High Incidence of PTSD Among Cancer Patients

Caryn Mei Hsien Chan, PhD

New data has revealed that 20% of patients with cancer experienced post-traumatic stress disorder (PTSD) within months of their diagnosis, and continue to live with the condition years later.

While the condition normally occurs after a traumatic or high-stress event, it has also been found to be strongly associated with the presence of early life stressors and FKBP5 genotypes, according to a separate study from the University of Alabama at Birmingham.

The new data - done by Caryn Mei Hsien Chan, PhD, and colleagues from the National University of Malaysia - published in the journal CANCER, examined 469 adult patients with various types of cancer within 1 month of their diagnosis. Patients were tested for PTSD after a 6-month period, with a follow-up assessment at the 4-year mark.

The incidence of PTSD 6 months post-diagnosis was 21.7%, dropping to 6.1% after 4 years follow-up. Despite the decrease in PTSD prevalence, an estimated 33% of patients that were diagnosed with PTSD were still experiencing persistent symptoms - in many cases worsening - at the time of the 4-year follow-up.

"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," Chan said in a statement. "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."

Chan and colleagues noted that patients with cancer often face the fear of relapsing out of remission, which causes stress anytime the patient finds a lump or bump, or experiences some sort of ache, pain, fatigue, or fever.

Patients often skip oncologist visits as well out of fear of triggering memories of the experience, Chan said. Charles Raison, MD, a professor of psychiatry at the University of Wisconson-Madison, told MD Magazine that older studies done on cancer patients found that many of them turned to alcohol to deal with their stressors.

Raison noted that based on what we know from these older studies, the use of psychedelics aided in the coping process. “People with cancer found that it helped give them acceptance of mortality,” he said.

More recently, 2 studies, one from New York University and another from Johns Hopkins University have revisited the use of psilocybin - a psychedelic compound found in mushrooms - to treat anxiety and depression in patients with cancer.

“They were both randomized, placebo-controlled, double-blind studies where people were blindly given either an active psilocybin or different placebos, but each study had a placebo,” Raison said. “They got one treatment, and then they were followed for about a month and a half, and then they did what's called a crossover. So the people who got psilocybin got placebo and vice versa, and then they followed them for another 6 months.”

The studies found that a single treatment resulted in reduced depression and anxiety scores, and after 6 months on the therapy, 60% to 70% of patients were completely in remission from their PTSD.

In August 2017, the US Food and Drug Administration (FDA) granted a Breakthrough Therapy Designation to methylenedioxymethamphetamine, otherwise known as MDMA, for the treatment of PTSD. In the study data presented to the FDA, it was shown to reduce PTSD by 68% after 6 months.

“They're finding the same things that their investigators found with psilocybin, which is that if you do this therapy program, a huge percentage of people months and months later are essentially in remission from their post-traumatic stress disorder symptoms,” Raison said.

Chan and colleagues also noted the importance of managing and treating PTSD among these patients. They found that the incidences of PSTD varied depending on the type of cancer the patient had and the amount of time since diagnosis. Data showed that breast cancer patients had 3.7 times less likely odds of developing PTSD at 6 months, but were just as likely as others after 4 years.

"We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follow-up because psychological well-being and mental health - and by extension, quality of life - are just as important as physical health," Chan said.

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