Patients have a range of normal reactions when they hear they have cancer. These include:
Patients may also have feelings of shock, fear, helplessness, or horror. These feelings may lead to cancer-related post-traumatic stress (PTS), which is a lot like post-traumatic stress disorder (PTSD). PTSD is a specific group of symptoms that affect many survivors of stressful events. These events usually involve the threat of death or serious injury to oneself or others. People who have survived military combat, natural disasters, violent personal attack (such as rape), or other life-threatening stress may suffer from PTSD. The symptoms for PTS and PTSD are a lot alike, but most cancer patients are able to cope and don't develop full PTSD. The symptoms of cancer-related PTS are not as severe and don't last as long as PTSD.
Patients dealing with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during possible recurrence of the cancer. Parents of childhood cancer survivors may also have post-traumatic stress.
This summary is about cancer-related post-traumatic stress in adults, its symptoms, and its treatment.
Cancer patients may have a lower risk of post-traumatic stress if they have the following:
Post-traumatic stress symptoms develop by conditioning.
Conditioning occurs when certain triggers become linked with an upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended.
Cancer may involve stressful events that repeat or continue over time. The patient may suffer symptoms of post-traumatic stress anytime from diagnosis through completion of treatment and possible cancer recurrence, so screening may be needed more than once. Different screening methods may be used to find out if the patient is having symptoms of PTS or PTSD.
In patients who have a history of PTSD from a previous trauma, symptoms may start again by certain triggers during their cancer treatment (for example, being inside MRI or CT scanners). These patients also may have problems adjusting to cancer and cancer treatment.
Symptoms of post-traumatic stress usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years afterwards. Therefore, cancer survivors and their families need long-term monitoring.
Some people who have had an upsetting event may show early symptoms but do not have full PTSD. However, patients with these early symptoms often develop PTSD later. These patients and their family members should receive repeated screening and long-term follow-up. See the PDQ summary on Adjustment to Cancer: Anxiety and Distress for more information.
For a patient coping with cancer, the specific trauma that triggers cancer-related post-traumatic stress isn't always known. Because the cancer experience involves so many upsetting events, it is much harder to know the exact cause of stress than it is for other traumas, such as natural disasters or rape.
Triggers during the cancer experience may include the following:
It is important to know the triggers in order to get treatment.
Some of the symptoms that may be seen in post-traumatic stress and in other conditions include:
Effects of post-traumatic stress are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may affect personal relationships, education, and employment. Because avoiding places and persons linked with cancer is part of post-traumatic stress, the patient may avoid getting professional care.
It is important that cancer survivors are aware of the possible mental distress of living with cancer and the need for early treatment of post-traumatic stress. More than one kind of treatment may be used.
The crisis intervention method aims to relieve distress and help the patient return to normal activities. This method focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient.
Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Through cognitive behavioral therapy (CBT), patients may be helped to:
Support groups may also help people who have post-traumatic stress symptoms. In the group setting, patients can get emotional support, meet others with similar experiences and symptoms, and learn coping and management skills.
For patients with severe symptoms of post-traumatic stress, medicines may be used. For example:
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Cancer-Related Post-traumatic Stress. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389374]
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