Can cancer survivors have PTSD? Although post-traumatic stress disorder (PTSD) is most often associated with war veterans and victims of assault, there’s growing evidence that cancer survivors suffer from it too.
Here’s what you need to know about the effect of PTSD on cancer survivors.
PTSD and Cancer
What Is PTSD?
- war or a combat experience;
- a violent assault (such as rape);
- a natural disaster; or
- a serious accident or illness (such as cancer).
Even though most people think of PTSD as a post-combat issue, it affects far more people than that. It can affect anyone who has experienced a traumatic event, whether through first-hand exposure or even indirectly (such as the violent death of a loved one). And women are twice as likely to develop PTSD than men are.
Regardless of the cause for PTSD, those affected by it have disturbing, intense thoughts relating to their traumatic experience that last long after the event occurred.
Can Cancer Survivors Have PTSD?
Until relatively recently, there hasn’t been a lot of research relating to PTSD in respect of cancer survivors. But that’s starting to change… and there’s growing evidence that life-threatening illnesses like cancer can precipitate the disorder.
Although it’s still unknown how many cancer survivors are affected by PTSD, one study suggests that 1 in 5 cancer survivors suffer from PTSD 6 months after diagnosis. The same study showed that about 6% of cancer survivors are still affected by PTSD 4 years after diagnosis, with over 34% of those people experiencing persistent or worsening PTSD symptoms.
So, can cancer survivors have PTSD? Unfortunately, yes – it’s more common than you probably imagined.
The Causes for PTSD in Cancer Survivors
From diagnosis and into remission, each state of a cancer survivor’s journey creates:
- physical pain and/or burdens; and
- emotional and mental trauma.
It only makes sense that these would cause stress and anxiety. There are three stages to a cancer survivor’s journey, each of which contributes to the stress and anxiety that might eventually lead to development of PTSD:
Stage 1: Pre-Diagnosis and Diagnosis
Fear
When it comes to cancer survivors and PTSD, there’s one unique aspect: the trauma doesn’t necessarily occur at the time of diagnosis. There’s an insane amount of fear that accompanies the pre-diagnosis phase. It comes from the fact that you’re constantly being reminded that you could have cancer. . . yet don’t know.
You’re spending an inordinate amount of time with doctors and at the hospital. And you’re being subjected to a number of tests that aren’t normal, are uncomfortable, and might even scare you.
Case in point: I spent 3 full days at my local hospital going between my doctors and a number of tests to figure out what I had, how bad it was, and what to do about it. One of those was an MRI, which I’d never been subjected to before. I found out the hard way that they make me feel claustrophobic and very anxious.
Lack of Control
The worst part of the pre-diagnosis phase is the loss of control over your life and your future. This lack of control is exacerbated by the fact that you don’t yet know what’s going on – and that only increases the fear you feel.
The entire experience is a recipe for trauma, high levels of stress, and serious anxiety. And then there’s the obvious emotional trauma caused by diagnosis itself.
[Related: for more about my story and how cancer changed me, listen to Episode #100 of the Life & Law Podcast (What Cancer Taught Me) >>>here.]
Stage 2: Cancer Treatment
Effect of Treatment
Cancer treatment makes you feel like crap physically and leaves an emotional toll. No matter what treatment you endure, it will zap your energy, have unexpected physical and mental consequences, and make you feel vulnerable in new ways.
The entire cancer journey batters your body and soul. It saps your emotional reserves and forces you to question yourself and your life in new, unexpected ways.
For example, during chemotherapy I often:
- endured extreme stomach pains;
- was physically exhausted to the point where I didn’t know if I could make it out of bed and into my shower; and
- felt vulnerable in ways I’d never felt before.
Some of these feelings and pains I expected, but not to the degree in which I experienced them.
Complete Loss of Control
The lack of control doesn’t go away after diagnosis. If anything, it gets worse. Lots of questions pop into your head that no one can answer, such as:
- Will treatment work?
- Will I need surgery and/or radiation after?
- If it doesn’t work, what then?
- What will be the long-term effect of treatment on my body?
Stage 3: Post-Treatment
Many cancer patients go through treatment yearning for the day when treatment ends. But then that day comes… and it’s not the celebration that was originally expected.
Your body, mind, and soul is battered during treatment. That doesn’t just go away because treatment has ended. Instead, you’re now dealing with:
- the long-term physical and emotional effects of treatment;
- having scars and looking different; and
- trying to figure out your “new” normal post-treatment.
None of this is easy and all of it is stressful, anxiety-ridden, and even traumatic. Moreover, even if you’re cancer-free, the fear that your cancer might come back will be ever-present. And going back to visit your doctor for post-treatment appointments and tests can be stressful and might trigger an emotional response.
[Recommended Reading: to learn how to figure out your “new” normal in a post-cancer life (or after any traumatic event, for that matter), read The Impossibility of Going Back (Life After Cancer)].
Signs of PTSD in Cancer Survivors: What to Look For
There are some common symptoms of PTSD to be aware of, which can be divided into 4 main categories: avoidance, invasive thoughts, reactive symptoms, and negative thinking.
Avoidance
Avoidance is exactly what it sounds like and involves trying to avoid anything that reminds you of your cancer or the related traumatic experiences. You might avoid people, places, situations, activities, and even objects that bring with them upsetting memories.
