Skip to main content

Advertisement

SpringerLink
Log in

Aspects of posttraumatic stress disorder in long-term testicular cancer survivors: cross-sectional and longitudinal findings

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this research is to study the prevalence of posttraumatic stress disorder (PTSD) and variables associated with PTSD in Norwegian long-term testicular cancer survivors (TCSs) both cross-sectionally and longitudinally.

Methods

At a mean of 11 years after diagnosis, 1418 TCSs responded to a mailed questionnaire, and at a mean of 19 years after diagnosis, 1046 of them responded again to a modified questionnaire. Posttraumatic symptoms related to testicular cancer were self-rated with the Impact of Event Scale (IES) at the 11-year study only. An IES total score ≥35 defined Full PTSD, and a score 26–34 identified Partial PTSD, and the combination of Full and Partial PTSD defined Probable PTSD.

Results

At the 11-year study, 4.5 % had Full PTSD, 6.4 % had Partial PTSD, and 10.9 % Probable had PTSD. At both studies, socio-demographic variables, somatic health, anxiety/depression, chronic fatigue, and neurotoxic adverse effects were significantly associated with Probable PTSD in bivariate analyses. Probable anxiety disorder, poor self-rated health, and neurotoxicity remained significant with Probable PTSD in multivariate analyses at the 11-year study. In bivariate analyses, probable PTSD at that time significantly predicted socio-demographic variables, somatic health, anxiety/depression, chronic fatigue, and neurotoxicity among participants of the 19-year study, but only probable anxiety disorder remained significant in multivariable analysis.

Conclusions

In spite of excellent prognosis, 10.9 % of long-term testicular cancer survivors had Probable PTSD at a mean of 11 years after diagnosis. Probable PTSD was significantly associated with a broad range of problems both at that time and was predictive of considerable problems at a mean of 19 year postdiagnosis.

Implications for cancer survivors

Among long-term testicular cancer survivors, 10.9 % have Probable PTSD with many associated problems, and therefore health personnel should explore stress symptoms at follow-up since efficient treatments are available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.

    Google Scholar 

  3. Mehnert A, Vehling S, Scheffold K, Ladehoff N, Schön G, Wegscheider K, et al. Prävalenz von Anpassungsstörungen, akuter und Posttraumatischer Belastungsstörungen sowie Somatoformen Störungen bei Krebspatienten. Psychother Psychosom Med. 2013;63:466–72.

    Article  Google Scholar 

  4. O’Connor M, Christensen S, Jensen AB, Møller S, Zachariae R. How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer. Br J Cancer. 2011;104:419–26.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tjemsland J, Søreide JA, Malt UF. Posttraumatic distress symptoms in operable breast cancer III: status one year after surgery. Breast Cancer Res Treat. 1998;47:141–51.

    Article  CAS  PubMed  Google Scholar 

  6. Rustad JK, David D, Currier MB. Cancer and post-traumatic stress disorder: diagnosis, pathogenesis and treatment considerations. Palliat Support Care. 2012;10:213–23.

    Article  PubMed  Google Scholar 

  7. Breslau N, Lucia VC, Davis GC. Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med. 2004;34:1205–14.

    Article  PubMed  Google Scholar 

  8. Cukor J, Wyka K, Jayasinghe N, Difede JA. The nature and course of subthreshold PTSD. J Anxiety Disord. 2010;24:918–23.

    Article  PubMed  Google Scholar 

  9. McLaughlin KA, Koenen KC, Friedman MJ, Ruscio AM, Karam EG, Shahly V, et al. Subthreshold posttraumatic stress disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. 2015;77:375–84.

    Article  PubMed  Google Scholar 

  10. Smith SK, Zimmerman S, Williams CS, Preisser JS, Clipp EC. Post-traumatic stress outcomes in Non-Hodgkin’s lymphoma survivors. J Clin Oncol. 2008;26:934–41.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Smith SK, Zimmerman S, Williams CS, Habtamu B, Abernethy AP, Mayer DK, et al. Post-traumatic stress symptoms in long-term Non-Hodgkin’s lymphoma survivors: does time heal? J Clin Oncol. 2011;29:4526–33.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fleer J, Sleijfer D, Hoekstra H, Tuinman M, Klip E, Hoekstra-Weebers J. Objective and subjective predictors of cancer-related stress symptoms in testicular cancer survivors. Patient Educ Couns. 2006;64:142–50.

    Article  PubMed  Google Scholar 

  13. Wittchen H-U, Gloster A, Beesdo K, Schönefeld S, Perkonigg A. Posttraumatic stress disorder: diagnostic and epidemiological perspectives. CNS Spectr. 2009;14(Suppl 1):5–12.

    PubMed  Google Scholar 

  14. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med. 2008;31:341–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med. 2011;73:697–707.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brydøy M, Fosså SD, Klepp O, Bremnes RM, Wist EA, Wentzel-Larsen T, et al. Paternity following treatment for testicular cancer. J Natl Cancer Inst. 2005;97:1580–8.

    Article  PubMed  Google Scholar 

  17. Thorsen L, Nystad W, Dahl O, Klepp O, Bremnes RM, Wist E, et al. The level of physical activity in long-term survivors of testicular cancer. Eur J Cancer. 2003;39:1216–21.

    Article  CAS  PubMed  Google Scholar 

  18. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  19. Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al. Development of a fatigue scale. J Psychosom Res. 1993;37:147–53.

    Article  CAS  PubMed  Google Scholar 

  20. Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res. 1998;45:53–65.

