Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.

Analysis of the Correlation between the Level of Posttraumatic Growth and Social Support among Caregivers of Children with Acute Leukemia

We investigate the current situation of stress burden and quality of life of primary caregivers of children with leukemia and analyze the correlation between their stress burden and quality of life, using the phenomenological research method in qualitative research. The posttraumatic growth experiences of the parents of children with leukemia included life perceptions (appreciation of life, change in priority of important things in life, and adjustment of self to reality); personal empowerment (increased sense of self-reliance and increased sense of self-achievement); and improvement of interpersonal relationships (increased family harmony, valuing parent-child bonding, benefiting from professional support from other parents and medical staff, and increased sense of empathy and altruism). The posttraumatic growth experiences of parents of children with leukemia are based on their roles (parenting) and responsibilities and can be used as an important basis for future trauma interventions, as well as an entry point for exploring the posttraumatic growth potential of parents of children with leukemia and ultimately improving the posttraumatic growth of parents of children with leukemia.

Cancer coping, healthcare professionals' support and posttraumatic growth in brain-tumor patients

The purpose of this study was to explore the influence of cancer coping and healthcare professionals' support on posttraumatic growth in patients with brain tumors. A cross-sectional, correlational design was used, in which a structured questionnaire was administered to 114 patients at a tertiary university hospital. Data were analyzed using descriptive statistics, independent t-test or one-way ANOVA, Pearson correlation, and hierarchical multiple regression analysis. Cancer coping (r = .33, p < .001) and healthcare professionals' support (r = .28, p = .002) correlated with posttraumatic growth. Among predictors, primary caregivers (brothers and sisters; β = .28), interpersonal coping (β = .26), and healthcare professionals' support (β = .20) had statistically significant influences on posttraumatic growth. The regression model explained approximately 22.0% of posttraumatic growth. These results contribute to cancer coping and healthcare professionals' support to significantly influence posttraumatic growth.

Psychosocial Impact of Cancer

Diagnosis and treatment of malignant diseases affect in many ways the lives of patients, relatives and friends. Common reactions immediately after the diagnosis are shock and denial, frequently followed by depression, anxiety and/or anger. About a third of all cancer patients suffer from a co-morbid mental health condition, requiring professional support by the entire medical team, including psycho-oncologists. Often overlooked issues are financial and social problems due to inability to work or due to out-of-pocket costs for the medical treatment.

Do cancer patients with high levels of distress benefit more than less distressed patients from outpatient art therapy?

PURPOSE

Several studies have evaluated the effectiveness of art therapy for cancer patients. Our aim was to determine the effects of outpatient art therapy on the quality of life (QoL) of highly vs. less distressed cancer patients.

METHODS

Participants completed the EORTC QLQ-C30 to measure QoL and the HADS to measure distress level before the intervention (t1), after completing the intervention (t2), and 6-months after t2 (t3). We performed analyses of covariance with repeated measures to test for group differences (highly vs. less distressed). We determined clinically relevant change scores and effect sizes in QoL domains (t1-t2; t1-t3) in patients with low vs. high levels of distress.

RESULTS

53 patient's participated at all three measuring points. Less (N = 22) vs. highly distressed patients (N = 31) differed at baseline and follow-up in their global QoL (mean t1:64.0 > 44.6; t2:65.5 > 55.6; t3:66.0 > 51.6; p = 0.01), emotional functioning (t1:65.2 > 37.4; t2:69.3 > 44.6; t3:57.8 > 48.5; p = 0.01), social functioning (t1:65.2 > 41.9; t2:77.3 > 52.7; t3:73.5 > 54.3; p = 0.01), cognitive functioning (t1:76.5 > 57.5; t2:74.4 > 62.4; t3:77.3 > 62.9; p = 0.02). There was no evidence of changes in physical functioning, role functioning, fatigue, pain, or insomnia. Interactions between distress, QoL, and time were not found. Effect sizes for clinical changes in QoL were medium regarding role functioning (Diff_t1-t3 = -14.4), fatigue (Diff_t1-t3 = -12.6) in the total group as well as in highly and less distressed patients.

CONCLUSION

No evidence of outpatient art therapy having an effect on QoL in cancer patients over time was found, in patients with either high or low levels of distress at baseline. Consequently, it remains unclear which patients benefit the most from art therapy.

Post-traumatic growth in survivors of allogeneic hematopoietic stem cell transplantation

OBJECTIVE

This study aimed to understand factors related to post-traumatic growth (PTG) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT), building baseline data for developing intervention programs to enhance PTG in HSCT survivors.

METHODS

A self-report survey was administered to 100 patients who received HSCT within the last 5 years. The Post-traumatic Growth Inventory, Impact of Event Scale-Revised, Perceived Social Support Scale, and Healthcare Professional's Support Scale were used, as well as items on demographic and clinical characteristics. Standard deviations of frequency and percentage, Chi-squared test between genders, independent t-test, correlation analysis between independent variables and extent of PTG, and regression analysis were conducted.

RESULTS

The PTG levels of HSCT survivors were statistically significantly higher when participants were women, carried out more religious activities, had higher educational levels, or utilized nurse counseling. The 'intrusive thinking' traumatic impact subcategory, as well as social support and support from healthcare professionals, were found to be highly related to PTG scores. Upon multiple regression analysis, factors with greatest influence on PTG in HSCT survivors were support from healthcare professionals, followed in order, by social support, utilization of nurse counseling, intrusive thinking, and frequency of religious activities.

CONCLUSIONS

We suggest implementing programs for HSCT patients to enhance support from healthcare professionals and to increase post-traumatic growth through greater utilization of nurse counseling, self-help meetings, and writing.