Cancer as a Criterion A Traumatic Stressor for Veterans: Prevalence and Correlates

Risk factors for post-traumatic stress disorder among young and middle-aged cancer patients in the intensive care unit: A case-control study

BACKGROUND

Young and middle-aged cancer patients in intensive care unit (ICU) often suffer from stress and pressure, causing huge physical and mental damage. Currently, there is few research on post-traumatic stress disorder (PTSD) among young and middle-aged cancer patients in ICU in China, and the psychological status of patients who have experienced both cancer development and ICU stay is still unclear.

AIM

To explore the risk factors for PTSD in young and middle-aged patients with cancer in ICU.

METHODS

Using convenient sampling method, we enrolled 150 young and middle-aged patients with cancer who were admitted to the ICU of our center during the period from July to December 2020. The general data of the patients and PTSD-related indicators were collected. The Impact of Event Scale-Revised (IES-R) was used for assessing PTSD one month after the discharge from the ICU. Binary Logistic regression analysis was performed to assess the independent risk factors for PTSD in these patients.

RESULTS

Among these 150 patients, 32 (21.33%) were found to be with PTSD. Binary Logistic regression analysis revealed that factors significantly associated with PTSD among young and middle-aged patients with cancer in ICU included monthly income (OR = 0.24, P = 0.02), planned transfers (OR = 0.208, P = 0.019), and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR = 1.171, P = 0.003).

CONCLUSION

The low monthly income, unplanned transfers, and increased APACHE II score are the risk factors for PTSD in young and middle-aged patients with cancer in ICU.

Investigating PTG in Cancer Patients: The Role of Time Dimension in the Experience of Personal Growth

This study explored the experience of growth related to being a cancer patient by implementing a thematic analysis. An online questionnaire was completed by 69 patients narrating their growth experience related to cancer. Collected narratives were analyzed by running a deductive thematic analysis, starting from the five domains of the Post-Traumatic Growth Inventory (PTGI) and searching for the presence or absence of topics. Descriptive statistics and correlational analysis were performed. The five factors of the PTGI were identified in the narratives. The thematic analysis we performed defined a further theme that we labeled the “time dimension”, which saturated 37.7% of the entire sample. The presences of four sub-themes related to the “time dimension” were also found: “tracing a new temporal rhythm”, “the value of deserved time”, “facing the caducity of life” and “a view on the future”. Each sub-theme significantly correlated with the theme of the “time dimension”. This emergent theme does not correlate in our results with other domains of personal growth in cancer previously described in the scientific literature, emerging as an independent variable not significantly associated with other domains of post-traumatic growth. Our results suggest further investigation in the role of the time dimension in the practical and emotional experience of growth with regard to cancer.

Posttraumatic growth and well-being among people living with HIV: A systematic review and meta-analysis in recognition of 40 years of HIV/AIDS

OBJECTIVES

This systematic review and meta-analysis aimed to synthesize, analyze, and critically review existing studies on the relationship between posttraumatic growth (PTG) and psychological well-being (operationalized either via positive or negative well-being indicators) among people living with HIV (PLWH). We also investigated whether this association varies as a function of socio-demographic, clinical characteristics, and study publication year.

METHOD

We conducted a structured literature search on Web of Science, Scopus, MedLine, PsyARTICLES, ProQuest, and Google Scholar. The most important inclusion criteria encompassed quantitative and peer-reviewed articles published in English.

RESULTS

After selection, we accepted 27 articles for further analysis (N = 6333 participants). Eight studies used positive indicators of well-being. The other 19 studies focused on negative indicators of well-being. Meta-analysis revealed that there was a negative weak-size association between PTG and negative well-being indicators (r = - 0.18, 95% CI [- 0.23; - 0.11]) and a positive medium-size association between PTG and positive well-being measures (r = 0.35, 95% CI [0.21; 0.47]). We detected no moderators.

CONCLUSIONS

The present meta-analysis and systematic review revealed expected negative and positive associations between PTG and negative versus positive well-being indicators among PLWH. Specifically, the relationship between PTG and positive well-being indicators was more substantial than the link between PTG and negative well-being measures in these patients. Finally, observed high heterogeneity between studies and several measurement problems call for significant modification and improvement of PTG research among PLWH.

Change in 9/11-related post-traumatic stress symptoms following cancer diagnosis

OBJECTIVE

Cancer can be a life-threatening stressor that may evoke pre-existing post-traumatic stress disorder (PTSD). We assessed change in 9/11-related PTSD symptoms following cancer diagnosis in a 9/11-exposed cohort, the World Trade Center Health Registry.

