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Symptoms of Posttraumatic Stress in Young Adult Survivors of Childhood Cancer

From the Children’s Hospital of Philadelphia, Division of Oncology; Department of Pediatrics, School of Nursing, University of Pennsylvania, Philadelphia, PA; Children’s Hospital at Strong, Division of Pediatric Hematology/Oncology, Rochester, NY; University of California at Los Angeles; Department of Psychiatry, Children’s Hospital of Los Angeles, Los Angeles, CA.

Address reprint requests to Wendy Hobbie, CRNP, Division of Oncology, The Children’s Hospital of Philadelphia, 324 S 34th St, Philadelphia, PA 19104-4399; email hobbie2{at}pobox.upenn.edu

PURPOSE: This study assessed the prevalence of posttraumatic stress symptoms in young adult survivors of childhood cancer and the association of posttraumatic stress with anxiety, adjustment, perceptions of illness and treatment, and medical data extracted from oncology records.

PATIENTS AND METHODS: Seventy-eight young adults (ages 18 to 40 years) who had been treated for childhood cancer completed questionnaires and psychiatric interviews assessing posttraumatic stress, anxiety, perceptions of their illness and treatment, and symptoms of psychologic distress. Data on treatment intensity and severity of medical late effects were collected via chart review.

RESULTS: Of the patient sample, 20.5% met American Psychiatric Association Diagnostic and Statistical Manual criteria for posttraumatic stress disorder (PTSD) at some point since the end of their treatment. Clinically significant levels of intrusive (9%) and avoidant (16.7%) symptoms were reported. Participants also reported elevated state and trait anxiety. Participants with PTSD reported higher perceived current life threat, more intense treatment histories, and higher (and clinically significant) levels of psychologic distress than those who did not have PTSD.

CONCLUSION: One-fifth of this sample of young adult survivors of childhood cancer met criteria for a diagnosis of PTSD, with clinically significant symptoms of intrusion and avoidance reported. As in other samples, PTSD in young adult survivors was associated with anxiety and other psychologic distress. Survivors’ perceptions of treatment and its effects were more highly associated with posttraumatic stress than were more objective medical data. The data suggest that cancer-related posttraumatic stress may emerge in young adulthood and may affect the achievement of developmental milestones and orientation toward health care.

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