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Wednesday, March 6, 2013

Surviving Is Traumatic Too

By Heather Millar

worried woman

I’ve got a close friend whose sister had breast cancer 15 years ago. Even now—decades on, with neither symptoms nor a recurrence—this sister constantly mentions her breast cancer. It’s like she’s stuck in an endless feedback loop: she has survived cancer, and yet she can’t get past it. It’s always there, top of mind, vanquished and yet still terrifying, old news and yet always today’s headline.

I’ve never even met my friend’s sister; she lives in a city hundreds of miles away from my home. But I bet if I were to sit down with and talk with this fellow survivor for a while, she’d show signs of post-traumatic stress syndrome.

You can find an in-depth discussion of PTSD on the WebMD site, here. Here’s the upshot: People who suffer from this condition, can’t get past the strong emotions associated with a traumatic event. Their minds constantly go back to the trauma, reliving it. They avoid people, places and sensations that might remind them of the trauma. Their emotions run high, often making it hard to sleep, to get along with others, or to concentrate. PTSD can even have physical symptoms: a racing heart rate, high blood pressure, rapid breathing or muscle tension.

PTSD used to be called “shell shock” or “battle fatigue.”

With decades of the cancer “war metaphor,” (See terms like “war on cancer,” “survivor,” etc.), is it really so surprising that cancer patients suffer from a syndrome that was first described in World War I soldiers?

What’s interesting is that researchers are just beginning to try to understand PTSD in cancer patients. Until the 1970s, the stigma associated with cancer was so great that not much research was done about patients’ mental state, or their quality of life. Over the last few decades, that has changed in a big way.

Last week, a study concluded that nearly one-quarter of breast cancer patients had some PTSD symptoms shortly after diagnosis. For about 12 percent of the 1,000-plus patients interviewed, the PTSD persisted. Being younger, and being black or Asian seemed to heighten the risk of PTSD.

This study follows many other recent efforts that explore PTSD and cancer. These are important, because when the symptoms and triggers of PTSD were first outlined in the 1980s, cancer wasn’t listed as a “suitable qualifier” for trauma. Obviously, the experts compiling the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) at that time didn’t have a deep understanding of the cancer experience!

In the following decade, PTSD came to be recognized as an important health concern because it can be debilitating and because it affects a lot of people. If you broaden your search terms, you’ll find that PTSD has been linked to patients who have come through all kinds of medical challenges: brain injuries, organ transplants, spine surgery, even giving birth.

In 1994, the American Psychological Association released the DSM IV and listed “being diagnosed with a life-threatening illness” as a stressor that can cause PTSD.

Since then, scientists have been trying to fill in the picture of what sorts of cancer patients suffer from PTSD, how they might be identified and how they might be helped:

In 2009, one study found that 20 percent of childhood cancer survivors met the clinical definition of PTSD. And here’s the really stunning thing: 45 to 90 percent of these survivors showed at least one symptom of PTSD, depending on the screening criteria used. In 2006, an Australian study showed that 22 percent of cancer patients suffered from PTSD, and that women seemed to have a higher risk. A 2008 Ohio State study showed that people who already suffered from mood and anxiety problems were more likely to suffer from PTSD.

While many of these conclusions might seem “obvious” to anyone who has experienced cancer, the work is important. If we’re going to help people who have PTSD after serious illness, we need to know more about it.

Have you had PTSD symptoms since your diagnosis? What did you do? Were you able to get help? If so, what helped you to work through the problem?

Posted by: Heather Millar at 9:25 am

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