Cancer-related post-traumatic stress (PTS) is a lot like post-traumatic stress disorder (PTSD) but not as severe.

Patients have a range of normal reactions when they hear they have cancer. These include:

• Repeated frightening thoughts.
• Being distracted or overexcited.
• Trouble sleeping.
• Feeling detached from oneself or reality.

Patients may also have feelings of shock, fear, helplessness, or horror. These feelings may lead to cancer-related post-traumaticstress (PTS), which is a lot like post-traumatic stress disorder (PTSD). PTSD is a specific group of symptoms that affect many survivors of stressful events. These events usually involve the threat of death or serious injury to oneself or others. People who have survived military combat, natural disasters, violent personal attack (such as rape), or other life-threatening stress may suffer from PTSD. The symptoms for PTS and PTSD are a lot alike, but most cancer patients are able to cope and don't develop full PTSD. The symptoms of cancer-related PTS are not as severe and don't last as long as PTSD.

Cancer-related PTS can occur anytime during or after treatment.

Patients dealing with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during possible recurrence of the cancer. Parents of childhood cancer survivors may also have post-traumatic stress.

Certain factors may make it more likely that a patient will have post-traumatic stress.

It is not completely clear who has an increased risk of cancer-related post-traumatic stress. Certain physical and mental factors that are linked to PTS or PTSD have been reported in some studies:

Physical factors

• Cancer that recurs (comes back) was shown to increase stress symptoms in patients.
• Breast cancer survivors who had more advanced cancer or lengthy surgeries, or a history of trauma or anxiety disorders, were more likely to be diagnosed with PTSD.
• In survivors of childhood cancer, symptoms of post-traumatic stress occurred more often when there was a longer treatment time. See the PDQ summary on Pediatric Supportive Care for more information.

Psychological, mental and social factors

• Previous trauma.
• High level of general stress.
• Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.
• The amount of social support available.
• Threat to life and body.
• Having PTSD or other psychological problems before being diagnosed with cancer.
• The use of avoidance to cope with stress.

Certain protective factors may make it less likely that a patient will develop post-traumatic stress.

Cancer patients may have a lower risk of post-traumatic stress if they have the following:

• Good social support.
• Clear information about the stage of their cancer.
• An open relationship with their healthcare providers.

Symptoms of cancer-related post-traumatic stress may be triggered when certain smells, sounds, and sights are linked with chemotherapy or other treatments.

Post-traumatic stress symptoms develop by conditioning.

Conditioning occurs when certain triggers become linked with an upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended.

The cancer experience is more than one stressful event.

Cancer may involve stressful events that repeat or continue over time. The patient may suffer symptoms of post-traumatic stress anytime from diagnosis through completion of treatment and possible cancer recurrence, so screening may be needed more than once. Different screening methods may be used to find out if the patient is having symptoms of PTS or PTSD.

In patients who have a history of PTSD from a previous trauma, symptoms may start again by certain triggers during their cancer treatment (for example, being inside MRI or CT scanners). These patients also may have problems adjusting to cancer and cancer treatment.

Cancer survivors and their families need long-term monitoring for post-traumatic stress.

Symptoms of post-traumatic stress usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years afterwards. Therefore, cancer survivors and their families need long-term monitoring.

Some people who have had an upsetting event may show early symptoms but do not have full PTSD. However, patients with these early symptoms often develop PTSD later. These patients and their family members should receive repeated screening and long-term follow-up.See the PDQ summary on Adjustment to Cancer: Anxiety and Distress for more information.

There are many possible triggers for cancer-related post-traumatic stress (PTS) in patients dealing with cancer.

For a patient coping with cancer, the specific trauma that triggers cancer-related post-traumatic stress isn't always known. Because the cancer experience involves so many upsetting events, it is much harder to know the exact cause of stress than it is for other traumas, such as natural disasters or rape.

Triggers during the cancer experience may include the following:

• Being diagnosed with a life-threatening illness.
• Receiving treatment.
• Waiting for test results.
• Learning the cancer has recurred.

It is important to know the triggers in order to get treatment.

Symptoms of cancer-related post-traumatic stress (PTS) are a lot like symptoms of other stress-related disorders.

PTS has many of the same symptoms as depression, anxiety disorders, phobias, and panic disorder.

Some of the symptoms that may be seen in post-traumatic stress and in other conditions include:

• Feeling defensive, irritable, or fearful.
• Being unable to think clearly.
• Sleeping problems.
• Avoiding other people.
• Loss of interest in life.

Treatments used for PTS may be the same as treatments for PTSD.

Although there are no specific treatments for post-traumatic stress in patients with cancer, treatments used for people with PTSD can be useful in relieving distress in cancer patients and survivors.

Cancer survivors with post-traumatic stress need early treatment with methods that are used to treat other trauma victims.

Effects of post-traumatic stress are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may affect personal relationships, education, and employment. Because avoiding places and persons linked with cancer is part of post-traumatic stress, the patient may avoid getting professional care.

It is important that cancer survivors are aware of the possible mental distress of living with cancer and the need for early treatment of post-traumatic stress. More than one kind of treatment may be used.

Crisis intervention techniques, relaxation training, and support groups may help symptoms of post-traumatic stress.

The crisis intervention method aims to relieve distress and help the patient return to normal activities. This method focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient.

Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Through cognitive behavioral therapy (CBT), patients may be helped to:

• Understand their symptoms.
• Learn ways to cope and to manage stress (such as relaxation training).
• Become aware of thinking patterns that cause distress and replace them with more balanced and useful ways of thinking.
• Become less sensitive to upsetting triggers.

Support groups may also help people who have post-traumatic stress symptoms. In the group setting, patients can get emotional support, meet others with similar experiences and symptoms, and learn coping and management skills.

Medicines may be used for severe symptoms of post-traumatic stress.

For patients with severe symptoms of post-traumatic stress, medicines may be used. For example:

• Tricyclic and monoamine oxidase inhibitor (MOA) antidepressants are used, especially when post-traumatic stress occurs along with depression.
• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine may reduce the stress that occurs in what is known as the "fight-or-flight syndrome".
• Antianxiety medicines may help reduce symptoms of anxiety. In certain cases, antipsychotic medicines may reduce severe flashbacks.