METHODS

We examined enrollees who had a first-time post-9/11 invasive cancer diagnosis and at least one pre- and two post-diagnosis 9/11-related PTSD assessments from enrolment through 2015. PTSD symptoms were measured using 17-item PTSD Checklist (PCL, range 17-85). Cancer was identified from New York State Cancer Registry and categorized as localized or advanced stage. We used piecewise spline linear mixed-effects models to examine rate of change in PCL scores from pre- to post-diagnosis periods, and whether the change differed by gender or stage, with time as fixed and random effects, adjusting for baseline age, race, and education.

RESULTS

9/11-related PTSD symptoms were slightly increasing in the pre-diagnosis period, while this trend reversed in the post-diagnosis period (β: -0.38; 95% CI: -0.60, -0.15). This trend was driven by male rescue/recovery workers (RRW), among whom significant decrease in rate of change in PCL scores was observed for those with advanced stage (slope change difference [95% CI]: -1.81 [-2.73, -0.90]). No significant difference in rate of change was observed among non-RRW. Among females, PCL scores tended to decrease slightly, with no significant difference in rate of change between pre- and post-diagnosis periods.

CONCLUSIONS

We observed significant reduction in the rate of change in 9/11-related PTSD symptoms among male RRW. The underlying mechanism is unknown, necessitating future research.

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.

Exploring narratives on PTG in cancer patients in active vs remission phases of disease: what about a peritraumatic growth?

OBJECTIVE

The present study aims to explore post-traumatic growth in cancer patients comparing the active phase, when patients undergo different treatments, and the remission phase, characterised by periodic follow-ups and gradually return to lives outside the hospital world.

METHODS

69 cancer patients (36 in active phase and 33 in remission phase) completed an online survey narrating their growth experience related to cancer disease. A modelling emergent theme analysis was implemented for narratives of both group by means of T-Lab software.

RESULTS

Four themes emerged for narratives of active phase group: 'the time of illness and the time of life (saturating the 46% of words)', 'the meaning-seeking' (21%), 'to find oneself in a battle (21%)' and 'to learn by battling' (12%). Remission phase group themes concerned 'the time of life' (40%), 'the seismic experience' (31%), 'to care for the Self and for others' (15%) and 'strength from vulnerability' (14%).

CONCLUSIONS

Remission group narratives are close to PTG as defined in scientific literature, while patients in the active phase of disease narrated PTG as the attempt of including illness in their life trajectory and learning from the battle against cancer. Author suggests the definition of peritraumatic growth as a transformation process parallel to treatment phase.

Moving closer to death: understanding psychosocial distress among older veterans with advanced cancers

BACKGROUND

Early identification of psychosocial distress is important to address the needs of vulnerable populations and influence symptom management. Older veterans diagnosed with life-limiting cancers are particularly vulnerable because they often have unmet needs, experiencing psychological or emotional problems and gaps in healthcare communication, which extends suffering. Lack of emotional support, ongoing physical pain, and unresolved symptom control can further increase distress among older veterans, contributing to complexity of decision-making for end of life (EOL) care.

OBJECTIVE

We explored older veterans' experiences and identification of psychosocial distress in cancer care to better understand how they describe distress while facing the end of life.

METHODS

Guiding this study is a conceptual framework from psychosocial oncology with the multifactorial experience of distress indicated by NCCN guidelines for distress screening. We use a phenomenological approach to explore the experience of psychosocial distress among older veterans diagnosed with advanced cancers at risk for dying within a year.

INCLUSION CRITERIA

Provider response of "no" to, "Would you be surprised if your patient died within a year?" and "yes", to the question, "Have you talked with your patient about the severity of their illness as being life-limiting, terminal?"

RESULTS

Five themes emerged: (1) the meaning of distress: "It's hard to explain"; (2) severity of advanced cancer: "There's no stage five"; (3) distressing thoughts about the possibility of dying: "Either way, it's life limiting"; (4) coping: "Deal with it and hope for a better day"; and (5) personal factors: "I don't want to be anything but a man who can handle adversity." Findings suggest older veterans may have unique cancer experiences different from other populations.

CONCLUSION

Older veterans in this study exhibited distressing symptoms which demonstrate they are at risk for declining health and in need of support for their distress. Healthcare providers are urged to understand the complexity of distress to provide the best possible treatment for older veterans.

Post-Traumatic Stress Disorder Symptoms from Multiple Stressors Predict Chronic Pain in Cancer Survivors

