Post-traumatic stress disorder (PTSD) is an anxiety disorder that a person can develop after experiencing or seeing a life-threatening or extremely frightening event. Although PTSD is often associated with situations such as war, weather-related disasters, sexual or physical attacks, and serious accidents, such as a plane crash, the disorder can also affect people with a history of cancer.

Causes

It is normal for people with cancer or cancer survivors to have feelings of anxiety, such as worry, fear, and dread. But when those feelings do not go away, continue to get worse, or interfere with day-to-day life, they could be a sign of PTSD.

Some aspects of the cancer experience may trigger PTSD, such as:

• Being diagnosed with the disease
• A diagnosis of an advanced cancer
• Long or painful tests and treatments
• Lengthy hospital stays
• A cancer recurrence (return of cancer)

PTSD can affect caregivers, too. One research study found that 20% of families with adolesecent survivors of childhood cancer had at least one parent with the condition. Other research shows that it is common for parents of children with cancer to develop post-traumatic stress (PTS), which is not as severe as PTSD, but closely related. Learning that a child has cancer, seeing a child in pain, and medical emergencies are stressful events that may contribute to the development of PTS or PTSD during treatment, or years after the child has survived the cancer.

Risk factors

It is not clear why some people with cancer develop PTSD while others do not. Some factors may make a person more likely to develop the disorder, including a younger age. Another study shows that survivors of childhood cancer [1], especially those who had longer and more intensive treatments, have an increased risk of PTSD.

PTSD also seems to be more common for:

• People who have had PTSD or other mental health conditions before being diagnosed with cancer
• Women from minority groups
• People with high levels of overall stress
• People who use avoidance strategies as a way to cope with stress, such as using drugs or alcohol
• People with less formal education
• People with low or no income
• Single people

Factors that may make a person less likely to develop PTSD include getting strong support from family and friends, being given correct information about the stage of the cancer (where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body), and having good relationships with members of the health care team.

Symptoms

PTSD symptoms can be different in each person and can come and go. Although symptoms usually develop within three months of a traumatic event, they can also occur several months or even years later. For people with a history of cancer, the symptoms can start after the diagnosis, during treatment, or after treatment is complete.

PTSD symptoms include:

• Nightmares and flashbacks (repeatedly reliving an event)
• Avoiding places, events, people, or things that bring back memories of the cancer experience
• Strong feelings of guilt, hopelessness, or shame
• Difficulty sleeping or concentrating
• Continuous feelings of fear, irritability, or anger
• Loss of interest in activities and relationships that used to be enjoyable
• Self-destructive behavior, such as drug or alcohol abuse
• Frightening or unwanted thoughts
• Trouble feeling emotions

It is not unusual to experience some of these symptoms in response to having a life-threatening disease, such as cancer. However, that doesn't mean a person has PTSD; but, if symptoms last more than one month, talk with your doctor about being screened by a mental health care professional for the condition.

It is important that people with cancer and survivors who are diagnosed with PTSD be treated because it can keep them from getting needed tests, treatments, or follow-up care. PTSD can also increase a person's risk for developing other mental, physical, and social problems, including depression, alcohol and drug abuse, eating disorders, and problems with relationships and employment.

Treatment

PTSD is treatable. Which treatments work best depends on each person's specific symptoms and situation. Common treatments, which are often used together, are:

Psychotherapy. This means talking with a mental health care professional who has experience in treating PTSD. Some specialize in helping people who have or have had cancer. There are different types of talk therapy a counselor or therapist may use to help a person cope with their feelings. Therapy can be done one-on-one or in a group setting. Some health insurance companies pay for a portion of the cost of this treatment. Read more about the benefits of counseling [2] and how to find a counselor [3].

Medications. Antidepressants and anti-anxiety drugs can help manage PTSD symptoms, such as sadness, anxiety, and anger. Medication is often used in combination with psychotherapy.

Support groups. Support groups can help many people cope with the emotional aspects of cancer by providing a safe place to share experiences and learn from others who are facing similar situations. Many studies have shown that support groups can help people with cancer feel less depressed and anxious and more hopeful. Learn more about support groups [4].

Resources

Many resources are available on PTSD and treatment. Start by asking your doctor or other members of your health care team for help and recommendations. Your hospital's social work or discharge department may also be able to give you names of counselors, counseling services, and support groups in your community. Here are some other tips for finding help:

• Contact your local health department, community mental health agency, or family services agency.
• If your workplace provides an employee assistance program, call and ask if it provides referrals to a mental health counselor.
• Ask your health insurance company for a list of local mental health counselors.
• Use the Internet to search for mental health and cancer service organizations. Many of these organizations have free referral services, including the Anxiety Disorders Association of America [5] and the U.S. Centers for Mental Health Services Locator [6].

More Information

Anxiety [7]

Coping [8]

How an Oncology Social Worker Can Help [9]

Additional Resources

National Cancer Institute: Post-traumatic Stress Disorder [10]

Last Updated: March 01, 2010