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Assessment of Post-traumatic Stress Disorder in the Cancer Setting

    A timely and careful assessment of cancer patients is critical to identify the symptoms of post-traumatic stress disorder (PTSD), to note the deleterious impact of the symptoms on functioning, and to plan interventions targeted at the most distressing symptoms. It is also critical that the assessment distinguishes between the full Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), PTSD syndrome (meets all required diagnostic criteria) and PTSD-related symptoms only.

    The most difficult aspect of PTSD assessment in the cancer setting is the determination of precisely when to evaluate the patient. Diagnosis is complicated because cancer is not an acute or discrete event, but is an experience marked by repeated traumas and indeterminate length. Thus, an individual may exhibit the symptoms of PTSD at any point from diagnosis through treatment, to treatment completion and, possibly, to recurrence.[1] Patients such as Holocaust survivors whose history of victimization causes PTSD or its symptoms can have the symptoms activated by any number of stimuli encountered during their treatment (e.g., clinical procedures such as being inside magnetic resonance imaging or computed tomography scanners). While such patients may have more difficulty in adjusting to cancer and cancer treatment, their PTSD symptomatology is likely to vary greatly according to their circumstances. The relative predominance of specific PTSD symptoms may wax and wane throughout the cancer experience and beyond.[2]

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    The definition in the DSM-IV indicates that although PTSD symptoms usually begin within the first 3 months after trauma, there may be a delay of months or even years before symptoms appear.[2,3] These findings support the necessity for long-term monitoring of survivors of cancer and their family members.

    At least one study found that individuals who have experienced a traumatic event may exhibit early symptoms without meeting the full criteria for a diagnosis of PTSD.[4] Nonetheless, the appearance of these early symptoms was found to predict later development of full PTSD syndrome. These results lend further credence to the need for both repeated and long-term follow-up of individuals exposed to the trauma of cancer. (Refer to the PDQ summary on Adjustment to Cancer: Anxiety and Distress for further information.)

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