Post-traumatic Stress Disorder and Breast Cancer

When thinking about breast cancer it is important that we remember that this diagnosis will impact all aspects of a patient and their family’s life. Post-Traumatic Stress disorder (PTSD) has been shown to not only be present in people with a breast cancer diagnosis, but also to possibly play a role in the trajectory of the disease.

Overview

A recent literature review examined studies from 2002 to 2016 that looked at the association between PTSD and breast cancer. They noticed that zero to thirty-two percent of people with breast cancer were diagnosed with PTSD. This sometimes depended on the method used to diagnose PTSD, as there are various tools that clinicians will use to make a diagnosis. To date, no consensus has been reached regarding additional risk factors that may make an individual with a cancer diagnosis more likely to have PTSD, but we can surmise that other factors such as lack of social support, and low economic status can play a role.

PTSD impacts all aspects of a person’s life, so it is essential that it is treated. It is important that PTSD be treated by specialized professionals, and that the entire healthcare team is on board with working together to treat the patient effectively.
Women who are diagnosed with breast cancer may later be asked to recall their first feelings after diagnosis. These symptoms can include out of body experiences, where the woman has the sensation that this is happening to someone else, feeling emotionally numb, experiencing nightmares, flashbacks and more. The Diagnostic and Statistical Manual of Mental Disorders (DSM) version IV has recognized that it is possible for people to get PTSD from a medical diagnosis. In the new DSM V cancer diagnosis is considered a traumatic event only when the diagnosis is sudden and severe. While the percentage of patients diagnosed with PTSD varied greatly, up to seventy-five percent of women with breast cancer had PTSD symptoms without meeting all of the criteria for a diagnosis. Even without the full diagnosis, PTSD symptoms can have a negative impact on the overall health of an individual.

The research

This literature review looked at 23 studies that looked at PTSD or PTSD symptoms in breast cancer. The studies that were chosen included randomized studies as well as cohort studies that had a good quality design, and a review that included control groups. Using these studies, the researchers then sought to determine whether or not a cancer diagnosis can act as a precipitator for PTSD. The results of their research varied greatly mostly in relation to the stage of the cancer and the method used for PTSD diagnosis.

Overall the research showed that PTSD is not a risk factor for cancer development, but it is clear that people with diseases such as breast cancer are at higher risk for developing PTSD. One study that was reviewed did show that there is a significant relationship between stressful events such as divorce, and death of a loved one, to breast cancer incidence. While the correlation has been identified, the mechanism is still not known.

Cortisol, which is commonly referred to as the stress hormone, has been shown to play a role in breast cancer development. Cortisol is always present in the body, but when an individual is stressed out, the cortisol stays in the system longer and is not well regulated. Laboratory data now shows that cortisol can alter the generation and activity of estrogen which is implicated in breast tumor development.

Research shows that patients with PTSD ins addition to breast cancer have a significantly lower performance status, physical health status, and mental health status than patients without PTSD. This often impacts an individual’s ability to continue working.

Implications

It is important that people who have PTSD are diagnosed early on so that they can get appropriate treatment and avoid long term consequences. It is present in higher rates in breast cancer than it is in colorectal, head and neck cancer, but lower than gynecological, and hematological cancers. Patients will need to adhere to PTSD treatment plans in the long term to avoid difficulties with information processing, decision making, and communication, as well as social issues. PTSD can decrease a patient’s quality of life. Having a concomitant PTSD diagnosis along with breast cancer, makes adjusting to life changes and implications of the breast cancer diagnosis more difficult. This can have a long-term impact and make the adjusting and coping difficult for years after the initial diagnosis. One study specifically noted that PTSD symptoms seem to have more of an effect on quality of life, relationships, and communication than chemotherapy does. Co-treatment for PTSD and breast cancer is essential in helping the entire person recover. This also means that healthcare professionals need to be trained in caring for patients with PTSD and breast cancer from a multidisciplinary team approach. All healthcare providers need to know how to provide trauma informed care so as not to further traumatize the patient.

This also brings up the issue of providing comprehensive and integrated psychological care for patients even after they have gone into remission. This can be challenging for many especially given the cost of mental healthcare coverage. In Europe, mental health care is not considered to be the responsibility of the hospital. Instead this task is given to private mental health care organizations. This alone shows how symptoms of psychological stress are present after patients have survived breast cancer. Continuing a team based approach to their health care would be ideal. This way all providers would be on board with ensuring that the patient is getting the care that she needs.

Whether a person is diagnosed with breast cancer or not, it is important that she work to keep stress levels to a minimum. The effect that stress has on breast cancer may be unknown, but we have plenty of research that tells us that stress negatively effects our bodies and lives in different way. Knowing the potential negative effects that stress has on our lives can help motivate us to reduce these stresses.

There are many different tactics that people can use to lower their stress with or without a PTSD or breast cancer diagnosis. What works for one person may not work for another. Talking with and having the support of loved ones is important and can be very therapeutic. Joining support groups can also help people process what they are experiencing, and find solace in knowing that they are not alone. Simple things such as exercising and writing in a journal can also help. Trying to maintain hobbies and having creative outlets can be a great way to process what you are going through. Also, everyone needs that objective person to talk to sometimes. There is no shame in seeking professional help with a licensed counselor or psychologist.

You can also find ways to get involved and support the breast cancer community. Whether that be through fundraising, volunteering, or helping to raise awareness, it can make patients feel proactive and like they are taking some control back over their lives. There are many different ways to get involved, so check out some breast cancer awareness organizations and look for some events near you!