Nearly one-quarter of women in a large prospective study of racially diverse patients with stage I to III breast cancer reported symptoms consistent with posttraumatic stress disorder (PTSD), with increased risk of PTSD among black, Asian, and younger women. “These potential risk factors can be identified at the time of diagnosis and may present an opportunity to minimize PTSD symptomatology. This approach may improve the quality of patients’ lives and may also have an indirect impact on the observed racial disparity in breast cancer survival,” the study authors concluded in their report in the Journal of the National Cancer Institute.
For the study, 1,139 women participating in the Breast Cancer Quality of Care Study at sites in New York, Detroit, and northern California completed three interviews—at baseline (2 to 3 months after diagnosis but before the third cycle of chemotherapy, if administered), and again at 4 and at 6 months after diagnosis. PTSD symptoms were assessed with the Impact of Event Scale, which “is one of the most commonly used measures of PTSD among adults and has been shown to perform well as a screening tool,” the researchers noted.
“At all three time points, women diagnosed at a younger age [< 50 years] had a higher likelihood of PTSD. Asian and black women were the largest groups with PTSD both at baseline (29.3% and 28.2%, respectively; P = .03) and at the second time point, although at the second time point, black women had higher PTSD than Asian women (23.6% vs 20.0%; P < .01),” the researchers reported. “Positive lymph node status was associated with increased PTSD both at baseline (28.7%; P = .01) and at the second time point (16.8%; P = .03). Both stage III (23.9%; P = .01) and HER2-positive status (19.8%; P = .03) were associated with higher PTSD only at the third time point.”
The prevalence of PTSD gradually declined over time, from 23% at baseline, to 16.5% at the first time point, and to 12.6% at the third time point. Persistent PTSD, defined as having PTSD at two consecutive interviews, was observed among 12.1% of participants.
“Persons with PTSD have substantially worse quality of life than those without. Thus, a higher rate of PTSD among blacks and Asians may make their survivorship experience more difficult,” the authors noted. In addition, PTSD may interfere with compliance and, through its impact on the immune system, “might contribute to cancer progression.” ■