Additionally, you might try to avoid talking about or remembering anything that triggers unwanted feelings. Here are a few ways that avoidance might show up in cancer survivors:
- not wanting to talk about anything that reminds you of your diagnosis, treatment, or the risk of recurrence;
- skipping post-cancer doctor appointments; or
- resistance to talking about how you feel about your cancer, your treatment, or risk of recurrence.
Invasive Thoughts
Invasive thoughts can come in several forms, such as through dreams, memories, and flashbacks. They might be spontaneous or cued by something that reminds you of the event. The constant is that they’re distressing and relate to memories of the trauma itself.
Here are some ways in which invasive thoughts could show up:
- recurrent dreams that relate to your cancer experience or draw from a fear of recurrence;
- mentally replaying traumatic aspects of your treatment or diagnosis over and over; or
- feeling profound psychological distress when preparing to visit and/or visiting with your doctors post-treatment.
Reactive Symptoms
Symptoms of reactivity and arousal are common among PTSD sufferers and include:
- angry outbursts;
- reckless and/or self-destructive behavior;
- having difficulty concentrating;
- being easily startled or having an exaggerated startle response;
- being overly irritable;
- having difficulty falling or staying asleep;
- being constantly on guard or hyper-vigilant; or
- having panic attacks.
These could show up in cancer survivors in various ways. You might call your doctor every time you’re tired or feel a bump due to your fear that it’s a sign of recurrence or metastases. Perhaps you internalize this fear and instead become irritable and angry much of the time. Or you could have difficulty falling asleep because of your worries over not feeling quite right.
Negative Thoughts and Feelings
Negative thoughts and feelings often present as:
- distorted beliefs about yourself;
- feeling detached or numb; or
- feelings of guilt, anger, fear, and/or shame.
You might believe your cancer is your own fault – and feel extreme guilt or shame over it. Negative thoughts could also present as persistent fear of recurrence that overcomes your ability to live normally. Moreover, you might withdraw from being around family and friends or become numb to activities you previously enjoyed.
When PTSD Is Diagnosed
The symptoms described above can be experienced by many who have gone through something traumatic (including cancer survivors). It’s not PTSD unless you’ve experienced symptoms for at least one month and they’re affecting your ability to function normally.
Most people with PTSD develop symptoms quickly after the traumatic event occurs – usually within a few months. However, sometimes the symptoms can appear later than that. Therefore, be aware of the symptoms and on the lookout – whether for yourself as a survivor or for family or friends who’ve recently been diagnosed with cancer or through treatment.
What to Do If You Or Someone You Know Shows Signs of PTSD
Get Help (and Don’t Be Ashamed of It)
PTSD is nothing to be ashamed of and it’s not your fault that you’re suffering. The best thing you can do is to admit that you’re having trouble and get help.
And let me be clear: you don’t have to live with PTSD as-is. Help is available and PTSD is treatable. Although your journey won’t likely be linear, you can get better over time. But you’re not as likely to get over PTSD without help (and certainly help will make it easier).
If you feel that you might be suffering from PTSD (or someone you know might be), then reach out for help. Ask your doctors or someone you trust for a referral to a specialist.
Treatment Options for PTSD
There are a variety of treatment options for PTSD, including:
- Cognitive behavioral therapy: a form of therapy where you work to change patterns of behavior and thinking that fuel PTSD symptoms.
- Eye movement desensitization and reprocessing (EMDR): the use of eye movement to redirect past traumatic thoughts to current non-traumatic thoughts.
- Exposure therapy: exposure to triggers that stimulate stress to help you alter your response.
- Medication: several types of medications might be used, including antidepressants, beta blockers, and anti-anxiety drugs.
Many people with PTSD need professional help to fully recover. And the earlier you get treatment, the better your outcome is likely to be.
Coping with PTSD
Even as you undergo treatment, you’ll need to learn how to cope with PTSD until it dissipates completely. Here are a few suggestions for how to cope with PTSD as you go through treatment:
- Avoid alcohol and caffeine. Alcohol is a depressant and might cause feelings of depression to be amplified. Additionally, if you’re taking medications for your anxiety or for depression then you’ll probably need to avoid alcohol altogether. Caffeine is a stimulant, which might increase anxiety and feelings of irritability.
- Work to improve your sleep hygiene. Sleeping can be difficult for those with PTSD. Thus, it’s important to ensure you do everything you can to increase your ability to fall and stay asleep at night (and to not continue with bad habits that hurt your body’s ability to sleep well). Go to bed and awaken each day around the same time, don’t watch television late at night, and don’t keep your phone or iPad close by at night. Also, consider implementing a nightly ritual that helps you to relax.
- Get support from people you trust and enjoy being around. You don’t just need support from your therapist. It’s also important to have the support of family and friends. Surround yourself with people who care about you and in whom you can confide. And consider joining a PTSD support group. Knowing that you’re not alone and spending time with people who understand what you’re going through is therapeutic and can help you get better, faster.
- Make time for relaxation. Relaxing is necessary for everyone. And it’s even more important when your body and mind are being assaulted by PTSD. When relaxing, try meditation and other mindfulness activities that are proven to help reduce stress and anxiety.
[Recommended Reading: Learn how to use mindfulness for stress reduction in this article about Mindfulness For Leaders].
In Summary
Yes, cancer survivors can struggle with PTSD. It’s not uncommon and is nothing to feel ashamed of.
If you believe you or someone you love is exhibiting signs for PTSD, reach out for help.
