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

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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.

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Funding

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.

Author information

Authors and Affiliations

  1. Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA

    Jennifer Allen, Victoria W. Willard, James L. Klosky & Sean Phipps

  2. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Chenghong Li & D. Kumar Srivastava

  3. Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Leslie L. Robison & Melissa M. Hudson

  4. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Melissa M. Hudson

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  1. Jennifer Allen
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Correspondence to Victoria W. Willard.

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The authors declare that they have no conflict of interest.

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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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Allen, J., Willard, V.W., Klosky, J.L. et al. Posttraumatic stress-related psychological functioning in adult survivors of childhood cancer. J Cancer Surviv 12, 216–223 (2018). https://doi.org/10.1007/s11764-017-0660-x

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