Are we missing PTSD in our patients with cancer? Part I

Alyssa Leano, Melissa B. Korman, Lauren Goldberg, Janet Ellis


Posttraumatic Stress Disorder (PTSD) can be defined by the inability to recover from a traumatic event. A common misconception is that PTSD can only develop in circumstances of war or acute physical trauma. However, the diagnostic criteria of PTSD were adjusted in the Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to include the diagnosis and treatment of a life-threatening illness, such as cancer, as a traumatic stressor that can result in PTSD. The word ‘cancer’ is so strongly linked to fear, stigma, and mortality, that some patients are fearful to even say ‘the C word’. Therefore, it is not surprising that patients may experience a diagnosis of cancer as sudden, catastrophic, and/or life-threatening. Cancer-related PTSD (CR-PTSD) can negatively affect a patient’s psychosocial and physical well-being during treatment and into survivorship. Unfortunately, CR-PTSD often goes undiagnosed and, consequentially, untreated. This article provides a general overview of PTSD with cancer as the traumatic event in order to define CR-PTSD, and reviews the growing pool of literature on this topic, including prevalence, risk factors, characterization, and treatment of CR-PTSD. The purpose of this article is to spread awareness of this relatively newly defined and commonly missed disorder among patients with cancer to clinicians and patients alike.

Full Text:



Abbey, G., Thompson, S.B., Hickish, T., & Heathcote, D. (2015). A meta-analysis of prevalence rates and moderating factors for cancer-related posttraumatic stress disorder. Psycho‐Oncology, 24(4), 371–381.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association Press; Text Revision.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association Press.

Andrykowski, M.A., & Kangas, M. (2010). Posttraumatic stress disorder associated with cancer diagnosis and treatment. In: J.C. Holland, W.S. Breitbart, P.B. Jacobsen, M.S. Lederberg, M.J. Loscalzo, R. McCorklen, Editors. Oxford textbook of psycho-oncology, 2 (pp. 348–57). New York, NY: Oxford University Press.

Atwoli, L., Stein D.J., Koenen, K.C., & McLaughlin, K.A. (2015). Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences. Current Opinion in Psychiatry, 28(4), 307–311.

Butler, L.D., Koopman, C., Classen, C., & Spiegel, D. (1999). Traumatic stress, life events, and emotional support in women with metastatic breast cancer: Cancer-related traumatic stress symptoms associated with past and current stressors. Health Psychol, 18, 555–60.

Caruso, R., Nanni, M.G., Riba, M.B., Sabato, S., & Grassi, L. (2017). The burden of psychosocial morbidity related to cancer: Patient and family issues. Int Rev Psychiatry, 29(5), 389–402.

Carpenter, K.M., Fowler, J.M., Maxwell, G.L., & Andersen, B.L. (2010). Direct and buffering effects of social support among gynecologic cancer survivors. Annals of Behavioral Medicine, 39(1), 79–90.

Chan, C.M.H., Wan Azman, W.A., Yusof, M.M., Ho, G.F., & Krupat, E. (2015). Prevalence and characteristics associated with the default of treatment and follow-up in patients with cancer. European Journal of Cancer Care, 24, 938–944.

Chan, C.M.H., Ng, C.G., Taib, N.A., Wee, L.H., Krupat, E., & Meyer, F. (2018). Course and predictors of post‐traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4‐year follow‐up study. Cancer, 124(2), 406–416.

Chen, A., Hsu, S., Felix, C., Garst, J., & Yoshizaki, T. (2017). Effect of psychosocial distress on outcome for head and neck cancer patients undergoing radiation. The Laryngoscope, 128(3), 641–645.

Cordova, M.J., Andrykowski, M.A., Kenady, D.E., McGrath, P.S., Sloan, D.A., & Redd, W.H. (1995). Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. J Consult Clin Psychol, 63, 981–986.

Cordova, M.J., & Andrykowski, M.A. (2003). Responses to cancer: posttraumatic stress and posttraumatic growth. Semin Clin Neuropsychiatry, 8, 286–96.

Cordova, M.J., Riba, M.B., & Spiegel, D. (2017). Post-traumatic stress disorder and cancer. The Lancet Psychiatry, 4(4), 330–338.

Ellis, J., & Zaretsky, A. (2018). Assessment and Management of Posttraumatic Stress Disorder. Continuum: Lifelong Learning in Neurology. Behavioral Neurology and Psychiatry, 24(3), 873–892.

Gandubert, C., Carriere, I., Escot, C., Soulier, M., Hermes, A., Boulet, P., … Chaudieu, I. (2009). Onset and relapse of psychiatric disorders following early breast cancer: A case–control study. Psycho-Oncology, 18, 1029–1037, doi:10.10 02/pon.1469.

Ghazali, N., Cadwallader, E., Lowe, D., Humphris, G., Ozakinci, G., & Rogers, S. N. (2013). Fear of recurrence among head and neck cancer survivors: Longitudinal trends. Psycho-Oncology, 22, 807–81.

Gold, J.I., Douglas, M.K., Thomas, M.L., Elliott, J.E., Rao, S.M., & Miaskowski, C. (2012). The relationship between posttraumatic stress disorder, mood states, functional status, and quality of life in oncology outpatients. Journal of Pain and Symptom Management, 44(4), 520–531.

