Post-traumatic growth,distress and attachment style among women with breast cancer

Identifying factors fostering post-traumatic growth (PTG) is very important to promote PTG itself through specific psychological interventions. To this end, we investigated PTG and its relationship with clinical and psychological variables in a sample of 108 female breast cancer survivors. Results showed that women with higher depressive symptoms presented lower levels of PTG than women without. Moreover, women who had undergone combined treatment presented higher levels of PTG than women who had not. The results highlighted the resulting importance of psychological intervention focusing on depressive symptoms, which negatively interfere with the patients’ psychological growth.     

Psychosocial and sexual functioning of survivors of breast cancer

The literature documents that the majority of breast cancer survivors have adjusted well after their first 2 years since diagnosis. However, there is a subset of survivors reporting psychological distress, including depression and anxiety, involving approximately 30% by 4 years post-treatment, but widely ranging from 5% to 50%, depending on when diagnosed and time since treatment completion. Further, a large proportion of survivors report cancer-related problems long after treatment completion, including cancer-related distress involving body image, fear of recurrence, post-traumatic stress disorder (PTSD), and sexual problems. Those with long-term medical sequelae, such as lymphedema, have worse adjustment compared to those who do not. Future research directions are suggested.     

An exploratory model of the relationships between cancer-related trauma outcomes on quality of life in non-Hodgkin lymphoma survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.     

An Exploratory Model of the Relationships Between Cancer-Related Trauma Outcomes on Quality of Life in Non-Hodgkin Lymphoma Survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.     

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing

Introduction: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. Methods: Fifty‐five post‐treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post‐diagnosis, were recruited from a state cancer registry and completed baseline and 3‐month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). Results: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3‐month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3‐month PTG. Conclusions: Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychosocial distress among young breast cancer survivors: implications for healthcare providers

Breast cancer (BC) experiences foster serious psychosocial problems among young survivors. Previous studies have repeatedly discussed younger age as a factor that puts women with BC at higher risk of psychosocial distress. Although most BC survivors receive the necessary information from healthcare providers on treatment options and procedures at diagnosis, they often fail to receive support and guidance after acute treatment has completed in dealing with the possible physical, emotional, social, and psychological effects of cancer. This article discusses common psychosocial problems experienced by young BC survivors, such as issues related to interpersonal relationships, sexuality, fertility, and employment. In particular, it examines influences of the Japanese sociocultural background on young survivors’ distress and considers the clinical implications for Japanese healthcare. The importance of integrating psychosocial care with routine oncology care cannot be overemphasized.     

Persistent psychological distress in long-term survivors of pediatric sarcoma: the experience at a single institution

BACKGROUND: The long-term psychological impact of pediatric sarcoma is largely unknown. As part of a cross-sectional study examining the late effects of pediatric sarcoma therapy, we examined whether psychological distress or posttraumatic stress symptoms are present in an adult cohort of pediatric sarcoma survivors. METHOD: Thirty-four patients participated in the study, an average of 17 years after their treatment ended, each completing the SCID module for Posttraumatic Stress Disorder, Impact of Events Scale, Brief Symptom Inventory (BSI) and a questionnaire assessing sociodemographic variables and psychosocial issues. RESULTS: Significant persistent psychological distress characterized this cohort of patients. Seventy-seven percent scored in the clinical range on the BSI. Twelve percent met diagnostic criteria for PTSD. Current psychological distress was associated with intrusive thoughts and avoidant behaviors, male gender, employment, difficulty readjusting to work/school after treatment, and enduring worries about health. No differences were found based on age, presence of metastatic disease or time since diagnosis. CONCLUSIONS: This is the first report of a clinical evaluation of psychological distress in a cohort of pediatric sarcoma survivors treated with intensive multimodal cancer therapy. The results suggest that survivors of pediatric sarcoma might be at high risk for adverse psychological outcomes. Appropriate interventions are proposed.     

Post-traumatic stress disorder in cancer: a review

The stressor criterion for Post-Traumatic Stress Disorder (PTSD) has been recently modified to include life-threatening illnesses, such as cancer, as precipitating traumatic events. We sought to examine the empiric evidence for cancer's inclusion as a traumatic stressor. Nine published studies assessing PTSD in cancer survivors and/or family members were identified in the literature. The studies were predominantly small (n<100) and cross-sectional. Study target groups included one or more of the following: children cancer survivors, parents of pediatric survivors and adult cancer survivors. There was considerable inter- and intra-study variability in the type and stage of cancer diagnosed and in the type of treatment regimens participants had undergone. Only three studies utilized a validated PTSD diagnostic tool to evaluate the disorder. Evidence of full-blown PTSD was found for adults and parents, and for children in all but one instance. These results suggest that a PTSD symptom assessment provides valuable clinical information concerning the post-treatment adjustment of cancer survivors and their immediate family members.     

