Posttraumatic stress disorder (PTSD) in survivors of Hodgkin's lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls

Abstract

Objectives Studies of PTSD document a significant proportion of cancer survivors reporting severe posttraumatic stress (PTS) symptoms, even when they do not meet full diagnostic criteria. However, few studies have directly examined the clinical significance of these “partial-PTSD” symptoms in survivors. This study aimed to investigate the prevalence of PTSD symptoms in a cohort of long-term survivors of HL, and to explore the clinical relevance of the partial-PTSD phenomenon by assessing impairment of function secondary to sub-threshold symptomatology. Methods The Posttraumatic Diagnostic Scale (PDS), was completed by 105 HL survivors and 101 sibling controls. Survivors age at time of participation ranged from 24–71 years, age at time of diagnosis ranged from 6–61 years, and the median time since diagnosis was 16 years (range = 7 – 34). Results PTSD prevalence was not significantly higher in HL survivors (13%) compared to sibling controls (6.9%, p = .098). However, a significantly larger proportion of survivors (35.2%) met criteria for partial-PTSD compared to siblings (17.8%, p = .004). Moreover, the majority of the survivors with partial-PTSD (86.5%) reported experiencing some functional impairment related to these PTS symptoms. Conclusions A significant number of HL survivors experience PTS symptoms severe enough to result in functional impairment. These findings underscore the importance of future research detailing the psychological and functional outcomes in survivors with partial-PTSD, and of careful clinical practice that assesses for functional impairment secondary to partial-PTSD symptomatology, in male and female survivors, even years after completion of therapy.

A narrative review of the occurrence of posttraumatic stress responses in adolescent and young adult cancer survivors

“…17,35,37,38 Only nine studies included a comparison or control group. 16,17,21,28,29,31,34,36,37 Seven self-report measures, including the Adolescent Dissociative Experiences Scale-II (A-DES), 39 Posttraumatic Stress Diagnostic Scale (PDS), 40 University of California at Los Angeles Posttraumatic Stress Disorder Index (PTSDI), 41 Posttraumatic Stress Checklist-Civilian Version (PCL-C), 42 Child Posttraumatic Stress Reaction Index -Revision 2 (CPTS-RI), 43 Trauma Symptom Checklist for ChildrenAlternate version (TSCC-A), 44 Posttraumatic Stress Disorder Reaction Index (PTSD-RI), 41 and one interview (Impact of Traumatic Stressors Interview Schedule [ITSIS]) 33 were used to measure PTSS. Three of these measures (PDS, PTSD-RI, and PTSDI) were also used to indicate "likely" cases of PTSD when scores fell in the clinically significant range.…”

“…29 The majority (number [n] =14) of studies examined both PTSS and PTSD outcomes; five assessed PTSD alone 16,18,25,36,37 and four evaluated PTSS alone. 22,27,34,38 Sample sizes ranged from 23-6,542, with ten samples of less than 100, 17,19,[23][24][25][30][31][32]36 eleven samples between 100 and 350, 18,20,22,26,29,[33][34][35]37,38 and two samples exceeding 6,500. 16,28 Most studies employed a cross-sectional design, with only four studies using a longitudinal design.…”

“…[31][32][33][34][35][36][37][38] The reported ages of participating survivors ranged from 7 years 21 to 71 years. 29 With regard to the heterogeneity of diagnoses, the majority of studies examined survivors of all cancers, with seven studies excluding central nervous system malignancies, 17,19,22,25,31,34,38 and only one focusing on Hodgkin's lymphoma survivors. 29 The majority (number [n] =14) of studies examined both PTSS and PTSD outcomes; five assessed PTSD alone 16,18,25,36,37 and four evaluated PTSS alone.…”

“…29 With regard to the heterogeneity of diagnoses, the majority of studies examined survivors of all cancers, with seven studies excluding central nervous system malignancies, 17,19,22,25,31,34,38 and only one focusing on Hodgkin's lymphoma survivors. 29 The majority (number [n] =14) of studies examined both PTSS and PTSD outcomes; five assessed PTSD alone 16,18,25,36,37 and four evaluated PTSS alone. 22,27,34,38 Sample sizes ranged from 23-6,542, with ten samples of less than 100, 17,19,[23][24][25][30][31][32]36 eleven samples between 100 and 350, 18,20,22,26,29,[33][34][35]37,38 and two samples exceeding 6,500.…”

“…Of the 23 studies reviewed, five studies focused on adolescent cancer survivors, [18][19][20][21][22] ten focused on adult (18 years and older) survivors of pediatric or AYA cancers, [16][17][23][24][25][26][27][28][29][30] and eight focused on both. [31][32][33][34][35][36][37][38] The reported ages of participating survivors ranged from 7 years 21 to 71 years.…”