A large majority of women with breast cancer develop symptoms of post-traumatic stress disorder (PTSD) within the first few months after diagnosis, according to a new study led by researchers at Ludwig-Maximilians-Universitaet (LMU) in Munich, Germany.
The findings reveal that receiving a breast cancer diagnosis often has a stronger psychological impact than experiencing other types of severe trauma, such as a serious accident or a violent assault. Over half of the breast cancer patients in the study still suffered from at least one symptom of PTSD one year after diagnosis.
“That the high level of stress should persist for such a long time is particularly striking,” said lead researcher Dr. Kerstin Hermelink of the Breast Cancer Center in the Department of Gynecology and Obstetrics at the LMU Medical Center.
“Indeed, the severity of the psychological and emotional impact of the cancer diagnosis is underlined by another result reported in the study. When patients who had already had a traumatic experience, such as a serious accident or a violent assault, prior to the development of malignancy, some 40 percent of them rated having breast cancer as the more severe traumatic event.”
For the study, the researchers studied a group of 166 patients newly diagnosed with breast cancer. Over the course of the following year, the participants were evaluated at three specific time-points for the presence of clinically significant symptoms of PTSD. The findings were then compared to a control group of healthy patients.
During the period of time between the cancer diagnosis and the initiation of treatment, 82.5 percent of all patients were found to exhibit symptoms of PTSD. These included recurrent and intrusive reminders of the experiences associated with cancer, feelings of detachment and emotional numbness, increased arousal, sudden outbursts of anger, and an exaggerated startle response.
Although a full diagnosis of PTSD was found in only two percent of patients one year after the cancer diagnosis, 57.3 percent of the patients continued to display one or more PTSD symptoms at that point. In contrast, the rate of PTSD symptoms due to other traumatic events was very low in the controls and the patients alike.
The researchers set out to identify factors that could account for the varying incidence and duration of symptoms of PTSD among the study patients. While the type of cancer treatment did not make much of a difference regarding PTSD symptoms, the researchers found that education levels did.
“Neither the type of surgery nor receipt of chemotherapy had any significant effect on either of these variables, but a high level of education did have a favorable impact. A university education is evidently a marker for resources that enable patients to recover more rapidly from the psychological stresses associated with a diagnosis of breast cancer,” Hermelink said.
Furthermore, only patients who were free of metastatic disease, and could therefore hope to get permanently cured, were recruited into the study. Women who had a history of psychiatric disease were excluded as well.
“Indeed, we assume that the study is likely to somewhat underestimate the true incidence of post-traumatic stress symptoms in breast cancer patients,” Hermelink said.
The findings are published in the journal Psycho-Oncology.