Cancer-Related Post-Traumatic Stress (PDQ®): Supportive care - Patient Information [NCI]

Overview

People react in different ways when they hear they have cancer.

Patients have a range of normal reactions when they hear they have cancer. These include:

• Repeated frightening thoughts.
• Being distracted or overexcited.
• Trouble sleeping.
• Feeling detached from oneself or reality.

These reactions may also be symptoms of cancer-related post-traumatic stress (PTS). Talk with your healthcare team if you continue to have these symptoms.

PTS can occur at any point during the cancer journey.

Patients with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during recurrence. Adult survivors of childhood cancer and their families may also have post-traumatic stress.

Cancer-related PTS may or may not lead to post-traumatic stress disorder (PTSD). PTSD is a specific group of symptoms that affect survivors of stressful events. These events usually involve the threat of death or serious injury to oneself or others. Cancer and its treatment may cause distress, but it does not mean it will develop into PTSD. Your healthcare team will evaluate your symptoms during your cancer journey.

Factors That Affect the Risk of Cancer-Related Post-Traumatic Stress (PTS)

Certain factors may make it more likely that a patient will have PTS.

Not everyone is at increased risk of cancer-related post-traumatic stress. Certain physical and mental factors that are linked to PTS or PTSD have been reported in studies:

Physical factors

• Cancer that recurs (comes back) was shown to increase stress symptoms in patients.
• In survivors of childhood cancer, symptoms of PTS occurred more often when there was a longer treatment time.
• Breast cancer survivors who had advanced cancer, long surgeries, or a history of trauma or anxiety disorders, were more likely to be diagnosed with PTSD.

Psychological, mental, and social factors

• Previous trauma.
• High level of general stress.
• Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.
• Lack of social support.
• Threat to life and body.
• Having PTSD or other psychological problems before being diagnosed with cancer.
• The use of avoidance to cope with stress.

Certain protective factors may make it less likely that a patient will develop PTS.

Cancer patients may have a lower risk of PTS if they have the following:

• Good social support.
• Clear information about the stage of their cancer.
• An open relationship with their healthcare providers.

PTS symptoms develop by conditioning.

Conditioning occurs when certain triggers become linked with an upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended.

In patients who have a history of PTSD from a previous trauma, symptoms may start again by certain triggers during their cancer treatment (for example, being inside MRI or CT scanners). These patients also may have problems adjusting to cancer and cancer treatment.

Screening for Cancer-Related Post-Traumatic Stress (PTS)

The cancer experience is more than one stressful event.

Cancer may involve stressful events that repeat or continue over time. The patient may suffer symptoms of post-traumatic stress anytime from diagnosis through treatment and possible cancer recurrence, so screening may be needed more than once. The healthcare team will look for symptoms of PTS or PTSD.

The specific cause of cancer-related PTS may be unknown.

For a patient coping with cancer, the specific trauma that triggers cancer-related post-traumatic stress isn't always known. Because the cancer experience involves so many upsetting events, it is much harder to know the exact cause of stress than it is for other traumas, such as natural disasters or physical assault.

Symptoms of cancer-related PTS are a lot like symptoms of other stress-related disorders.

PTS has many of the same symptoms as depression, anxiety disorders, and phobias.

Some of the symptoms that may be seen in PTS and in other conditions include:

• Feeling defensive, irritable, or fearful.
• Being unable to think clearly.
• Sleeping problems.
• Avoiding people.
• Avoiding stressful memories.
• Guilt and self-blame.
• Loss of interest in life.

Treatment of Cancer-Related Post-Traumatic Stress (PTS)

Treatments used for PTS may be the same as treatments for PTSD.

Although there are no specific treatments for PTS in patients with cancer, treatments used for people with PTSD can be useful in relieving distress in cancer patients and survivors.

Talking with a counselor, relaxation training, and support groups may help reduce symptoms of PTS.

A crisis intervention may be used to relieve distress and help the patient return to normal activities. This method focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient.

Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Through cognitive behavioral therapy (CBT), patients may:

• Understand their symptoms.
• Learn ways to cope and to manage stress (such as relaxation training).
• Become aware of thinking patterns that cause distress and negative emotions and replace them with more balanced and useful ways of thinking.
• Become less sensitive to upsetting triggers.

Support groups may also help people who have PTS symptoms. In the group setting, patients can get emotional support, learn coping skills, and meet others with similar experiences and symptoms.

Medicines may help severe symptoms of PTS.

For patients with severe symptoms of PTS, medicines may be used. For example:

• Tricyclic and monoamine oxidase inhibitor (MOA) antidepressants may be used when PTS occurs along with depression.
• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine may reduce the stress that occurs in what is known as the "fight-or-flight syndrome".
• Antianxiety medicines may help reduce symptoms of anxiety. In certain cases, antipsychotic medicines may reduce severe flashbacks.

Post-Traumatic Stress in Children With Cancer and Cancer Survivors

Children and teens with cancer may be at risk for post-traumatic stress disorder (PTSD).

In children and teens with cancer, symptoms of PTS or PTSD may occur during treatment or after treatment has ended. Those who feel very uncertain about their disease and future may be more likely to have PTSD symptoms.

Childhood cancer survivors who are diagnosed with PTSD are more likely to have depression, lower satisfaction with life, and lack of daily life skills.

Cancer survivors with PTS need early treatment with methods that are used to treat other trauma victims.

Effects of PTS are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may affect personal relationships, education, and employment. Patients may avoid getting professional care to avoid places and persons linked with cancer.

It is important that cancer survivors are aware of the possible mental distress of living with cancer and the need for early treatment of PTS. Follow-up cancer care may be given by the cancer treatment doctor or the main provider, such as the family doctor. Many survivors get help from therapists who are experts in helping people who are recovering from cancer. More than one kind of treatment may be used.

Cancer survivors and their families need long-term monitoring for PTS.

Symptoms of PTS usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years. Therefore, cancer survivors and their families need long-term monitoring. For more information, see Adjustment to Cancer: Anxiety and Distress.

Current Clinical Trials

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of cancer-related post-traumatic stress. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:

PDQ® Supportive and Palliative Care Editorial Board. PDQ Cancer-Related Post-Traumatic Stress. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389374]

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Last Revised: 2023-04-17

If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.