Goncalves, V., Jayson, G., & Tarrier, N. (2011). A longitudinal investigation of posttraumatic stress disorder in patients with ovarian cancer. J Psychosom Res, 70, 422–431, doi:10.1016/j.jpsychores.2010.09.017.

Grassi, L., Spiegel, D., & Riba, M. (2017). Advancing psychosocial care in cancer patients. F1000Research, 6.

Gurevich, M., Devins, G., & Rodin, G.M. (2002). Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics, 43, 259–91

Hahn, E.E., Hays, R.D., Kahn, K.L., Litwin, M.S., & Ganz, P.A. (2015). Post‐traumatic stress symptoms in cancer survivors: Relationship to the impact of cancer scale and other associated risk factors. Psycho‐Oncology, 24(6), 643–652.

Kangas, M., Henry, J. & Bryant, R.A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clin Psychol Rev, 22, 499–524.

Kangas, M., Tate, R.L., Williams, J.R., & Smee, R.I. (2012). The effects of radiotherapy on psychosocial and cognitive functioning in adults with a primary brain tumor: a prospective evaluation. Neuro Oncol,14(12), 1485–502.

Li, X., Li, J., Shi, Y., Wang, T., Zhang, A., Shao, N., & Wang, Z. (2017). Psychological intervention improves life quality of patients with laryngeal cancer. Patient Prefer Adherence, 11, 1723–1727.

Mehnert, A., Lehmann, C., Graefen, M., Huland, H., & Koch, U. (2010). Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. European Journal of Cancer Care, 19(6), 736–745.

Mystakidou, K., Parpa, E., Tsilika, E., Panagiotou, I., Galanos A., Sakkas, P., & Gouliamos A. (2012). Traumatic experiences of patients with advanced cancer. J Loss Trauma, 17, 125–136. doi:10.1080/15325024.2011.595296.

Parikh, D., De Ieso, P., Garvey, G., Thachil, T., Ramamoorthi, R., Penniment, M., & Jayaraj, R. (2015). Post-traumatic stress disorder and post-traumatic growth in breast cancer patients—A systematic review. Asian Pac J Cancer Prev, 16(2), 641–646

Posluszny, D.M., Edwards, R.P., Dew, M.A., & Baum, A. (2011). Perceived threat and PTSD symptoms in women undergoing surgery for gynaecologic cancer or benign conditions. Psycho-Oncology, 20, 783–787, doi:10.1002/ pon.1771.

Posluszny, D.M., Dougall, A.L., Johnson, J.T., Argiris, A., Ferris, R.L., Baum, A., ... Dew, M.A. (2015). Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners. Head & Neck, 37(9), 1282–1289.

Pranjic, N., Bajraktarevic, A., & Ramic, E. (2016). Distress and PTSD in patients with cancer: Cohort study case. Materia socio-medica, 28(1), 12.

Riedl, D., Gastl, R., Gamper, E., Arnold, C. R., Dejaco, D., Schoellmann, F., & Rumpold G. (2018). Cancer patients’ wish for psychological support during outpatient radiation therapy: Findings from a psychooncological monitoring program in clinical routine. Strahlenther Onkol, [Epub ahead of print]. doi:10.1007/s00066-018-1288-0

Ristvedt, S.L., & Trinkaus, K.M. (2009). Trait anxiety as an independent predictor of poor health-related quality of life and post-traumatic stress symptoms in rectal cancer. British Journal of Health Psychology,14(4), 701–715.

Shand, L.K., Cowlishaw, S., Brooker, J.E., Burney, S., & Ricciardelli, L.A. (2015). Correlates of posttraumatic stress symptoms and growth in cancer patients: A systematic review and meta-analysis. Psychooncology, 24, 624–34.

Smith, S.K., Zimmerman, S., Williams, C.S, Benecha, H., Abernethy, A.P., Mayer, D.K., … Ganz, P.A. (2011). Post-traumatic stress symptoms in long-term non-Hodgkin’s lymphoma survivors: Does time heal? Journal of Clinical Oncology, 29(34), 4526–4533.

Swartzman, S., Booth, J.N., Munro, A., & Sani, F. (2017). Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depression and Anxiety, 34(4), 327–339.

Thomas, K.S., Bower, J.E., Williamson, T.J., Hoyt, M.A., Wellisch, D., Stanton, A.L., & Irwin, M. (2012). Post-traumatic disorder symptoms and blunted diurnal cortisol production in partners of prostate cancer patients. Psychoneuroendocrinology, 37(8), 1181–1190.

Urbaniec, O.A., Collins, K., Denson, L.A., & Whitford, H.S. (2011). Gynecological cancer survivors: Assessment of psychological distress and unmet supportive care needs. Journal of Psychosocial Oncology, 29(5), 534–551.

Varela, V.S., Ng, A., Mauch, P., & Recklitis, C.J. (2013). Posttraumatic stress disorder (PTSD) in survivors of Hodgkin’s lymphoma: Prevalence of PTSD and partial PTSD compared with sibling controls. Psycho‐Oncology, 22(2), 434–440.

Wachen, J., Patidar, S., Mulligan, E., Naik, A., & Moye, J. (2014). Cancer-related PTSD symptoms in a veteran sample: Association with age, combat PTSD, and quality of life. Psychooncology, 23, 921–927.

Wess, M. (2007). Bringing hope and healing to grieving patients with cancer. The Journal of the American Osteopathic Association, 107, ES41–ES47.


  • There are currently no refbacks.