1 July 2013

Post traumatic stress, a disorder associated with victims of major 7/7 type incidents, is now also being recognised as a condition in cancer patients as they face life after diagnosis, Dr Sue Gessler explains.


Ovacome: “What is post traumatic stress disorder?”

Dr Sue Gessler: “PTSD is defined by five criteria: exposure to a traumatic event which has threatened your ‘physical integrity’ or life; and you have responded to it with feelings of intense fear, horror or helplessness; together with specific symptoms, which must be persistent, last more than one month after the trauma has occurred, and significantly impair life – social, work or other."

“The main triad of symptoms is: re‑experiencing the event via intrusion, such as flashback memories and recurring, distressing dreams; avoidance of places or people associated with the event, or incapacity to feel (emotional numbing); and hyper-arousal – jumpiness, irritability or increased sensitivity to pain."

“Other symptoms may include muscle aches and pains, diarrhoea, irregular heartbeats, feelings of panic or fear, depression, drinking too much alcohol or using drugs (including painkillers). Of course, some of these overlap with the effects of the illness and treatment."

“It’s also important to say that anyone faced with an extreme situation may have some of these responses and it is certainly not abnormal to feel this way during diagnosis and treatment. But if symptoms endure in the months after treatment, you may want to talk to your health care practitioner."

“After the 7/7 London bombings, the trauma psychology services distributed a leaflet emphasising that we should allow the normal processes of recovering after an extreme event (accompanied sometimes by flashbacks, dreams, preoccupation, jumpiness and so on) and that people should seek help only if these symptoms did not settle over the initial months after the event."


Ovacome: “Why does PTSD happen?”

Dr Gessler: “We understand PTSD as a need within the person to process an enormously difficult experience. While treatment is going on, there can be a sort of ‘shutting down’ of thinking and worrying, as so much of a woman’s energy, both physical and mental, has to be directed to ‘getting through’ treatment. The symptoms are in some way an attempt to master a highly threatening and emotional event in the mind so that it can be ‘digested’ and recalled in a useful format.”


Ovacome: “Is PTSD the same as depression?”

Dr Gessler: “No, depression is one of the ways you may respond to trauma, but you can have PTSD or a trauma response without depression; and you can have depression, or depressive symptoms, without having PTSD."

“Depression presents itself as persistent sadness or low mood, not being able to enjoy things, losing interest in life or relationships, finding it harder to make decisions, not coping with things that used to be easy, difficulties getting to sleep, or sleeping too much, lack of interest in sex, excessive self-criticism and even thoughts of self-harm.
The emotional side of a cancer diagnosis and treatment is getting higher status in the medical community. “These symptoms often overlap with the effects of cancer and its treatment.”


Ovacome: “When should a woman seek help?”

Dr Gessler: “If you are experiencing any of the symptoms above, you should seek help. Cancer care throughout the NHS aims to offer appropriate psychological assessment and treatment for all cancer patients. You may be able to access this via your clinical nurse specialist or consultant, or your GP may have primary care psychology or counselling attached to their practice."

“While you may not have formal PTSD, anyone experiencing distress during cancer treatment should be offered supportive care. There are also local support groups for more informal help, although this won’t usually be a specific therapy. Advice on finding these may come from your nurse, your local Macmillan information centre, Maggie’s Centre or Ovacome."

“We understand that the process of healing is a long one, and the cancer world as a whole now knows that the period after treatment ends can be one of the most difficult ones to manage.”


Ovacome: “What are the treatment options?”

Dr Gessler: “There are different treatments for depression and PTSD, but both respond well to psychological (talking) therapies."

“NICE recommends that formal PTSD be treated with CBT (cognitive behavioural therapy) or EMDR (eye movement desensitization and reprocessing), after which medication can be tried. In the context of cancer, many psycho-oncology professionals within your local service will have methods of working with ‘partial PTSD’ or trauma symptoms taking account of your cancer diagnosis and treatment. Depression is very well understood by psycho‑oncology professionals."

“The goal of treatment is to process the memories so that they move from being at the front of your mind, and dominating things, to the background."

“The whole cancer community is increasingly paying attention to the emotional side of cancer diagnosis and treatment."

“In a busy cancer clinic it may appear that there is no time to talk about these feelings: but your doctor and nurse are part of a system which does acknowledge that there can be many difficulties after your treatment is over.”


Ovacome: “And self-help?”

Dr Gessler: “Try and get back to normal and to your usual routine. Talk to someone else about what you’ve been through. Work is helpful, if you can return to it physically."

“Relaxation exercises can help (either via your cancer centre, GP or online). Eating regularly and taking what exercise you can is important: it can be as effective as anti-depressant medication in mild and moderate depression. Allow yourself time with family and friends, let your doctor know what is happening and expect that you will get better. And try to get enough sleep."

“It’s important not to use alcohol, coffee or tobacco to cope. Don’t miss meals or avoid people and become isolated."

“Don’t avoid the hospital or places associated with your diagnosis and treatment."

“Be gentle on yourself. You have been through a very difficult period and with time and, if necessary, help, these memories will settle. Don’t demand too much of yourself in ‘getting rid’ of them too fast. They are there for a reason.”


Ovacome: “How can family and friends help?”

Dr Gessler: “Cancer seems to attract a lot of strong views and people with cancer can be the target for very firm, and contradictory, advice which is not very helpful. Being badgered by others to ‘be positive’ can have the opposite effect."

“What helps: time to talk about what you’ve been through; time to do interesting or relaxing things and help with practical things such as making meals."

“What doesn’t help: avoiding you, telling you to ‘forget it’ or refusing to let you discuss what has happened to you."

“It may help to join a peer support or buddy system, as this allows you to talk freely about details of your medical experience as well as its impact on you in a way that you may not want to do with family and friends.”


Dr Sue Gessler consultant clinical psychologist at University College London Hospitals’ Gynaecological Cancer Centre; and honorary senior lecturer, Department of Women’s Cancers, University College London.

Dr Sue Gessler: emotional recovery can be hard. For a full report from Dr Gessler visit www.ovacome.org.uk.

This piece has been reviewed by Professor Lesley Fallowfield of SHORE-C, University of Sussex.

First published in the Ovacome summer newsletter 2013