Journal of Cancer Survivorship

, Volume 12, Issue 2, pp 216–223 | Cite as

Posttraumatic stress-related psychological functioning in adult survivors of childhood cancer

  • Jennifer Allen
  • Victoria W. Willard
  • James L. Klosky
  • Chenghong Li
  • D. Kumar Srivastava
  • Leslie L. Robison
  • Melissa M. Hudson
  • Sean Phipps
Article

Abstract

Purpose

The majority of research examining posttraumatic stress symptoms/disorder (PTSS/PTSD) among adult survivors of childhood cancer has been oriented to cancer, assuming that cancer has been the most traumatic experience in their lives. Whether that assumption is valid, and how it might impact assessment of PTSS, is unknown.

Methods

Survivors in the St. Jude Lifetime Cohort study completed an assessment of PTSS without cancer orientation, global psychological functioning, perceived stress, and cancer-related anxiety.

Results

Participants (n = 2969; Mage = 32.5 ± 8.5 years, 24.1 years since diagnosis, 49.1% female) obtained a mean score on the PTSD Checklist of 27.7, which is comparable to a normative population. Using established cutoffs, 11.8% obtained scores in the at-risk range. Multivariable modeling indicated that psychological factors [global distress (p < 0.0001), perceived stress (p = 0.001), cancer-related anxiety (p < 0.0001)] and demographic variables [female gender (p < 0.0001), survivors with less than a college education (p = 0.002)] were risk factors for increased PTSS. Only 14.5% identified a cancer-related traumatic event, and there was no difference in PTSS scores between those who identified cancer vs. non-cancer events as most stressful (28.4 ± 12.6 vs. 28.5 ± 12.7, p = 0.93).

Conclusion

One in eight adult long-term survivors of childhood cancer had PTSS above the cutoff, though subgroups (e.g., females and those with lower education) report more distress symptoms. Most adult survivors do not identify cancer as their most stressful event.

Implications for cancer survivors

Screening for distress in survivorship clinics should not assume that distress is directly related to the survivor’s cancer experience.

