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Post-Traumatic Stress Outcomes in Non-Hodgkin's Lymphoma Survivors

Sophia K. Smith, Sheryl Zimmerman, Christianna S. Williams, John S. Preisser, Elizabeth C. Clipp

From the University of North Carolina at Chapel Hill, Chapel Hill; Duke University, Durham, NC

Corresponding author: Sophia Smith, PhD, Cecil Sheps Center for Health Services Research, Campus Box 7590, 725 Martin Luther King Jr Blvd, Chapel Hill, NC 27599-7590; e-mail: sophia_smith{at}unc.edu

Purpose A large body of evidence suggests that being diagnosed with and treated for cancer adversely affects functioning and quality of life, yet less is known about longer term outcomes. Therefore, this study aims to estimate the prevalence of post-traumatic stress disorder (PTSD) symptoms in survivors of adult non-Hodgkin's lymphoma (NHL) who are at least 2 years postdiagnosis and identify the risk factors associated with PTSD symptoms, with a focus on those that are amenable for screening and modifiable.

Patients and Methods A total of 886 NHL survivors identified from the cancer registries of two hospitals in North Carolina participated, ranging in age from 25 to 92 years old and ranging from 2 to 44 years postdiagnosis. Survivors were mailed a survey that assessed PTSD symptoms and quality of life.

Results Participants averaged 10.2 years postdiagnosis, and most (61%) reported no PTSD symptoms. The adjusted prevalence for full PTSD was 7.9%, with an additional 9.1% meeting criteria for partial PTSD. Modifiable risk factors that were independently associated with PTSD in multiple linear regression included less social support, negative appraisals of life threat and treatment intensity, and more employment and insurance issues. Additionally, several demographic characteristics (nonwhite race, less education, and younger age) and clinical or health-related factors (active disease, more recent diagnosis, and more comorbidity) were independently associated with PTSD.

Conclusion Although only 8% of survivors met PTSD diagnostic criteria, the impact of a cancer diagnosis and treatment persists for many survivors, as evidenced in 39% of this sample. Early identification of those at risk could enable treatment to minimize PTSD symptomatology.

Supported by Grant No. R03-CA-101492 from the National Cancer Institute, Doctoral Training Grant in Oncology Social Work Grant No. DSW-0321301-SW from the American Cancer Society, and the University Research Council, University of North Carolina at Chapel Hill.

Presented in part at the 11th Annual Society for Social Work Research Conference, January 11-14, 2007, San Francisco, CA, and at the National Cancer Institute/American Cancer Society Cancer Survivorship Research Conference, October 4-6, 2006, Bethesda, MD.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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