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PTSD symptoms common after diagnosis of breast cancer
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Approximately one in four women who were newly diagnosed with breast cancer reported symptoms consistent with posttraumatic stress disorder shortly after diagnosis, according to recent study results.
Previous studies have identified risk factors for posttraumatic stress disorder (PTSD) after a diagnosis of cancer, including demographic, social, psychosocial and clinical characteristics, such as socioeconomic status, lower education, reduced social support, younger age at diagnosis, type of surgery, lymph node involvement and stage of disease.
Racial disparities also have been a concern in breast cancer care, primarily in differences in survival outcomes, but studies indicate that PTSD risk may be dissimilar among racial/ethnic groups.
“This study is one of the first to evaluate the course of PTSD after a diagnosis of breast cancer,” Alfred Neugut, MD, PhD, professor of medicine and epidemiology at Columbia University’s College of Physicians and Surgeons and Mailman School of Public Health, said in a press release. “If we can identify potential risk factors for PTSD, when women are diagnosed with breast cancer, we could provide early prevention and intervention to minimize PTSD symptoms. This approach might also have an indirect impact on the observed racial disparity in breast cancer survival.”
To investigate changes in PTSD symptoms in the first 6 months after diagnosis and assess racial/ethnic differences in PTSD symptoms over time, Neugut and colleagues conducted interviews with 1,139 women with newly diagnosed breast cancer from three sites in the United States.
The researchers conducted three telephone interviews beginning with a baseline 2 to 3 months after diagnosis, with first follow-up at 4 months and second follow-up at 6 months, measuring traumatic stress in each interview using the Impact of Events Scale.
Neugut and colleagues also recorded sociodemographic, tumor and treatment factors, and they used generalized estimating equations and polytomous logistic regression modeling to study the relationship between variables of interest and PTSD.
According to study results, 23% of surveyed patients reported symptoms consistent with a diagnosis of PTSD at baseline: 16.5% at first follow-up and 12.6% at the second follow-up. Among participants without PTSD at baseline, 6.6% developed PTSD at the first follow-up interview.
Younger women were more likely than older women to have PTSD symptoms, whereas Asian (OR=1.69, 95% CI, 1.10-2.59) and black (OR=1.48, 95% CI, 1.04-2.10) women were at higher risk for PTSD than white women.
“We found PTSD among approximately 25% of the women shortly after diagnosis; when examining patterns of PTSD, we found that the prevalence of PTSD decreased over time,” Neugut and colleagues wrote. “The main factors associated with PTSD were younger age and being Asian or black. These potential risk factors can be identified at the time of diagnosis and may present an opportunity to provide early prevention and intervention to minimize PTSD symptomatology.”
Perspective
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Liana D. Castel, PhD, MSPH
Among breast cancer patients, there is a need for better understanding of posttraumatic stress disorder (PTSD) prevalence, course over time and risk factors.
Vin-Raviv and colleagues report an analysis from a large, racially diverse cohort that assessed baseline clinical and demographic characteristics, as well as longitudinal PTSD, with excellent follow-up/retention rates. Useful information about PTSD prevalence and course is presented.
The authors report that the polytomous model assumptions were violated, yet use the polytomous rather than the logistic model as the basis for the study's conclusions.
In the logistic model, age younger than 50 years at diagnosis was the strongest risk factor observed, associated with a more than twofold increased risk of PTSD. In decreasing order of magnitude of association, Asian race, recruitment site and black race also were associated with increased PTSD risk.
The discussion, title and abstract focus nearly exclusively on the findings among patients of black race. There is little contextualization of findings on recruitment site and Asian race.
PTSD may negatively affect health outcomes by influencing compliance with cancer treatment. This link should be researched further, and risk factors should be considered in terms of their relative strength and precision, in order to inform specific recommendations for future interventions.
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