Sean Phipps, James L. Klosky, Alanna Long, Melissa M. Hudson, Qinlei Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Robert B. Noll, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Clin Oncol. 2014 Mar 1;32(7):641-6. doi: 10.1200/JCO.2013.49.8212. Epub 2014 Jan 21.
To examine posttraumatic stress disorder and posttraumatic stress symptoms (PTSD/PTSS) in children with cancer using methods that minimize focusing effects and allow for direct comparison to peers without a history of cancer.
Children with cancer (n = 255) stratified by time since diagnosis, and demographically matched peers (n = 101) were assessed for PTSD using structured diagnostic interviews by both child and parent reports, and survey measures of PTSS and psychological benefit/growth by child report.
Cancer was identified as a traumatic event by 52.6% of children with cancer, declining to 23.8% in those ≥ 5 years from diagnosis. By diagnostic interview, 0.4% of children with cancer met criteria for current PTSD, and 2.8% met lifetime criteria by self-report. By parent report, 1.6% of children with cancer met current criteria and 5.9% met lifetime criteria for PTSD. These rates did not differ from controls (all Ps >.1). PTSS levels were descriptively lower in children with cancer but did not differ from controls when all were referring to their most traumatic event (P = .067). However, when referring specifically to cancer-related events, PTSS in the cancer group were significantly lower than in controls (P = .002). In contrast, perceived growth was significantly higher in the cancer group when referring to cancer (P < .001).
These findings suggest no evidence of increased PTSD or PTSS in youths with cancer. Although childhood cancer remains a significant and challenging event, these findings highlight the capacity of children to adjust, and even thrive, in the face of such challenge.
采用最小化聚焦效应的方法，对癌症患儿进行创伤后应激障碍（PTSD）和创伤后应激症状（PTSS）研究，并与无癌症病史的同龄人进行直接比较。
根据诊断后时间将癌症患儿（n=255）分层，并与在人口统计学上相匹配的无癌症病史的同龄患儿（n=101）进行比较。采用结构访谈对 PTSD 进行评估，评估方式包括儿童和家长的报告，以及儿童报告的 PTSD 和心理获益/成长的调查量表。
52.6%的癌症患儿将癌症视为创伤性事件，在诊断后≥5 年的患儿中，这一比例降至 23.8%。通过诊断访谈，有 0.4%的癌症患儿符合当前 PTSD 的诊断标准，2.8%的患儿符合自我报告的终生诊断标准。通过家长报告，1.6%的癌症患儿符合当前 PTSD 的诊断标准，5.9%符合终生 PTSD 的诊断标准。这些比率与对照组（均 P>.1）无差异。癌症患儿的 PTSD 水平较低，但当所有患儿都指他们经历过的最严重创伤事件时，其水平与对照组无差异（P=0.067）。然而，当特指癌症相关事件时，癌症组的 PTSD 水平明显低于对照组（P=0.002）。相比之下，当特指癌症相关事件时，癌症组认为自己在癌症方面获得的成长明显更高（P<.001）。
这些发现表明癌症患儿中并未出现 PTSD 或 PTSS 增加的证据。尽管儿童癌症仍然是一个重大且具有挑战性的事件，但这些发现强调了儿童在面临此类挑战时适应甚至茁壮成长的能力。
