Hobbie W L, Stuber M, Meeske K, Wissler K, Rourke M T, Ruccione K, Hinkle A, Kazak A E
Children's Hospital of Philadelphia, Division of Oncology, Philadelphia, PA 19104-4399, USA.
J Clin Oncol. 2000 Dec 15;18(24):4060-6. doi: 10.1200/JCO.2000.18.24.4060.
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.
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.
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.
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.
本研究评估了儿童癌症成年幸存者中创伤后应激症状的患病率，以及创伤后应激与焦虑、适应、对疾病和治疗的认知，以及从肿瘤学记录中提取的医学数据之间的关联。
78名曾接受儿童癌症治疗的年轻人（年龄在18至40岁之间）完成了问卷调查和精神科访谈，评估创伤后应激、焦虑、对自身疾病和治疗的认知，以及心理困扰症状。通过病历审查收集治疗强度和医学晚期效应严重程度的数据。
在患者样本中，自治疗结束以来，有20.5%的人在某个时间点符合美国精神医学协会《诊断与统计手册》中创伤后应激障碍（PTSD）的诊断标准。报告了具有临床意义水平的侵入性症状（9%）和回避性症状（16.7%）。参与者还报告了状态焦虑和特质焦虑水平升高。与没有PTSD的参与者相比，患有PTSD的参与者报告当前感知到的生命威胁更高、治疗经历更强烈，以及心理困扰水平更高（且具有临床意义）。
在这个儿童癌症成年幸存者样本中，五分之一的人符合PTSD的诊断标准，报告了具有临床意义的侵入性和回避性症状。与其他样本一样，成年幸存者中的PTSD与焦虑和其他心理困扰相关。与更客观的医学数据相比，幸存者对治疗及其效果的认知与创伤后应激的关联更强。数据表明，与癌症相关的创伤后应激可能在成年期出现，并可能影响发育里程碑的实现以及对医疗保健的取向。
