Many stressful events surround a cancer diagnosis and may act as trigger points for a severe emotional reaction. Trauma may set in during treatments, while navigating treatment side effects, and when waiting for test results.

Cancer-related post-traumatic stress (PTS) is fairly common, and may occur along with depression and anxiety. The conditions that surface due to the emotional trauma—and their ongoing presence—may be so significant that post-traumatic stress disorder (PTSD) is diagnosed. Full-blown PTSD appears in about 3 to 4 percent of patients who are recently diagnosed and up to 35 percent of patients evaluated after cancer treatment, according to a National Cancer Institute (NCI) Physician Data Query report. The degree and severity of symptoms are what distinguish PTSD from similar mental health conditions, such as cancer-related PTS or acute stress disorder.

The NCI defines PTSD as “an anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress.” Its report says symptoms may be similar to those found with depression, anxiety disorders, phobias and panic disorders. Those symptoms of PTSD or PTS may include:

• Recurrent, involuntary and intrusive distressing memories or dreams of the traumatic event
• Dissociative reactions such as flashbacks
• Persistence of negative beliefs or distorted cognitions
• Hypervigilance
• Exaggerated startle response
• Depersonalization and derealization
• Defensive, irritable or fearful feelings
• Problems with concentration
• Sleep disturbance
• Avoidance of internal or external reminders 
• Loss of interest in life

Therapeutic options for emotional trauma

Therapeutic options are available to reduce stress, including techniques from crisis intervention techniques to comfort pets. The intent is to make it easier for people to resume normal activities and improve their quality of life.

Cognitive behavioral therapy (CBT) trains cancer patients to change how they think. By doing this, CBT helps patients to:

• Recognize their symptoms
• Learn ways to cope and manage stress, such as through breathing and relaxation techniques, guided imagery or laughter therapy
• Replace distressful thoughts with more balanced and useful thinking patterns
• Understand and deal with upsetting triggers
• Consider self-care options by getting them to realize the connection between their physical health and emotional well-being
• Seek out support groups, which provide emotional support through sharing with others having similar cancer experiences and symptoms

Another psychotherapy treatment for PTSD is eye movement desensitization and reprocessing (EMDR), which has a patient focus on eye movements while bringing up underlying traumatic events and then slowly turning thoughts to more pleasant situations.

Some patients may require medicines to treat their symptoms. These may include:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or tricyclic (TCA) and monoamine oxidase inhibitors (MAOIs)
• Anti-anxiety or antipsychotic medicines

Risk factors for post-traumatic stress

Studies show that some cancer patients are more susceptible to post-traumatic stress. They include:

• Cancer survivors who have a recurrence
• Patients who have more advanced cancer or undergo lengthy surgeries, or who have a history of trauma or anxiety disorders
• Childhood cancer survivors
• Patients who had previous trauma, PTSD or other psychological problems before their cancer diagnosis
• Patients with a high level of general stress or limited social support outlets
• Patients with genetic and biological factors that affect memory and learning
• Patients who use avoidance to cope with stress

Find support

The American Society of Clinical Oncology (ASCO) recommends that patients ask their oncologist or care team for help connecting with counseling and other services for navigating PTSD or cancer-related PTS.

ASCO recommends the following resources:

• Local health department, community mental health agency or family services agency
• Workplace employee assistance program (ask whether it provides mental health counselor referrals)
• Health insurance company (request a list of local mental health counselors)
• Free online referral services, such as the Anxiety and Depression Association of America’s Find a Therapist tool and the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator