PTSD is an anxiety disorder which occurs in response to traumatic events. Sufferers will often relive the event through nightmares and flashbacks. They may also feel isolated, irritable or guilty.
The condition can be triggered by anything from serious road accidents to military combat, traumatic childbirth and being caught up in natural disasters. What is lesser-known is that it can also be triggered by a cancer diagnosis.
While there has been little research on PTSD and cancer carried out in the UK, government survey data suggests one in five people with cancer (21%) report having moderate to severe mental health issues. Macmillan Cancer Support estimates this to be around 530,000 people in the UK.
To explore the link between cancer and PTSD further, Caryn Mei Hsien Chan, from the National University of Malaysia, and her colleagues studied 469 adults with various types of cancer within one month of diagnosis at a single oncology referral centre. Patients underwent additional testing after six months and again after four years.
Clinical evaluations revealed that PTSD affected one fifth of the group six months after diagnosis. These rates dropped after the four-year follow-up, with a PTSD incidence of 6.1%.
Although overall rates of PTSD decreased with time, roughly one third of patients initially diagnosed with PTSD were found to have persistent or worsening symptoms four years later.
Dr Chan said: “Many cancer patients believe they need to adopt a ‘warrior mentality’, and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer. To these patients, seeking help for the emotional issues they face is akin to admitting weakness.
“There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval―particularly depression, anxiety, and PTSD―post-cancer.”
Symptoms of PTSD
The most common symptom of PTSD is ‘re-experiencing’, where a person vividly re-lives a traumatic event. This may be through flashbacks, nightmares, repetitive images or physical sensations like pain, sweating, nausea or trembling.
These feelings may lead to people questioning whether they could have prevented the event, or even why it happened to them, leading to feelings of guilt or shame.
People with PTSD may also try to avoid being reminded of the event by deliberately steering clear of certain people or places. According to the NHS, these people will try to push memories of the event out of their mind, often distracting themselves with work or hobbies.
Others attempt to deal with their feelings by trying not to feel anything at all, which is known as ‘emotional numbing’.
Hyperarousal, or feeling ‘on edge’, is another issue linked to PTSD which results in people struggling to relax. They may be constantly aware of threats, easily startled and prone to irritability, angry outbursts, sleeping problems and difficulty concentrating. They may also suffer from depression, anxiety, phobias, headaches, dizziness, chest pains and stomach aches.
Dr Chan stressed that many patients live in fear that their cancer may come back, and they may think the cancer has returned with every lump or bump, pain or ache, fatigue or fever.
Additionally, survivors might skip visits to their oncologists or other physicians to avoid triggering memories of their past cancer experience. This can lead to delays in seeking help for new symptoms or even refusal of treatment for unrelated conditions, she said.
Researchers said the findings, published in the online journal Cancer, highlight the need for early identification, careful monitoring and treatment of PTSD in cancer survivors.
Dr Chan concluded: “We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follow-ups because psychological well-being and mental health―and by extension, quality of life―are just as important as physical health.”
Martin Ledwick, Cancer Research UK’s head information nurse, told HuffPost UK: “Being diagnosed and going through treatment for cancer can be a very traumatic experience, so it comes as no surprise that some people may develop PTSD in later life.
“This study adds to our understanding of this. In the UK, strategies like the Cancer Patient Recovery Package [an initiative to aid recovery and reintegration after cancer treatment] should help to identify and address some of the problems that people affected by cancer face after treatment.
“It’s important that the longer term emotional impact of cancer continues to be investigated as well as finding out what strategies might prevent PTSD or help people overcome it.”
Dany Bell, Macmillan Cancer Support’s specialist advisor on treatment and recovery, told HuffPost UK: “It is tragic, but sadly not surprising, that so many people with cancer suffer from PTSD. Being diagnosed with a life-threatening disease, and then receiving gruelling treatment, can understandably take its toll on your mental health. We know that these issues can continue long after cancer treatment has ended.
“While a common perception is that people should feel ‘lucky’ to have survived cancer, we often hear from people who felt that the support they received ‘dropped away’ when their treatment ended.
“The health and care system has a long way to go in terms of supporting people after cancer treatment. Everyone should have access to a personalised recovery package which would support them to have the best possible quality of life after their treatment ends.”