnostic delay and cancer-related distress: a cross-sectional study of patients with colorectal cancer

“…While symptoms of full‐PTSD are typically less frequent than those of depression and anxiety, they are found in a significant minority of cancer survivors (e.g. ), with much higher rates of sub‐threshold symptoms (e.g. 33% ).…”

“…33% ). Consequently, there have been specific calls for more research into factors that can increase vulnerability to cancer‐related distress . Symptoms of trauma comprise avoidance, intrusive thoughts and hyper‐arousal and reflect subjective distress in relation to a traumatic event.…”

“…There are a number of ways in which perceived delay could affect the patient. Patients may be concerned that any delay in diagnosis has resulted in more advanced disease and necessitated more toxic or invasive treatments, both of which are associated with higher distress . In addition, the belief that there has been a delay in diagnosis could also increase fears of cancer recurrence and raise concerns that the cancer and its treatment have had an unnecessarily adverse effect on the individual's quality of life.…”

Course and predictors of post‐traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4‐year follow‐up study

“…Such similar-to-population levels of PTSD prevalence can mask the reality that patients remain at risk of PTSD 6 months or even 4 years after their cancer diagnosis. 32,36 Several limitations of our study must be acknowledged. Approximately one-third (34.1%) of patients with cancer who are initially diagnosed with full or subsyndromal PTSD at 6-months went on to develop chronic or full PTSD at 4-years follow-up.…”

Posttraumatic Stress Disorder and Cancer Risk: A Nested Case‐Control Study

“…Although we attempted to account for some of these factors, the complex integration of the impact of stress on lifestyle and the resulting risk of cancer should be explored in further studies. Additionally, PTSD is often diagnosed as a consequence of cancer rather than a precursor (Abbey, Thompson, Hickish & Heathcote, ). Therefore, we attempted to account for the potential overlap by performing a sensitivity analysis among patients with a PTSD code from at least 1 year prior to index date to avoid reverse causality between PTSD and cancer.…”