Need for psychological follow-up among young adult survivors of childhood cancer

Follow-up is recommended for survivors of childhood cancer. Decisions about care tend to be made in terms of physical health, but psychological late effects including post-traumatic stress disorder (PTSD) and symptoms (PTSS) are prevalent. We report prevalence of PTSD/PTSS in a UK cohort, self-care and implications for organisation of follow-up. Eligible survivors (n= 218) under regular follow-up were invited to complete measures of PTSD, late effects and self-efficacy. Information about late effects was also taken from medical notes. A total of 118 survivors responded (54.1%) and 108 (49.5%) completed questionnaires. Prevalence of clinical PTSD (13.9%) was comparable with US findings. Female subjects and those who reported more late effects reported more PTSD. In regression analyses, number of survivor-reported late effects (but not number-recorded in medical notes) and PTSS predicted self-efficacy. Significant numbers of survivors report PTSS but this is unrelated to diagnosis or treatment. Female subjects and those who reported more physical late effects also reported more PTSS. Decisions to discharge survivors from routine care must consider psychological well-being as well as physical late effects. We recommend routine psychological screening for all survivors of childhood cancer and suggest this can be acceptable to survivors and feasible in clinic.     

Post-traumatic stress after childhood cancer I: The role of appraisal

Life threat or physical injury have been shown to produce post-traumatic stress symptoms in children. Recent studies have demonstrated that a subset of survivors of pediatric cancer report post-traumatic stress symptoms years after completing successful treatment. However, it is not clear whether these symptoms represent a response to the perception of life-threat or to the repeated intrusive procedures that accompany cancer treatment. In this exploratory study, 30 childhood cancer survivors 8 to 19 years old, who were at least 22 months off treatment without recurrence of disease, were evaluated using self-report questionnaires. The survivor's appraisal of treatment intensity signficantly correlated with the severity of post-traumatic stress symptoms. When age at the time of diagnosis was evaluated, appraisal of treatment intensity was significantly correlated with symptoms only in those six years old and younger. For children aged seven years or older at the time of diagnosis, duration of treatment was a significant contributor to symptoms. Diagnostic category (leukemia or solid tumor), length of time since completion of treatment and the child's appraisal of life-threat were not significantly correlated with severity of post-traumatic stress symptoms. Further study of the impact of intensive pediatric treatment on children and the importance of developmental factors in traumatic response to illness appears to be indicated.     

Rumination,post‐traumatic growth,and distress: structural equation modelling with cancer survivors

Objective: Theoretical models of post‐traumatic growth (PTG) have been derived in the general trauma literature to describe the post‐trauma experience that facilitates the perception of positive life changes. To develop a statistical model identifying factors that are associated with PTG, structural equation modelling (SEM) was used in the current study to assess the relationships between perception of diagnosis severity, rumination, social support, distress, and PTG. Method: A statistical model of PTG was tested in a sample of participants diagnosed with a variety of cancers (N=313). Results: An initial principal components analysis of the measure used to assess rumination revealed three components: intrusive rumination, deliberate rumination of benefits, and life purpose rumination. SEM results indicated that the model fit the data well and that 30% of the variance in PTG was explained by the variables. Trauma severity was directly related to distress, but not to PTG. Deliberately ruminating on benefits and social support were directly related to PTG. Life purpose rumination and intrusive rumination were associated with distress. Conclusions: The model showed that in addition to having unique correlating factors, distress was not related to PTG, thereby providing support for the notion that these are discrete constructs in the post‐diagnosis experience. The statistical model provides support that post‐diagnosis experience is simultaneously shaped by positive and negative life changes and that one or the other outcome may be prevalent or may occur concurrently. As such, an implication for practice is the need for supportive care that is holistic in nature. Copyright © 2010 John Wiley & Sons, Ltd.     

Factors Contributing to Posttraumatic Growth and Its Buffering Effect in Adult Children of Cancer Patients Undergoing Treatment

This study examined relationships among demographic, clinical, and psychosocial variables in adult children of cancer patients. Two hundred and fourteen participants completed measures of posttraumatic growth (PTG), distress, posttraumatic stress disorder (PTSD) symptoms, social support, and family functioning. Significant gender differences in all PTG dimensions were found, as well as associations among PTG, gender, parental dependency, distress, PTSD, and family functioning. Social support was not a mediator in the relationship between gender and PTG. Gender, education, disease duration, dependency, distress, and family flexibility predicted PTG. Finally, PTG had a moderating effect in the relationship between distress and PTSD/social support. These results may guide psychosocial interventions in this population.     

