Abstract
It is a well-established multidisciplinary practice at the European Institute of Oncology, that nurses and physicians often report their difficulties to clinical psychologists regarding adherence to hospital scheduling and procedures, when faced with women who, having been diagnosed with cancer, may be too overwhelmed to understand medical advice. We thus undertook an observational-prospective-cohort study, to investigate the prevalence and variation of PTSD symptomatology in women awaiting a mastectomy at a mean of 30 days after diagnosis and up to 2 years after discharge from hospital. The presence of any correlations between PTSD symptoms and medical and psycho-social variables was also investigated. Between March 2011 and June 2012, 150 women entered the study and were evaluated at four points in time: pre-hospital admission, admission for surgery, hospital discharge and two years later. The prevalence of distress at pre-hospital admission was 20% for intrusion symptoms, 19.1% for avoidance symptoms and 70.7% for state anxiety. Intrusion was negatively correlated with time from diagnosis independently of tumor dimensions, i.e. independently of the perceived seriousness of the illness. Even though at two-year follow up the prevalence of intrusion and avoidance is similar to that in the general population, patients with high levels of intrusion and avoidance at pre-hospital admission will maintain these levels, showing difficulties in adjusting to illness even two years later. As for psycho-social factors, the presence of a positive cancer family and relational history is associated with high levels of distress, in particular with intrusive thinking. Proper interventions aimed at the management of these issues and at their implications in clinical practice is clearly warranted.
Highlights
Nowadays, the psychological consequences of a cancer diagnosis are well-recognized worldwide
In other studies (Zabora et al 2001; Palyo and Gayle 2006) it emerges that post-traumatic stress disorder (PTSD) symptoms are correlated with pain perception and levels of fatigue underlining the importance of the cognitive dimension (E.g. “which resources may I use?”) in modulating emotional functioning. These results have important clinical implications: physicians and surgeons should be made aware of the high prevalence of post-traumatic stress symptoms in their newly-diagnosed breast cancer patients and they, should be helped in adapting their communication skills to these issues thorough continuing medical education (CME) programs: CME programs could be viewed as offering systematic assistance in identifying patients emerging needs
Our results underline the importance of a standardized measurement of psychological distress being incorporated into the hospital routine with specific attention paid to PTSD symptoms
Summary
The psychological consequences of a cancer diagnosis are well-recognized worldwide. In 1994, the American Psychiatric Association (APA) recognized diagnosis with a life-threatening illness, such as cancer, as a traumatic stressor that could precipitate another psychological syndrome: the post-traumatic stress disorder (PTSD) (American Psychiatric Association 1994). The Diagnostic and Statistic Manual of Mental Disorders - V edition (American Psychiatric Association 2013) includes PTSD in a new chapter on trauma and stress-related disorders: PTSD, regardless of its trigger event, is characterized by clinically significant distress or impairment in the individual’s social interactions, ability to work, or in other key areas of functioning. Symptoms that accompany PTSD fall into four distinct diagnostic clusters, instead of three (American Psychiatric Association 1994): re-experiencing, avoidance, negative cognitions and mood, and arousal
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