PTSD symptoms as a consequence of breast cancer diagnosis: clinical implications

Abstract

It is a well-established multidisciplinary practice at the European Institute of Oncology, that nurses and physicians often report their difficulties to clinical psychologists regarding adherence to hospital scheduling and procedures, when faced with women who, having been diagnosed with cancer, may be too overwhelmed to understand medical advice. We thus undertook an observational-prospective-cohort study, to investigate the prevalence and variation of PTSD symptomatology in women awaiting a mastectomy at a mean of 30 days after diagnosis and up to 2 years after discharge from hospital. The presence of any correlations between PTSD symptoms and medical and psycho-social variables was also investigated. Between March 2011 and June 2012, 150 women entered the study and were evaluated at four points in time: pre-hospital admission, admission for surgery, hospital discharge and two years later. The prevalence of distress at pre-hospital admission was 20% for intrusion symptoms, 19.1% for avoidance symptoms and 70.7% for state anxiety. Intrusion was negatively correlated with time from diagnosis independently of tumor dimensions, i.e. independently of the perceived seriousness of the illness. Even though at two-year follow up the prevalence of intrusion and avoidance is similar to that in the general population, patients with high levels of intrusion and avoidance at pre-hospital admission will maintain these levels, showing difficulties in adjusting to illness even two years later. As for psycho-social factors, the presence of a positive cancer family and relational history is associated with high levels of distress, in particular with intrusive thinking. Proper interventions aimed at the management of these issues and at their implications in clinical practice is clearly warranted.

A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory

“…These symptoms decreased over time, 16.5% had PTSD symptoms at 4-month follow-up; 12.6% at the second follow-up. Also, other studies confirmed these results 4,5,10,12…”

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

“…2 Cancer diagnosis and treatment are unique, long-term traumatic stressors, as first described by PTSD field trials for the DSM-IV. 6 There is limited knowledge about how the rates of PTSD and other psychiatric disorders among patients with cancer may differ according to nation, region, and culture. [3][4][5] PTSD is an especially pertinent issue in cancer given its association with maladaptive patterns of avoidance behavior, which may increase the likelihood of nonadherence with cancer surveillance or treatment and poorer cancer outcomes.…”

“…[3][4][5] PTSD is an especially pertinent issue in cancer given its association with maladaptive patterns of avoidance behavior, which may increase the likelihood of nonadherence with cancer surveillance or treatment and poorer cancer outcomes. 6 There is limited knowledge about how the rates of PTSD and other psychiatric disorders among patients with cancer may differ according to nation, region, and culture. [7][8][9] Findings from the BQUAL study, 7 which focused on symptoms of PTSD among oncology patients up to 6 months after their initial cancer diagnosis, suggest that Asian patients with cancer may be at greater risk of PTSD symptoms compared with patients of Caucasian descent.…”

An assessment of the mental health of mastectomized women in South India

“…Intrusion is characterized by unbidden thoughts and images, troubled dreams, strong pangs or waves of feelings, and repetitive behavior (Horowitz, Wilner, & Alvarez, 1979). Breast cancer patients diagnosed with high levels of intrusion and avoidance tend to maintain up to two years after diagnosis (Arnaboldi et al, 2014), and the frequency of intrusive thoughts seems to be positively related to psychological distress (Vickberg, Bovbjerg, DuHamel, Currie, & Redd, 2000). Post traumatic symptoms were found to persist even after recovery from cancer (Amir & Ramati, 2002).…”