Cancer survivorship and psychological distress in later life

Recent research in psychosocial oncology has pointed to the traumatic nature of the stress experienced by cancer survivors. Most of this research has focused on children, young adults survivors and their families. This investigation proposes a conceptual model for understanding general psychological distress (anxiety, hostility and depression) and symptoms of posttraumatic stress (hyper-arousal, avoidance and intrusiveness) that may be associated with cancer survivorship among older adults. Findings from a survey of 180 older adult, long-term cancer survivors are used to illustrate the key features of this model. Results of multivariate analysis show that most older adult long-term cancer survivors do not demonstrate clinical levels of posttraumatic stress disorder (PTSD), although over 25% evidence clinical levels of depression. However, many survivors display important symptoms of psychological distress that are related to the continuing effects of cancer and its treatment. Current cancer-related symptoms are the strongest predictors of depression (beta=0.27, p=0.046) and the PTSD sub-dimension of hyper-arousal (beta=0.377, p=0.004). These effects persist even when the effects of other stressors and non-cancer illness symptoms are statistically controlled. Additionally, it appears in this sample that symptoms of PTSD are significantly correlated with traditional measures of psychological distress.     

Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors.

PURPOSE: Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. PATIENTS AND METHODS: Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. RESULTS :The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. CONCLUSION: The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.     

Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function

A breast cancer diagnosis can be a life-changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one-third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well-recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress-driven activation of inflammatory pathways and the long-term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition.     

The valence of attentional bias and cancer-related rumination in posttraumatic stress and posttraumatic growth among women with breast cancer

Objective: To examine the effects of self‐reported attentional bias on posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG) through the potential mediator of cancer‐related rumination. Design: A cross‐sectional survey design was used and women with breast cancer (N=170) were recruited. Measures: Attentional biases, cancer‐related ruminations, PTSD symptoms, and PTG were assessed. Results: Negative attentional bias and negative cancer‐related rumination were positively related to PTSD symptoms following cancer diagnosis and treatments, but they were not related to PTG. Positive attentional bias and positive cancer‐related rumination were positively related to PTG, but positive attentional bias was not related to PTSD symptoms. Findings showed that negative cancer‐related rumination partially mediated the relationship between negative attentional bias and PTSD symptoms, while positive cancer‐related rumination partially mediated the relationship between positive attentional bias and PTG. Conclusion: Findings support that there are differential trajectories to PTSD symptoms and PTG with respect to different valence of habitual attentional style and cancer‐related rumination. They may serve as potential therapeutic leverages in the alleviation of PTSD symptoms and facilitation of PTG following cancer diagnosis and treatments. Copyright © 2010 John Wiley & Sons, Ltd.     

Posttraumatic growth in prostate cancer survivors and their partners

We examined posttraumatic growth (PTG) in men treated for prostate cancer and their partners 1 year after surgery. Levels of PTG in prostate cancer survivors and their partners were similar and modest. For survivors, higher levels of presurgery negative affect, and coping by using positive reframing and emotional support were associated with higher levels of PTG 1 year following surgery. For partners, PTG 1 year after the patient's surgery was higher in partners who were partnered to employed patients, were less educated, endorsed higher cancer-specific avoidance symptoms of stress at presurgery, and used positive reframing coping. Quality of life was largely unrelated to PTG in survivors or partners. Findings suggest that psychological disruption associated with the cancer experience and coping are related to PTG in prostate cancer survivors and their partners.     

Subjective cognitive dysfunction in breast cancer patients: a systematic review

Objective: Results from studies examining subjective cognitive dysfunctioning (SCD) in breast cancer (BC) patients are unclear. Therefore, this review examined (i) the prevalence of SCD, (ii) the differences between (treatment) groups in SCD, (iii) the course of SCD, (iv) the relationship of SCD with psychological factors, and (v) the relationship between SCD and objective cognitive dysfunctioning (OCD). Methods: Through a systematic literature search, we identified 27 studies concerning SCD in BC patients. The methodological quality of these studies was examined according to predefined criteria. The methodological limitations and heterogeneity across studies were taken into account. Results: Eight studies were graded of high, 12 of moderate, and seven of low quality. Twenty‐one to 90% of the patients reported SCD. The comparison between different (treatment) groups, at different time points of the cancer trajectory, rendered inconclusive evidence regarding the relation of SCD to the cancer itself, chemotherapy, and hormonal therapy. SCD and OCD were unrelated, but SCD was associated with psychological distress, fatigue, and health status. Conclusions: SCD does exist in BC patients, but it remains unclear if this is more commonly found in BC patients than in the general population. It is inconclusive if SCD is developed post‐treatment or already exists pretreatment. Since there is a relationship between SCD and anxiety and depression, SCD may be more indicative of emotional distress instead of OCD. Attention toward SCD in future research is warranted in order to draw valid conclusions regarding SCD in BC patients. Copyright © 2009 John Wiley & Sons, Ltd.