Gallo-Silver Les, Weiner Michael O
Cancercare, New York, NY 10001, USA.
J Psychosoc Oncol. 2006;24(1):107-34. doi: 10.1300/J077v24n01_08.
The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psychosocial clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.
被诊断患有癌症的童年性虐待（CSA）幸存者的发病率尚不清楚。据估计，在美国，三分之一的女性和六分之一的男性是CSA幸存者。被诊断患有癌症的CSA幸存者面临着多重且可能不断累积的创伤。癌症诊断和治疗带来的再次创伤性质会影响CSA幸存者护理的各个方面，并可能阻碍其治疗。迄今为止，CSA对癌症患者医疗治疗的影响尚未得到探索，现有的关于患有癌症的CSA女性幸存者的研究主要集中在治疗后的经历及其较高的性功能障碍发生率上。本文描述了CSA对18名CSA幸存者癌症治疗的影响以及为满足这一人群独特的心理社会需求而采用的临床干预措施。轶事信息表明，CSA幸存者可能会发现癌症经历的某些方面让人想起他们的虐待史。所有18名CSA幸存者在癌症治疗期间都经历了与虐待相关的痛苦回忆。15名CSA幸存者出现了在癌症诊断之前意识思维过程无法触及的创伤性记忆。心理动力学干预解决了癌症治疗中的干扰问题、不依从问题以及与医疗团队关系方面的困难。抑制强烈情感和痛苦想法而非进行探索提高了CSA幸存者对癌症治疗的依从性。获得自我安慰技能帮助CSA幸存者在癌症经历中感觉不那么像再次成为受害者。建立内部和外部安全的环境改善了与医疗团队的沟通。医疗保健/心理社会临床医生对适当干预措施的认识和使用可以将再次创伤的影响降至最低，并增强CSA幸存者的治疗体验。
