Cancer recurrence as a traumatic event

The authors hypothesized that cancer recurrence can be understood and therefore treated as a traumatic event that places patients at risk for stress response symptoms. To test this, they gave 40 patients with recurrent malignancies of mixed sites the Impact of Event Scale (a measure of response to specific stressors), the Psychosocial Adjustment to Illness Scale-Self-Report version (a measure of general adjustment to illness), and a semi-structured interview in which the patients were asked about their reactions to and experiences surrounding the recurrence, compared with those surrounding their initial diagnosis. In self-report measures and in the interview, patients clearly perceived that adjustment to recurrence is more problematic than adjustment to initial diagnosis. The findings were consistent with an expectation derived from the stress-disorder literature: patients who reported having been completely surprised by the recurrence and those undergoing their first recurrence showed significantly more intrusive and avoidant stress response symptoms. Given the heterogeneity of the patient population and the relatively limited sample size, further study is needed to assess the contribution of other important mediating factors in the development of stress disorders. Because the predictors in this study (extent of surprise and number of previous recurrences) can be identified before or immediately following a recurrence, primary and secondary interventions might help prevent stress disorders in patients who may have had unrealistic expectations.