Post-traumatic stress disorder (PTSD) is often associated with war veterans or survivors of natural disasters, but there is growing recognition that battling a life-threatening illness like cancer can also precipitate the disorder. From diagnosis to treatment and survivorship, each step of living with cancer carries not only physical but emotional burdens, the latter of which can create extreme stress and trauma.
It’s unknown exactly how many cancer survivors are living with PTSD, but a study by researchers at the National University of Malaysia suggest about one-fifth — 21.7 percent — of survivors may suffer from PTSD at six months following their diagnosis. Rates dropped with time, and at a four-year follow-up only about 6 percent of the cancer survivors experienced PTSD.
In about one-third of the PTSD cases, however, symptoms persisted or became worse after four years. Cancer-related PTSD is unique in that feelings of fear, lack of control and devastation often accompany a cancer diagnosis and may begin even in the weeks leading up to it, as various tests or surgeries are performed. Difficult treatments, such as chemotherapy or radiation, represent another form of ongoing trauma to many patients.
Even after treatment is completed, the stress continues as survivors may live with a constant fear of recurrence. While initially the diagnosis and treatment of the disease may trigger PTSD, in time, the fear of recurrence may be the primary stressor for cancer-related PTSD.
Visiting a doctor’s office or hospital for a routine treatment or follow-up appointment can trigger PTSD symptoms, which could prompt some survivors to skip them altogether, putting their health at risk. Other signs of PTSD include nightmares and flashbacks, difficulty sleeping or concentrating, loss of interest in activities you once enjoyed, unwanted or frightening thoughts or difficulty feeling emotions.
Importantly, the featured study revealed that patients with breast cancer were 3.7 times less likely to develop PTSD at six months (though not at four years), likely because of the availability of a support program that focused primarily on breast cancer patients. Speaking with The ASCO Post, study author Caryn Mei Hsien Chan, Ph.D. explained the importance of psychological evaluation, support and follow-up services for people with cancer, noting:
“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 … 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.” 
If you’re a cancer patient or survivor, it’s normal to experience feelings of fear or anxiety. However, if those feelings get worse over time instead of better or begin to interfere with your daily life, seek help from a mental health professional.
1. Cancer November 20, 2017
2. J Psychiatr Pract. 2011 Jul; 17(4): 270–276
3. Cancer.net PTSD and Cancer January 2016
4. The ASCO Post November 29, 2017
Living Better with Cancer