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



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.


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.


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).


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.


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



This study was supported by the National Cancer Institute (CA195547, M. Hudson, Principal Investigator). Support to St. Jude Children’s Research Hospital was also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and ALSAC.

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.


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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

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