A Guide To Cancer And PTSD

You can’t sugarcoat it: cancer is rough. The moment your doctor mentions the C-word, everything changes. Cancer creeps into every aspect of your life, changing your body, routines, plans, relationships, and even thoughts and feelings.

Shock, fear, anxiety, helplessness, and sadness are all normal responses to finding out that you have cancer. Undergoing treatment and facing the possibility of recurrence of cancer all add to the stress.

For some people, these thoughts and feelings are manageable. For others, they can develop into more serious psychological conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD).¹

What is PTSD?

You can develop PTSD in response to a traumatic event such as a violent attack or natural disaster. However, not everyone who experiences a traumatic event develops PTSD. To be diagnosed with PTSD, you need to meet the following criteria.

The traumatic event must:

• Be perceived as a threat to your physical or psychological integrity

• Cause a reaction of helplessness or horror

You must experience the following symptoms for more than a month after the traumatic event, and they must interfere with your daily functioning:

• Sensory flashbacks, intrusive memories, and nightmares

• Avoidance of reminders of the trauma

• Anxiety, irritability, hypervigilance, insomnia

• Numbing or dissociation

Many potential triggers in the cancer experience

Your cancer experience is not a single traumatic event but rather a series of stressors that may be experienced as traumatic for some individuals but not for others. Because of this, it’s possible to develop the symptoms of PTSD² at any stage during the experience and even after you have beaten cancer.

Diagnosis

The anxiety that comes with discovering a serious health issue like cancer, and the subsequent diagnostic and staging procedures, can be overwhelming. This can be exacerbated by having to process complex medical information and make potentially life-altering decisions about treatment options.

Treatment

Cancer treatment,³ which can include surgery, chemotherapy, radiation, immunotherapy, and hormonal therapy, is often complicated, painful, and prolonged.

Recurrence

Even after you’ve beaten cancer, you always have the lingering possibility of recurrence, which in itself causes emotional stress.

Could the stress caused by cancer amount to PTSD?

The simple answer to this question is yes. However, things get a little tricky when it comes to a diagnosis, as PTSD shares many symptoms with other stress-related disorders such as acute stress disorder and adjustment disorder.

The Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5), published by the American Psychiatric Association, is a guide to the classification of mental disorders. This manual is periodically updated, and the criteria for certain disorders are sometimes changed with each new edition.

In the case of cancer-related PTSD (CR-PTSD), small but significant changes¹ were made between the fourth and fifth editions of the manual. The DSM-5 states that a life-threatening or debilitating medical condition should not necessarily be considered a traumatic event (the first criterion for PTSD).

Medical incidents that do qualify as traumatic are those that are sudden, extreme, and potentially catastrophic.

So, if you have all of the symptoms of PTSD but nothing in your cancer experience can be considered a traumatic event, you would now more likely be diagnosed with adjustment disorder rather than PTSD.

Signs and symptoms of CR-PTSD

If you have cancer-related PTSD, you might:

• Persistently mentally replay your cancer diagnosis or treatment experiences

• Have flashbacks or nightmares about traumatic aspects of the treatment

• Miss follow-up appointments with your doctor

• Stop treatments before they’re finished

• Be unable to remember various aspects of your treatment or your initial diagnosis discussion

• Stop communicating with family or friends to avoid speaking about cancer

• Avoid places or situations that remind you of your cancer

• Become preoccupied with the fear that your cancer will return

Can caregivers develop PTSD?

Evidence⁴ suggests that, in some cases, the family members of people diagnosed with and treated for cancer might also develop PTSD. Studies have found that the rates of PTSD are higher in the parents of adolescent cancer survivors than in the survivors themselves.

While only a small percentage of parents meet the full criteria for PTSD, a considerable number experience clusters of post-traumatic stress symptoms.

Risk factors for CR-PTSD

Research suggests that what occurs before you’re diagnosed with cancer can significantly influence whether you’re likely to develop cancer-related PTSD.

Your risk increases if, before being diagnosed with cancer, you’ve been exposed to another traumatic event, have been diagnosed with another mental health condition, or have many personal life stressors.

Other risk factors for CR-PTSD include:

• Low socioeconomic status

• Young age at the time of diagnosis

• Limited social support

• Invasive treatments

• Diagnosis of more advanced cancer

Treatment for CR-PTSD

A broad range of therapies can be used to treat CR-PTSD. In addition to teaching you specific coping skills and providing a safe and supportive environment, your therapist might also use cognitive-behavior techniques to help you understand what you are experiencing and help you identify and challenge negative thoughts.

If you have very severe or distressing PTSD symptoms, your doctor may also prescribe medication as part of your treatment.

Medications used to treat the symptoms of PTSD include

• Tricyclic and monoamine oxidase-inhibitor antidepressants: For depressive symptoms

• Selective serotonin reuptake inhibitors (SSRIs): For hyperarousal and intrusive symptoms

• Anti-anxiety medications: To reduce overall arousal and anxiety

• Antipsychotic medications: To reduce severe intrusive flashbacks

The lowdown

A minority of cancer survivors develop cancer-related PTSD. For this reason, it’s important to pay attention to your mental health and how you’re coping with your cancer experience.

Because the diagnostic criteria for CR-PTSD are very specific, you may not be diagnosed with PTSD but might still require psychological help if you’re experiencing some symptoms of PTSD.