New Developments in Lymphoma

By Peter Martin, MD

Post-traumatic stress disorder (PTSD) is a chronic condition characterized by anxiety and re-experiencing of a particularly stressful psychological trauma. Typically, we associate PTSD with events like wars or serious accidents. There is increasing data, however, that survivors of serious medical illness can also be affected by symptoms of PTSD. Long-term results of a study designed to evaluate PTSD in survivors of non-Hodgkin lymphoma (NHL) were recently reported in the Journal of Clinical Oncology.

The investigators administered surveys to 886 individuals with a history of NHL. They found that 39% of patients experienced PTSD symptoms with 8% meeting diagnostic criteria for PTSD. In a follow up study performed five years later, 566 of the original group of patients responded to a second survey. The investigators found that roughly one-third of patients experienced persisting or worsening PTSD symptoms. Only 12% of patients had symptoms that resolved over the course of the study. People most likely to experience persistent or worsening symptoms of PTSD were those with a lower annual income and those that reported a negative impact from the cancer (e.g., appearance concerns, body changes, life interferences, worry).

These results are particularly concerning for two reasons. First, the assumption that cancer-related anxiety will improve over time appears to be flawed. Second, as the population of patients with cancer ages, and as cancer care becomes more expensive, we are likely to see an increase in persistent PTSD symptoms. Clearly, we need to find ways to improve the initial cancer experience and to intervene earlier in patients at risk of persistent PTSD symptoms. The statement “survivorship begins at diagnosis” appears to be truer than ever.