Background: Despite the association between chronic pain and post-traumatic stress disorder (PTSD), little is known about the longitudinal course of pain and PTSD during cancer treatment. Objectives: We examined the prevalence of PTSD and chronic pain at three time periods in veterans with a diagnosis of cancer, and the relationship between the experience of pain and PTSD. Methods: Participants (N = 123) with oral-digestive cancers were recruited from the Veterans Healthcare System (age M = 65.31 and SD = 9.13; 98.4% male) and completed face to face interviews at 6, 12, and 18 months post-diagnosis. Measures included the Post-traumatic Stress Disorder Checklist-Stressor-Specific version (PCL-S), Primary care PTSD (PC-PTSD), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Impact Scale. Results: About one-third (26.8%) of the sample had chronic pain, defined as elevated pain at two time periods. About one-fifth (20.3%) endorsed symptoms of combat-related PTSD at 6 months, and 22.8% endorsed symptoms of cancer-related PTSD, exceeding a clinical cutoff for older adults (12 months = 21.1%, 18 months = 23.1%). Changes over time were observed for cancer-related PTSD symptom clusters of hyperarousal (F = 3.85 and p = 0.023) and emotional numbing (F = 4.06 and p = 0.018) with a statistically significant quadratic function increasing at 18 months. In logistic regression, individuals with both combat and cancer-related PTSD symptoms at six months had 8.49 times higher odds of experiencing chronic pain (χ² = 25.91 and p < 0.001; R² = 0.28). Conclusions: Persisting pain may be a concern in veterans with cancer. Individuals who have experienced traumatic events with persisting PTSD symptoms may be at elevated risk for chronic pain. Veterans with PTSD symptoms from both cancer and combat are at the highest risk to experience chronic pain.

Évaluation des symptômes de stress post-traumatique chez les femmes atteintes d’un cancer du sein nouvellement diagnostiqué

Introduction : Le diagnostic du cancer du sein est un événement potentiellement mortel associé à une détresse importante. La présente étude visait à évaluer la prévalence et la sévérité des symptômes de stress post-traumatique ; et à analyser l’association entre les symptômes de stress posttraumatique et la dépression, les données relatives à la maladie cancéreuse et les données sociodémographiques chez ces femmes.

Méthodes : Soixante et une femmes atteintes d’un cancer du sein nouvellement diagnostiqué ont rempli deux questionnaires : l’Impact of Event Scale révisé (IES-R) et la souséchelle DASS–Dépression des échelles de dépression, de stress et d’anxiété (DASS-21). Les femmes ont été interrogées quatre semaines après l’annonce du diagnostic. Les patientes étaient âgées de 18 à 65 ans et avaient un cancer du sein histologiquement confirmé et sans antécédents d’autres cancers.

Résultats : L’âge moyen des patientes incluses dans cette étude était de 46,5 ans. La majorité d’entre elles vivaient en milieux urbains (82 %) et avaient un niveau socioéconomique moyen (83,6 %). Trente-six pour cent des patientes atteintes d’un cancer du sein ont été diagnostiquées à un stade avancé (III et IV) et ont reçu un traitement chirurgical dans 73,8 % des cas. 57,4 % des patientes atteintes d’un cancer du sein nouvellement diagnostiqué présentaient des symptômes de stress post-traumatique supérieurs au seuil (score IER-S > 33) et 18,0 %des symptômes dépressifs (score DASS-dépression > 9). L’absence de revenu (notamment être sans profession ou étudiante) et la dépression étaient les meilleurs prédicteurs des symptômes du trouble de stress post-traumatique dans notre population.

Conclusion : L’observation de la complexité du vécu des patientes atteintes de cancer du sein renforce l’idée de la nécessité d’un accompagnement spécifique. Une évaluation précoce des besoins psychoémotionnels des patientes atteintes de cancer du sein et une intervention précoce pourraient être particulièrement utiles.

Resilience in Cancer Patients

Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events. Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer. Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress. Results: Biological, personal, and most importantly social factors contribute to cancer patients' resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed. Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care.

Post-traumatic stress disorder and cancer

Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.

Military veteran cancer survivors' preferences for a program to address lifestyle change and psychosocial wellness following treatment

This study aimed to understand military veteran cancer survivors' preferences regarding the delivery of post-treatment wellness services. Thirty-three military veteran cancer survivors were interviewed about their perceptions of three models of health service delivery (home-, primary care-, and oncology-based services). Conventional qualitative content analysis revealed strengths and weaknesses of each service delivery model's content and structure (e.g., program location, inclusion of emotional support, access to clinical experts). All service delivery programs had strengths, with clinic-based programs offering the greatest breadth of services deemed important for wellness by cancer survivors.

Breast cancer survivors suffer from persistent postmastectomy pain syndrome and posttraumatic stress disorder (ORTHUS study): a study of the palliative care working committee of the Turkish Oncology Group (TOG)

PURPOSE

Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD.

METHOD

The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist-civilian version (PCL-C) was used.

RESULTS

Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and <46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4 ± 11.1. PMPS and being married at the time of the evaluation were linked with PTSD.

CONCLUSIONS

It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.

A Patient Navigation Model for Veterans Traveling for Cancer Care

Cancer care navigation teams can address patient needs and break down barriers to care in veteran patients with cancer.

Development and Implementation of a Veterans' Cancer Survivorship Program

The integration of a cancer survivorship program and coordination of care with primary care providers in community settings is essential to address veteran cancer survivors' unique needs and to meet national guidelines.