    Article  CAS  PubMed  Google Scholar 

  21. Oldenburg J, Fosså SD, Dahl AA. Scale for Chemotherapy-induced Long-term Neurotoxicity (SCIN): psychometrics, validation, and findings in a large sample of testicular cancer survivors. Qual Life Res. 2006;15:791–800.

    Article  PubMed  Google Scholar 

  22. Eid J, Thayer JF, Johnsen BH. Measuring post-traumatic stress: a psychometric evaluation of symptom- and coping questionnaires based on a Norwegian sample. Scand J Psychol. 1999;40:101–8.

    Article  CAS  PubMed  Google Scholar 

  23. van der Ploeg E, Mooren TTM, Kleber RJ, van der Velden PG, Brom D. Construct validation of the Dutch version of the Impact of Event Scale. Psychol Assess. 2004;16:16–26.

    Article  PubMed  Google Scholar 

  24. Tuinman MA, Hoekstra HJ, Sleijfer DT, Fleer J, Vidrine DJ, Gritz ER, et al. Testicular cancer a longitudinal pilot study on stress response symptoms and quality of life in couples before and after chemotherapy. Support Care Cancer. 2007;15:279–86.

    Article  PubMed  Google Scholar 

  25. Wohlfarth TD, van den Brink W, Winkel FW, ter Smitten M. Screening for posttraumatic stress disorder: an evaluation of two self report scales among crime victims. Psychol Assess. 2003;15:101–9.

    Article  PubMed  Google Scholar 

  26. Neal LA, Busuttil W, Rollins J, Herepath R. Convergent validity of measures of post- traumatic stress disorder in a mixed military and civilian population. J Trauma Stress. 1994;7:447–55.

    Article  CAS  PubMed  Google Scholar 

  27. Aasland OG, Amundsen A, Bovim G, Fauske S, Mørland J. Identification of patients at risk of alcohol related damage (in Norwegian). Tidsskr Nor Laegeforen. 1990;110:1523–7.

    CAS  PubMed  Google Scholar 

  28. Brugha T, Bebbington P, Tennant C, Hurry J. The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med. 1985;15:189–94.

    Article  CAS  PubMed  Google Scholar 

  29. Ingebrigtsen G, Sandanger I, Sorensen T, Dalgard OS. Posttraumatisk stress forstyrrelser i Norge, forekomst og relasjon til sosialt nettverk. In: Dalgard OS, Døhlie E, Ystgaard M, editors. Sosialt nettverk, helse og samfunn. Oslo: Universitetsforlaget; 1995. p. 64–85. in Norwegian.

    Google Scholar 

  30. Greimel E, Dorfer M, Lambauer M, Bjelic-Radisic V, Gramm S, Lahousen M, et al. Posttraumatic stress disorder in female cancer patients: an inappropriate diagnosis in oncology? Psychother Psychosom. 2013;82:271–2.

    Article  PubMed  Google Scholar 

  31. Einsle F, Kraft D, Köllner V. Post-traumatic stress disorder (PTSD) in cardiology and oncology—which diagnostic tools should be used? J Psychosom Med. 2012;72:434–8.

    Article  Google Scholar 

  32. Gurevich M, Devins GM, Rodin GM. Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics. 2002;43:259–81.

    Article  PubMed  Google Scholar 

  33. Kessler RC, Rose S, Koenen KC, Karam EG, Stang PE, Stein DJ, et al. How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World Psychiatry. 2014;13:265–74.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Husky MM, Lépine J-P, Gasquet I, Kovess-Masfety V. Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey. J Trauma Stress. 2015;28:275–82.

Download references

Acknowledgments

The 11-year study was supported by a grant from The Norwegian Cancer Association.

Author information

Authors and Affiliations

  1. National Advisory Unit for Long-Term Adverse Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, P.O. Box 4953, Nydalen, N-0424, Oslo, Norway

    Alv A. Dahl & Sophie D. Fosså

  2. University of Oslo, Oslo, Norway

    Alv A. Dahl, Erik Wist & Sophie D. Fosså

  3. Faculty of Medicine, University of Southern Denmark, Odense, Denmark

    Marie Østby-Deglum

  4. Department of Oncology, Akershus University Hospital, Lørenskog, Norway

    Jan Oldenburg

  5. Department of Oncology, University Hospital of Northern Norway, University of Northern Norway, Tromsø, Norway

    Roy Bremnes

  6. Department of Oncology, Haukeland University Hospital, University of Bergen, Bergen, Norway

    Olav Dahl

  7. Department of Oncology, Saint Olav’s Hospital, National University for Science and Technology, Trondheim, Norway

    Olbjørn Klepp

  8. Department of Oncology, Oslo University Hospital, Ullevål Hospital, Oslo, Norway

    Erik Wist

Authors
  1. Alv A. Dahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Østby-Deglum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Oldenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roy Bremnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olav Dahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olbjørn Klepp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erik Wist
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sophie D. Fosså
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alv A. Dahl.

Ethics declarations

Funding

This study has no funding.

Conflict of interest

The authors have no conflicts to disclose.

Ethical approval

Study procedures, collection, storing, and distribution of data were done in accordance with existing legislation regulating the FHR. Gathering of health information necessary for analyses of non-responders was approved by the Regional Committee for Medicine and Health Research Ethics of South-East Norway.

Informed consent

The study was done on human subjects who all gave written informed consent.

Previous presentations

None.

Disclaimer

The authors are responsible for the statements made in this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dahl, A.A., Østby-Deglum, M., Oldenburg, J. et al. Aspects of posttraumatic stress disorder in long-term testicular cancer survivors: cross-sectional and longitudinal findings. J Cancer Surviv 10, 842–849 (2016). https://doi.org/10.1007/s11764-016-0529-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-016-0529-4

Keywords

Search

Navigation