Hi to all. The past few months in my blog postings I have primarily concentrated on coping with the trauma of breast cancer through stress reduction techniques, seeking abundance,and improving self-awareness by getting in touch with the authentic self/the Divine inside each of us. While writing these blog posts, I have continued researching updated published data regarding cancer-related Post Traumatic Stress Disorder.
In a study done at Columbia University College of Physicians and Surgeons, Dr. Alfred I. Neugut, MDPhD, an oncologist and a professor of epidemiology states “Anyone who’s had a life-threatening experience, including a cancer diagnosis can be a victim”(of PTSD). A research team led by Dr. Neuget recently surveyed 1,139 breast cancer patients in the six months following diagnosis and found that nearly one in four met the criteria for PTSD(Living with Cancer, Vol. 16, NO. 4 Fall 2013). In this study they found that approximately 25% of cancer patients and in some cases, even their caregivers are suffering the symptoms of Post Traumatic Stress Disorder. In Living With Cancer PTSD symptoms are broken down into simpler terms than the actual criteria in the Diagnostic and Statistical Manual…DSM IV(the DSM criteria is in an earlier posting from July 2013). It asks “could you have cancer-related PTSD? Talk to your cancer care team if one or more of these symptoms lasts a month or more.”
Panic attacks (both isolated and chronic), which include a racing heartbeat, trembling or shortness of breath
Avoidance of follow-up checkups and other appointments, or anything you associate with your cancer treatment
Feeling hyper-alert, almost like you’re on watch for something
Worry that any change in your body means your cancer has returned
Feeling jumpy or easily startled
Trouble falling asleep or staying asleep
Frequent nightmares or flashbacks
Additional information is from the National Cancer Institute: PDQ Post Traumatic Stress Disorder. Bethesda, MD:National Cancer Institute. Date last modified 06/15/2012. It states that the incidence of the full syndrome of PTSD (meeting full DSM-IV diagnostic criteria) ranges from 3% to 4% in early-stage patients recently diagnosed to 35% in patients evaluated after treatment. I understand this statistic as we are initially traumatized with the diagnosis and treatment, but are so physically and emotionally involved with surviving that it is not until treatment ends that symptoms of PTSD become more apparent in ourselves and possibly caregivers/loved ones. The PDQ further states that when incidence of the Post Traumatic Stress Disorder-like symptoms (subsyndromal…not meeting the full diagnostic criteria) is measured, the rates are higher, ranging from 20% in patients with early-stage cancer to 80% in those with recurrent cancer. Patients with former trauma and PTSD are more likely to experience cancer related PTSD or Acute Stress Disorder (ASD). These individuals with a history of PTSD are at a substantial risk for continued emotional difficulties. In a study of 115 patients with all stages of breast cancer, 4% met the full diagnostic criteria for PTSD; 41% met the subsnydromal criteria (not meeting the full criteria of symptoms) for PTSD. To put these statistics into my own words and easier reading: more survivors suffer from some of the symptoms of PTSD without meeting the full diagnostic criteria for the disorder. This, of course, does not mean that the symptoms from the criteria that are being experienced are not uncomfortable and/or causing avoidance of reminders of the trauma. It is the avoidance behaviors that could seriously affect follow-up care. The presence of pain and other physical symptoms has been shown to correlate with levels of intrusive thought. Late-stage cancer and cancer recurrence has been shown to increase the likelihood of stress symptoms. This, of course, would be obvious to those of us who are cancer survivors. I have found that survivors who have continued discomfort from their breast reconstruction have a more difficult time adjusting and experience more intrusive thoughts and anger. In recurrence one is experiencing the original trauma all over again, along with more intense future-oriented fears.
Protective factors in this NCI PDQ summary were greater perceived availability of social support, and the availability and timeliness of accurate-health related information. Women who were unaware of their cancer stage reported higher stress response symptoms than those who were more knowledgeable about the stage of their disease. It therefore appears that the quality of a patient’s relationship with their medical care team is a protective factor from stress related symptoms. The NCI PDQ summary correctly notes that a PTSD diagnosis is complicated in cancer patients because cancer is not an acute or discrete event, but is an experience marked by repeated traumas and indeterminate length. It continues, stating that the relative predominance of specific PTSD symptoms may wax and wane throughout the cancer experience and beyond. It concluded that there may be a delay of months or even years before symptoms appear in cancer survivors and their family members.
The NCI PDQ summary states that while no specific therapies for PTSD in the cancer setting have been developed, treatment modalities (types) used with other people with PTSD can help alleviate distress in cancer survivors. Most clinicians use a multimodal (a combination of treatment types) approach to meet the specific needs of each client and taking into account any additional problems such as depression or substance abuse (sometimes used to self-medicate the painful emotions away). Cognitive-behavioral techniques have proven especially helpful. Some of these methods include helping the client to understand symptoms, teaching effective coping strategies and stress management techniques (such as relaxation training), restructuring cognitions (thought patterns), and providing exposure to opportunities for systematic desensitization of symptoms. Support groups also appear to benefit people who experience post-traumatic symptoms. In the group setting survivors can receive emotional support and be with others with similar experiences and symptoms, thereby validating their own experiences and learning a variety of coping and management strategies. For clients with particularly distressing or severe symptoms, psychopharmacology (drugs) may provide an additional means of treatment. Anti-depressant and antianxiety medications may help reduce overall depression, arousal and anxiety symptoms. As per NCI PDQ, infrequently, antipsychotic medications may reduce severe intrusive flashbacks.
Remember, as survivors we are all here to help and inform each other. It is important to recognize the level of help that you feel you need or that you may feel a loved one needs to find relief from full-blown PTSD, subsyndromal symptoms of PTSD, depression, or anxiety. If you wish to find relief from uncomfortable emotions using more holistic methods there are a variety of sites that can assist with this: Breast Cancer Authority Blog by survivor, Diane Ross, with many knowledgeable contributors or Breastcancer.org are two excellent resources. There is also a wonderful new resource available from Gai Comans, a fellow survivor. You can access her website at Gaicomans.com. Among other valuable information Gai has just completed a compilation of inspiring survivor stories called“Survivor Secrets-Empower Your Life.” Each survivor (including Gai) answers the question “What did you wish you had known when you were first diagnosed with breast cancer?” The answer to that question and the inspiring story that each of these 21 survivors share give us all hope and inspiration. Blessings to all.
Feel free to email me at Karenfb22@yahoo.com. All emails will be confidential.