Childhood cancer not associated with future PTSD

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1. Children with a history of cancer are not shown to have an increased risk for Post-Traumatic Stress Disorder (PTSD) or Post-Traumatic Stress Symptoms (PTSS).

Evidence rating level: 2 (Good)

Study Rundown: Previous studies examining the psychological impact of cancer diagnosis and treatment in childhood have suggested that Post-Traumatic Stress Disorder (PTSD) and Post-Traumatic Stress Symptoms (PTSS) are widespread and are the directly result of this traumatic event. Estimates for cancer-related PTSD have ranged from 20% to 35% in survivors. However, the authors of this study suggest that these findings are the result of imperfect study designs with focusing effects, non-standardized diagnostic interviewing methodology, and absent controls, biasing the literature towards pathology. Therefore, the purpose of this study was to eliminate these biases in order to better understand the relationship between childhood cancer and PTSD.

At the conclusion of this control-matched cohort study, the authors found that there was no statistically significant difference in rates of PTSD/PTSS between children with cancer and demographically matched controls. Interestingly, when specifically referring to cancer, PTSS was significantly lower and perceived growth much higher in the cancer group compared to the control group. Based on these findings, the authors suggest that the findings of widespread PTSD from previous studies are in fact overstated. They conclude that, though the experience of cancer in childhood remains a highly significant event, resilience among children should not be underestimated.

These results benefit from the methodology of this study, which included efforts to reduce focusing effects, including a matched comparison group with identical assessments, and using a structured diagnostic interview gold standard for PTSD. Nevertheless, it should be noted that patients and controls were recruited from a single site, limiting these findings’ generalizability. The comparison group was also not completely matched, though this was corrected in analysis. Finally, selection bias is possible as more distressed patients may have been less likely to participate, though analysis of referrals for psychological services showed no difference between participants and non-participants.

Click to read the article in JCO

Relevant reading: Post-traumatic stress disorder following cancer: A conceptual and empirial review

In-Depth [Prospective cohort study]: The study authors recruiting patients from St. Jude Children’s Research Hospital aged 8-17 years, >1 month post-diagnosis, diagnosis of malignancy, and no significant cognitive or sensory deficits. They were stratified by time elapsed since diagnosis. The control group included 8-17 year-old children without a history of serious illness or cognitive/sensory deficits recruited from regional schools. Both groups were interviewed with a structured assessment based on DSM-IV PTSD criteria in youth, based on the event spontaneously identified by the child as most traumatic—rather than starting with a prompt to think of cancer as a traumatic event. PTSD diagnostic interviews were based on the event identified by the child as most traumatic. The primary outcomes were the percentage of cancer patients who spontaneously identified a cancer-related event as their most traumatic, rates of full PTSD in cancer and healthy controls, rates of child-reported PTSS, and self-reports of perceived benefit. Parents were also interviewed separately about their children’s symptoms.

A total of 255 children with cancer and 101 demographically matched controls were interviewed. Cancer was spontaneously identified as a traumatic event by 52.6% of children with cancer, decreasing with time from diagnosis. By the diagnostic interview, 0.4% and 2.8% of children with cancer had current PTSD or met lifetime criteria, respectively. By parent report, 1.6% and 5.9% had current PTSD or met lifetime criteria. There was no significant difference in any of these rates compared to the control group (P > 0.1 for all). PTSS was descriptively lower in the cancer group but with no significant difference from controls (P = 0.067). However, when referring specifically to cancer-related events, PTSS in the cancer group were significantly lower than controls (P = 0.002), and perceived group significantly higher (P < 0.001).

By Monica Parks and Andrew Bishara

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