Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
J Cancer Surviv. 2018 Apr;12(2):216-223. doi: 10.1007/s11764-017-0660-x. Epub 2017 Nov 3.
The majority of research examining posttraumatic stress symptoms/disorder (PTSS/PTSD) among adult survivors of childhood cancer has been oriented to cancer, assuming that cancer has been the most traumatic experience in their lives. Whether that assumption is valid, and how it might impact assessment of PTSS, is unknown.
Survivors in the St. Jude Lifetime Cohort study completed an assessment of PTSS without cancer orientation, global psychological functioning, perceived stress, and cancer-related anxiety.
Participants (n = 2969; M = 32.5 ± 8.5 years, 24.1 years since diagnosis, 49.1% female) obtained a mean score on the PTSD Checklist of 27.7, which is comparable to a normative population. Using established cutoffs, 11.8% obtained scores in the at-risk range. Multivariable modeling indicated that psychological factors [global distress (p < 0.0001), perceived stress (p = 0.001), cancer-related anxiety (p < 0.0001)] and demographic variables [female gender (p < 0.0001), survivors with less than a college education (p = 0.002)] were risk factors for increased PTSS. Only 14.5% identified a cancer-related traumatic event, and there was no difference in PTSS scores between those who identified cancer vs. non-cancer events as most stressful (28.4 ± 12.6 vs. 28.5 ± 12.7, p = 0.93).
One in eight adult long-term survivors of childhood cancer had PTSS above the cutoff, though subgroups (e.g., females and those with lower education) report more distress symptoms. Most adult survivors do not identify cancer as their most stressful event.
Screening for distress in survivorship clinics should not assume that distress is directly related to the survivor's cancer experience.
大多数研究都针对儿童癌症成年幸存者的创伤后应激症状/障碍（PTSS/PTSD）进行了研究，认为癌症是他们生活中最具创伤性的经历。这种假设是否合理，以及它如何影响 PTSD 的评估尚不清楚。
圣裘德终身队列研究中的幸存者完成了一项 PTSD 评估，评估内容不针对癌症，包括整体心理功能、感知压力和与癌症相关的焦虑。
参与者（n=2969；M=32.5±8.5 岁，诊断后 24.1 年，女性占 49.1%）的 PTSD 检查表平均得分为 27.7，与常模人群相当。使用既定的截断值，11.8%的人处于危险范围。多变量模型表明，心理因素（整体困扰（p<0.0001）、感知压力（p=0.001）、与癌症相关的焦虑（p<0.0001））和人口统计学变量（女性（p<0.0001）、受教育程度低于大学的幸存者（p=0.002））是 PTSD 增加的风险因素。只有 14.5%的人确定了与癌症相关的创伤性事件，并且将癌症与非癌症事件视为最具压力的事件的 PTSD 评分没有差异（28.4±12.6 与 28.5±12.7，p=0.93）。
八分之一的儿童癌症成年长期幸存者 PTSD 评分超过临界值，尽管亚组（例如女性和受教育程度较低者）报告的症状更为严重。大多数成年幸存者并不认为癌症是他们最具压力的事件。
在生存诊所进行的困扰筛查不应假设困扰与幸存者的癌症经历直接相关。
