Posttraumatic stress disorder among cancer patients-Findings from a large and representative interview-based study in Germany

A Systematic Review of Trajectories of Clinically Relevant Distress Amongst Adults with Cancer: Course and Predictors

To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.

New progress in an old debate? Applying the DSM-5 criteria to assess traumatic events and stressor-related disorders in cancer survivors

OBJECTIVE

The rather broad definition of medical trauma within DSM-IV has contributed to long-lasting debates on the applicability of Posttraumatic Stress Disorder (PTSD) in oncological patients and its differentiation from Adjustment Disorder (AjD) which results from non-traumatic critical life events. The DSM-5 criteria have introduced a narrower definition of medical traumatization. However, studies on updated prevalence rates in cancer patients are missing.

METHODS

Within a cross-sectional study, we assessed hematological cancer survivors using the Structured Clinical Interview for DSM-5. We investigated (i) the frequency and type of cancer-related stressors, (ii) the proportion of stressors qualifying as traumatic according to DSM-5 (i.e., an event of sudden and catastrophic character) and (iii) the prevalence of PTSD, AjD and cancer-related PTSD according to DSM-5.

RESULTS

291 patients participated (response rate: 58%). Mean age was 54 years, 60% were male. 168 patients (59%) reported cancer-related stressors, with the most frequent being cancer diagnosis disclosure (n = 58, 27%). Eight percent of reported stressors qualified as traumatic events according to DSM-5. Five (1.8%), 15 (5.3%) and 20 (7.0%) cancer survivors met DSM-5 criteria for current PTSD, lifetime PTSD and AjD, respectively. Among all PTSD cases, three were cancer-related (1.1%). In addition, seven patients (2.5%) met all symptoms for cancer-related PTSD, but not the DSM-5 criterion for medical trauma. Considering receiving the cancer diagnosis as traumatic event, which is debatable according to DSM-5, 38% of stressors qualified as traumatic and six patients (2.1%) met criteria for cancer-related PTSD.

CONCLUSIONS

DSM-5 criteria enable a clear identification of traumatic events in the context of cancer. This change may inform discussions on the appropriateness of PTSD in cancer patients and facilitates its differentiation from AjD. Larger studies need to validate our findings.

Quality of life and post-traumatic stress disorder among adult females with cancer in Palestine: a cross-sectional study

Background: Little research has been conducted on the quality of life (QoL), functional status, and traumatic symptoms related to the diagnosis and treatment of cancer in the Arab region, particularly in Palestine, where the psychological problems in patients with cancer are often neglected.Objective: The aim of the study was to assess QoL and post-traumatic stress disorder (PTSD) symptoms among adult female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem.Method: Participants were recruited from 4 April 2015 to the end of July 2015. The sample included 253 female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem. Data were collected using self-reported questionnaires, including a socio-demographic data sheet, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the post-traumatic stress disorder checklist for PTSD symptoms.Results: The current study showed poor global QoL (57.4%) and poor physical function (48.5%) for female patients with cancer. Insomnia, fatigue, and loss of appetite were the most troublesome symptoms that the participants complained about. The prevalence of PTSD symptoms was 3%. Regarding PTSD symptom severity, 2% reported severe symptoms, 23.3% reported moderate symptoms, and (68.8%) reported mild symptoms, based on a 1991 classification of PTSD symptom severity scores. Finally, Pearson's test revealed a strong, statistically significant, inverse relationship between QoL domains and PTSD.Conclusion: The study found that the overall QoL of female patients with cancer was low and strongly associated with PTSD symptoms, suggesting that early detection and treatment of these symptoms is critical.

Predictors of positive and negative post-traumatic psychological outcomes in a sample of Iranian cancer survivors

Objectives This study aimed to identify predictors of positive and negative post-traumatic psychological outcomes within a sample of Iranian cancer survivors. Methods In this cross-sectional research, 300 (167 females; age M = 53.00, SD = 27.57) cancer survivors (breast cancer, leukaemia, colorectal cancer) were recruited from oncology outpatient clinics in Iran. Participants completed measures of post-traumatic stress disorder (PTSD), post-traumatic growth (PTG), cognitive processing, attentional biases, and autobiographical memory specificity. Results Using partial least square structural equation modelling, it was found that the proposed model was capable of predicting PTSD and PTG. Negative attentional biases were significantly associated with PTSD symptoms, but were not significantly associated with PTG. In contrast, memory specificity and positive attentional biases tended to be associated with PTG, but were not significantly associated with PTSD symptoms. Second, negative cognitive processing was significantly associated with PTSD symptoms, while positive cognitive processing was significantly associated with PTG. Finally, there was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing. Conclusions Our findings support growing evidence for differential trajectories to PTG and PTSD symptoms in cancer. Such cognitive factors may be important therapeutic targets in psycho-oncology interventions. Statement of contribution What is already known on this subject? The diagnosis of cancer and its subsequent treatment can result in symptoms of post-traumatic stress disorder (PTSD). Positive changes and psychosocial growth (post-traumatic growth; PTG) are also common as a result of patients' experience of cancer. What does this study add? This study identified predictors of positive (PTG) and negative trauma (PTSD) outcomes within a sample of Iranian cancer survivors (N = 300). General habitual cognitive tendencies (memory specificity, attentional biases) were associated with cognitive processing, which in turn contributed to psycho-traumatic adaption. There was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing.

Trauma- and stressor-related disorders among hematological cancer patients with and without stem cell transplantation: protocol of an interview-based study according to updated diagnostic criteria

Background

Trauma- and stressor-related disorders pose an important threat for patients with medical conditions by negatively affecting the outcomes of the underlying somatic disease. Nevertheless, research on distress in the course of hematological cancer is sparse to date. For this patient group, however, treatment is often more toxic and invasive than for other cancer populations. A subgroup of these patients is treated with stem cell transplantation (SCT) which is associated with many stressors including spatial isolation or fear of life-threatening complications. Existing results are inconsistent and primarily based on self-report questionnaires and small samples. Moreover, diagnostic criteria of trauma- and stressor-related disorders have recently been updated.

Methods

This German cross-sectional study will recruit at total of 600 hematological cancer patients, of which 300 will have undergone either autologous or allogeneic SCT. Participants will be assessed for trauma- and stressor-related disorders (adjustment disorder and posttraumatic stress disorder) using a structured clinical interview (SCID-5) based on updated diagnostic criteria. Qualitative investigation of the reported stressors will be used for differential diagnostic investigations and to examine which stressors are experienced as most distressing. Additionally, severity of distress (i.e., general distress as well as anxious, depressive and stressor-related symptomatology) will be assessed by validated questionnaires. We will (i) provide the prevalence of trauma- and stressor-related disorders, (ii) investigate medical and sociodemographic risk factors and (iii) compare the levels of distress within the patient group (SCT vs. non-SCT) and between patients and age- and gender-matched reference groups from the German general population.

Discussion

This study will assess the prevalence of stressor-related disorders and the level of distress among hematological cancer patients across different treatment settings. Identification of medical and sociodemographic risk factors will help to closely monitor patients with a high risk of distress and to deliver psycho-oncological treatment as soon as possible. Comparisons between patients and norm values will be used to identify the need for psycho-oncological treatment in subgroups of hematological patients and thus help to further develop and implement tailored psycho-oncological interventions.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-6047-9) contains supplementary material, which is available to authorized users.