Keywords

Posttraumatic stress Cancer survivorship Adult survivors St. Jude Lifetime Cohort (SJLIFE) 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Howlader N, Noone AM, Krapcho M, Miller DA, Bishop K, Kosary CL, et al. SEER cancer statistics review, 1975–2014. Bethesda: National Cancer Institute; 2017.Google Scholar
  2. 2.
    Tillery R, Howard Sharp KM, Okado Y, Long A, Phipps S. Profiles of resilience and growth in youth with cancer and healthy comparisons. J Pediatr Psychol. 2016;41:290–7.  https://doi.org/10.1093/jpepsy/jsv091.CrossRefPubMedGoogle Scholar
  3. 3.
    Oancea SC, Brinkman TM, Ness KK, Krull KR, Smith WA, Srivastava DK, et al. Emotional distress among adult survivors of childhood cancer. J Cancer Surviv. 2014;8:293–303.  https://doi.org/10.1007/s11764-013-0336-0.
  4. 4.
    Lehmann V, Grönqvist H, Engvall G, Ander M, Tuinman MA, Hagedoorn M, et al. Negative and positive consequences of adolescent cancer 10 years after diagnosis: an interview-based longitudinal study in Sweden. Psychooncology. 2014;23:1229–35.  https://doi.org/10.1002/pon.3549.
  5. 5.
    Kamibeppu K, Murayama S, Ozono S, Sakamoto N, Iwai T, Asami K, et al. Predictors of posttraumatic stress symptoms among adolescent and young adult survivors of childhood cancer: importance of monitoring survivors’ experiences of family functioning. J Fam Nurs. 2015;21:529–50.  https://doi.org/10.1177/1074840715606247.
  6. 6.
    Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M. An integrative model of pediatric medical traumatic stress. J Pediatr Psychol. 2006;31:343–55.  https://doi.org/10.1093/jpepsy/jsj054.CrossRefPubMedGoogle Scholar
  7. 7.
    Stuber ML, Meeske KA, Leisenring W, Stratton K, Zeltzer LK, Dawson K, et al. Defining medical posttraumatic stress among young adult survivors in the Childhood Cancer Survivor Study. Gen Hosp Psychiatry. 2011;33:347–53.  https://doi.org/10.1016/j.genhosppsych.2011.03.015.
  8. 8.
    American Psychological Association. Diagnostic and statistical manual of mental disorders. 4th, text rev edn. Washington, DC: Author; 2000.Google Scholar
  9. 9.
    Kangas M, Henry JL, Bryant RA. Posttraumatic stress disorder following cancer. A conceptual and empirical review. Clin Psychol Rev. 2002;22:499–524.CrossRefPubMedGoogle Scholar
  10. 10.
    Bruce M. A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev. 2006;26:233–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Vuotto SC, Perez KM, Krull KR, Brinkman TM. A narrative review of the occurrence of posttraumatic stress responses in adolescent and young adult cancer survivors. Clin Oncol Adolesc Young Adults. 2015;5:19–33.Google Scholar
  12. 12.
    Stuber ML, Meeske KA, Krull KR, Leisenring W, Stratton K, Kazak AE, et al. Prevalence and predictors of posttraumatic stress disorder in adult survivors of childhood cancer. Pediatrics. 2010;125:e1124–34.  https://doi.org/10.1542/peds.2009-2308.
  13. 13.
    Phipps S, Klosky JL, Long A, Hudson MM, Huang Q, Zhang H, et al. Posttraumatic stress and psychological growth in children with cancer: has the traumatic impact of cancer been overestimated? J Clin Oncol. 2014;32:641–6.  https://doi.org/10.1200/JCO.2013.49.8212.
  14. 14.
    Gerhardt CA, Yopp JM, Leininger L, Valerius KS, Correll J, Vannatta K, et al. Brief report: post-traumatic stress during emerging adulthood in survivors of pediatric cancer. J Pediatr Psychol. 2007;32:1018–23.Google Scholar
  15. 15.
    Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995;8:75–90.Google Scholar
  16. 16.
    McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD Checklist: a critical review. Clin Psychol Rev. 2010;30:976–87.  https://doi.org/10.1016/j.cpr.2010.06.012.CrossRefPubMedGoogle Scholar
  17. 17.
    Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the paper presented at the 9th annual conference of the ISTSS, San Antonio, TX; 1993.Google Scholar
  18. 18.
    Hudson MM, Ehrhardt MJ, Bhatka N, Baassiri M, Eissa H, Chemaitilly W, et al. Approach for the classification and severity grading of long-term and late-onset health events among childhood cancer survivors in the St. Jude Lifetime Cohort. Cancer Epidemiol Biomark Prev. 2017;26:666–74.  https://doi.org/10.1158/1055-9965.EPI-16-0812.
  19. 19.
    Hudson MM, Ness KK, Nolan VG, Armstrong GT, Green DM, Morris EB, et al. Prospective medical assessment of adults surviving childhood cancer: study design, cohort characteristics, and feasibility of the St. Jude Lifetime Cohort study. Pediatr Blood Cancer. 2011;56:825–36.  https://doi.org/10.1002/pbc.22875.
  20. 20.
    Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34:669–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.  https://doi.org/10.2307/2136404.CrossRefPubMedGoogle Scholar
