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PTSD Often Seen With Breast Cancer Diagnosis
Nearly a quarter of women newly diagnosed with breast cancer experienced post-traumatic stress disorder (PTSD), with blacks, Asians, and women younger than 50 reporting distress more often, a study found.
Of 1,139 participants culled from the 2006-2010 Breast Cancer Quality of Care Study (BQUAL), 23% reported PTSD at baseline of 2 to 3 months post diagnosis, according to Alfred I. Neugut, MD, PhD, of Columbia University in New York City, and colleagues. Symptoms diminished over time, with 16.5% of participants reporting PTSD symptoms 4 months after diagnosis, and 12.6% reporting it at 6 months.
Identifying PTSD in women with breast cancer early in diagnosis would help manage their symptoms and treatment better, they wrote online in the Journal of the National Cancer Institute. The authors said they believed this study was one of the first of its kind to measure PTSD among women with newly diagnosed breast cancer.
All participants were newly diagnosed with stage I, II or III breast cancer. The study was conducted by telephone between 2006 and 2010, and participants were recruited from three sites nationally: New York-Presbyterian Columbia University Medical Center and Mount Sinai School of Medicine in New York City; the Henry Ford Health System in Detroit; and Kaiser-Permanente in Northern California.
Investigators conducted three telephone interviews with participants: one at baseline -- 2 to 3 months after diagnosis -- a first follow-up at 4 months after diagnosis, and a second follow-up at 6 months after diagnosis.
PTSD was measured on a 15-item Impact of Event Scale, which assessed whether the patient experienced avoidance, arousal, and reliving the stress associated with diagnosis. Life-threatening illnesses like cancer have been included in the Diagnostic and Statistical Manual of Mental Disorders since 1994.
The authors noted that 12.6% of participants reported having PTSD at the second follow-up interview. A total of 12.1% of participants had "persistent" PTSD, defined as having reported it at two consecutive interviews.
Of participants who did not report PTSD at baseline, 6.6% developed PTSD by 2 to 3 months at the first follow-up interview, they noted.
Being younger than 50 at diagnosis (OR 2.98, 95% CI 1.58 to 5.12), being black (OR 1.48 versus white, 95% CI 1.04 to 2.10), and being Asian (OR 1.69 versus white, 95% CI 1.10 to 2.59) all increased the odds of developing PTSD.
Some demographics in this study may have "confounded" the relation between PTSD and race, the authors wrote. Compared with white women, black women might be at higher risk for PTSD because of factors like lower income levels and less education, they said. "However, in the current study, we did not observe an association between PTSD and lower education or lower income."
Women from the New York site reported more PTSD than other sites, but only at baseline, the authors wrote.
Positive lymph node status showed increased PTSD at baseline (28.7%, P=0.01) and at first follow-up (16.8%, P=0.03). At the second follow-up, higher PTSD was reported among patients with stage III cancer (23.9%, P=0.01) and positive HER2 status (19.8%, P=0.03).
Prior studies have shown lifelong exposure to trauma associated with PTSD, and traumatic events were most often reported in the Detroit population. And although most of the participants were insured in this study, the authors said they could not generalize about uninsured patients.
The study was supported by the U.S. Department of Defense, the National Cancer Institute, the Breast Cancer Foundation, and the Environmental Health Foundation.
The authors reported no conflicts of interest.
Primary source: Journal of the National Cancer Institute
Source reference:
Neugut, A, et al "Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: The BQUAL Study" J Nat Cancer Inst 2013; DOI: 10.1093v/JNCI Jour.
Source reference:
Neugut, A, et al "Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: The BQUAL Study" J Nat Cancer Inst 2013; DOI: 10.1093v/JNCI Jour.
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