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“We found similar rates of cancer-related PTSS [posttraumatic stress symptoms] in breast cancer survivors diagnosed at a young age compared with the general breast cancer population despite their well-documented increased risk of overall distress,” wrote Danny Vazquez, M.D., M.P.P., of Dana-Farber Cancer Institute and colleagues. “Nevertheless, factors associated with posttraumatic stress should be considered at diagnosis and in survivorship to identify young patients who may benefit from psychosocial resources.”
The findings were based on data collected as part of the Young Women’s Breast Cancer Study—an ongoing prospective cohort study of more than 1,300 women diagnosed with breast cancer at or before the age of 40. Study participants received a baseline survey within six months of diagnosis, and follow-up surveys were sent every six months for the first three years after diagnosis and yearly thereafter.
At baseline, all participants filled out questionnaires assessing symptoms of anxiety and depression, fear of cancer recurrence, and presence of social support; participants were also asked about psychiatric comorbidities and use of psychiatric medications. At 30 months, the participants were asked to fill out the 17- item PTSD Checklist-Specific Version questionnaire and rate the severity of PTSD symptoms they had experienced over the prior month specifically related to “cancer treatment or your experience with cancer” on a scale from 1 (“not at all”) to 5 (“extremely”). A score ≥ 50 was considered positive for clinically significant posttraumatic stress symptoms. Women diagnosed with stage 0 or stage 4 cancer, those with missing PTSD data, and those who experienced a recurrence within 12 months of the PTSD survey were excluded from the analysis.
Of the 700 women who had been diagnosed with stage 1-3 breast cancer included in the analysis, about 2% had psychiatric comorbidities and 3% reported taking psychiatric medications. Additionally, 8% screened positive for depression, 23% screened positive for anxiety, and 23% of women reported substantial fears of recurrence at baseline.
Clinically significant posttraumatic stress symptoms at 30 months were significantly associated with anxiety (odds ratio=12.43) and stage 2 vs. stage 1 disease (odds ratio= 2.26), the authors reported. There was no increased risk seen with stage 3 vs. stage 1 disease, but the authors noted that this might be due to the low number of women with stage 3 breast cancer (99 of 700) in the analysis. Women with a college degree and greater social support were less likely to report posttraumatic stress symptoms at 30 months.
“Early identification of those at risk could facilitate individualized screening strategies for the development of PTSS, as well as targeted medical interventions to improve [the] mental health and quality of life of breast cancer survivors diagnosed at a young age,” Vazquez and colleagues wrote.
(Image: iStock/Ridofranz)
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