  22. 22.
    Derogatis LR. Brief Symptom Inventory (BSI)-18. Administration, scoring, and procedures manual. Minneapolis: NCS Pearson, Inc; 2001.Google Scholar
  23. 23.
    Recklitis CJ, Parsons SK, Shih MC, Mertens A, Robison LL, Zeltzer L. Factor structure of the Brief Symptom Inventory-18 in adult survivors of childhood cancer: results from the childhood cancer survivor study. Psychol Assess. 2006;18:22–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Cox CL, McLaughlin RA, Steen BD, Hudson MM. Predicting and modifying substance use in childhood cancer survivors: application of a conceptual model. Oncol Nurs Forum. 2006;33:51–30.  https://doi.org/10.1188/06.ONF.51-60.CrossRefPubMedGoogle Scholar
  25. 25.
    Cox CL, Montgomery M, Rai SN, McLaughlin RA, Steen BD, Hudson MM. Supporting breast self-examination in female childhood cancer survivors: a secondary analysis of a behavioral intervention. Oncol Nurs Forum. 2008;35:423–30.  https://doi.org/10.1188/08.ONF.423-430.CrossRefPubMedGoogle Scholar
  26. 26.
    Hoeting JA, Madigan D, Raferty AE, Volinsky CT. Bayesian model averaging: a tutorial. Stat Sci. 1999;14:382–417.CrossRefGoogle Scholar
  27. 27.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kessler RC, Berglund P, Delmer O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.CrossRefPubMedGoogle Scholar
  29. 29.
    Wu X, Wang J, Cofie R, Kaminga AC, Liu A. Prevalence of posttraumatic stress disorder among breast cancer patients: a meta-analysis. Iranaian. J Public Health. 2016;45:1533–44.Google Scholar
  30. 30.
    Engelhard IM, Van den Hout MA, Weerts J, Arntz A, Hox JJ, McNally RJ. Deployment-related stress and trauma in Dutch soldiers returning from Iraq. Prospective study. Br J Psychiatry. 2007;191:140–5.  https://doi.org/10.1192/bjp.bp.106.034884.CrossRefPubMedGoogle Scholar
  31. 31.
    American Psychological Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  32. 32.
    Stuber ML, Kazak AE, Meeske K, Barakat L, Guthrie D, Garnier H, et al. Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics. 1997;100:958–64.Google Scholar
  33. 33.
    Kwak M, Zebrack BJ, Meeske KA, Embry L, Aguilar C, Block R, et al. Prevalence and predictors of post-traumatic stress symptoms in adolescent and young adult cancer survivors: a 1-year follow-up study. Psychooncology. 2013;22:1798–806.  https://doi.org/10.1002/pon.3217.
  34. 34.
    Kazak AE, Derosa BW, Schwartz LA, Hobbie W, Carlson C, Ittenbach RF, et al. Psychological outcomes and health beliefs in adolescent and young adult survivors of childhood cancer and controls. J Clin Oncol. 2010;28:2002–7.  https://doi.org/10.1200/JCO.2009.25.9564.
  35. 35.
    Zebrack BJ, Gurney JG, Oeffinger K, Whitton J, Packer RJ, Mertens A, et al. Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2004;22:999–1006.  https://doi.org/10.1200/JCO.2004.06.148.
  36. 36.
    Packer RJ, Gurney JG, Punyko JA, Donaldson SS, Inskip PD, Stovall M, et al. Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: Childhood Cancer Survivor Study. J Clin Oncol. 2003;21:3255–61.  https://doi.org/10.1200/JCO.2003.01.202.
  37. 37.
    Liptak C, Manley P, Recklitis CJ. The feasibility of psychosocial screening for adolescent and young adult brain tumor survivors: the value of self-report. J Cancer Surviv. 2012;6:379–87.  https://doi.org/10.1007/s11764-012-0237-7.CrossRefPubMedGoogle Scholar
  38. 38.
    O'Leary TE, Diller L, Recklitis CJ. The effects of response bias on self-reported quality of life among childhood cancer survivors. Qual Life Res. 2007;16:1211–20.  https://doi.org/10.1007/s11136-007-9231-3.CrossRefPubMedGoogle Scholar
  39. 39.
    Armstrong GT, Liu Q, Yasui Y, Huang S, Ness KK, Leisenring W, et al. Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2009;101:946–58.  https://doi.org/10.1093/jnci/djp148.
  40. 40.
    Derogatis LR. BSI-18 Administration, Scoring, and Procedures Manual. Minneapolis: National Computer Systems; 2000.Google Scholar
  41. 41.
    Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Med Care. 2007;45:S3–S11.  https://doi.org/10.1097/01.mlr.0000258615.42478.55.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jennifer Allen
    • 1
  • Victoria W. Willard
    • 1
  • James L. Klosky
    • 1
  • Chenghong Li
    • 2
  • D. Kumar Srivastava
    • 2
  • Leslie L. Robison
    • 3
  • Melissa M. Hudson
    • 3
    • 4
  • Sean Phipps
    • 1
  1. 1.Department of PsychologySt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of BiostatisticsSt. Jude Children’s Research HospitalMemphisUSA
  3. 3.Departments of Epidemiology and Cancer ControlSt. Jude Children’s Research HospitalMemphisUSA
  4. 4.Department of OncologySt. Jude Children’s Research HospitalMemphisUSA

Personalised recommendations