Post-Traumatic Stress Disorder in Cancer Patients

Cancer can trigger post-traumatic stress disorder. Indeed, most people who receive this diagnosis consider it to be potentially life-threatening. In this article, we discuss the importance of psychological intervention for this eventuality.

Written and verified by the psychologist Elena Sanz.

Last update: 15 March, 2023

Generally, we associate post-traumatic stress disorder (PTSD) with certain experiences, such as assaults, accidents, or abuse. However, receiving a diagnosis of a disease can also trigger the same process. In fact, post-traumatic stress in cancer patients is a well-documented reality about which there’s now increasingly more information available.

The experience of this illness doesn’t always lead to PTSD. There are specific individual and contextual risk factors. Even so, it’s estimated that between five and 35 percent of cancer patients end up developing PTSD. This implies the need to carry out appropriate psychological follow-ups and to apply interventions to reduce the symptoms of the disorder.

The relationship between PTSD and cancer

Post-traumatic stress disorder is a disorder that‘s triggered when an individual perceives an extremely serious threat that compromises their survival. When the event is sudden and unexpected and generates a strong emotional impact that’s impossible to handle and is experienced with feelings of terror and hopelessness, we speak of trauma. When it comes to cancer, there are several elements that contribute to the experience taking this form.

For example, the time of diagnosis, different tests and treatments, unfavorable results, hospital stays… All these events are potential stressors.

In addition, certain factors have been identified that increase the risk of triggering PTSD. For instance, the severity of the cancer, the presence of pain, the side effects of the treatment, any previous traumas, and inadequate social support.

In all cases, it’s natural for the patient with cancer (or who’s survived it) to suffer anxiety, fear, and a great burden of uncertainty, especially if the diagnosis is recent. However, when this discomfort is really severe, significantly interferes with their daily functioning, and doesn’t subside over time, they may be suffering from a mental disorder that needs to be addressed.

Symptoms and manifestations of post-traumatic stress disorder in cancer patients

The symptoms of cancer-related post-traumatic stress disorder are similar to those that occur after other types of traumatic experiences. For instance:

• Constant worry.
• Fear of a recurrence of the disease.
• Nightmares and flashbacks about the illness or treatments.
• Fear of the future and terrifying intrusive thoughts.
• Irritability, agitation, insomnia, and fatigue.
• Avoidance behaviors related to those events, people, or places that remind them of the disease. Also, related emotions and thoughts.
• Feelings of guilt, hopelessness, shame, and anger.
• Emotional numbness or difficulty feeling emotions.

All these symptoms not only generate great emotional discomfort in the patient but also interfere with their daily functioning. This can become especially dangerous when their tendency to avoidance makes them not attend medical appointments, undergo any relevant tests, or follow prescribed treatments. For this reason, it’s essential to pay attention to the possible appearance of the disorder and intervene appropriately.

Neurobiological correlates

Post-traumatic stress disorder in cancer patients hasn’t only been identified from testimonies and manifestations of the patients. In fact, it’s also been discovered at the level of anatomical and functional changes in the brain. Indeed, some studies have verified that the alteration in the neurobiological systems involved in PTSD also occurs in cases of cancer.

More specifically, the following processes take place:

• The activity of the amygdala is intensified. This generates an exacerbated response to fear and to stimuli the patient perceives as threatening.
• It decreases the receptivity of the prefrontal cortex. This prevents the functional inhibition of the amygdala.
• There’s an alteration in the volume and function of the hippocampus. It leads to deficits in explicit memory.
• There’s hyperactivity of the insula. This makes the patient relive the trauma, and experience intrusive thoughts and avoidance behaviors.
• Broca’s area is deactivated. This creates difficulties in cognitive structuring. It means patients struggle to describe and verbalize their traumatic experiences.

It’s been observed that intrusive symptoms are those that are most evident in cancer patients with PTSD. In fact, in these cases, they constitute the core of the disorder. Furthermore, due to the difficulties of verbalization, it’s preferable to opt for multimodal interventions and not only conversational ones to address the trauma.

Detecting and treating PTSD in cancer patients

All of the above indicates that post-traumatic stress disorder related to cancer is relatively common, Therefore, it’s important that it should be detected and interventions applied as soon as possible. In fact, if it’s not treated, it may lead the patient to not fully accept the disease, not receive the appropriate care, or suffer depressive or anxiety disorders as well.

It must be considered that PTSD can appear at any time during the illness or even after recovery. Moreover, it can also affect caregivers and relatives (especially in the case of childhood cancer). For this reason, follow-ups are necessary.

Once the presence of cancer-associated PTSD is detected, it’s possible to intervene in different ways. Medication may be necessary in severe cases and support groups are essential. They offer safe spaces for patients to express and share their emotions and experiences.

The most useful treatment is psychotherapy based on EMDR or cognitive-behavioral therapy. These procedures can help the patient properly process the trauma, reduce PTSD symptoms, and teach them how to deal with stress and triggers. This means they’ll be able to continue their treatment and start to cope appropriately with the illness.