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    Personality an important predictor of coping with cancer stress

    Sean Phipps, PhD

    Children with anxious personalities are more likely to experience symptoms of post-traumatic stress than childhood cancer survivors, St. Jude researchers report.

    A survey of about 300 children, including 199 St. Jude cancer patients, found that for most cancer patients, their adaptive style was a better predictor of their risk for either post-traumatic stress symptoms (PTSS) or post-traumatic stress disorder (PTSD) than their cancer diagnosis. Adaptive style is a personality measure.

    The findings were published in the September edition of the journal of Psycho-Oncology. Sean Phipps, PhD, Behavioral Medicine chair, said children who scored highest for anxiety on screening tests were most symptomatic, regardless of their cancer history. Phipps is the study’s corresponding author.

    “There has been a presumption that cancer might lead to adverse psychological outcomes in children,” he said. “I think cancer is a highly significant event, but it need not be a traumatic event. I think of it more as a challenge than a trauma.”

    PTSD is an anxiety disorder that can develop weeks or years after a traumatic event, like combat experience or a natural disaster. In 1994, the definition of PTSD was expanded in the diagnostic manual used by health professionals. The list of potential triggering events now includes a life-threatening illness of oneself or a loved one. Symptoms of the disorder include being easily startled, difficulty falling asleep, re-experiencing the trauma through flashbacks or nightmares, avoiding reminders of the event, feelings of detachment and intrusive thoughts.

    The expanded definition prompted some medical centers to launch PTSD prevention efforts for new pediatric cancer patients and their families, Phipps said. But growing evidence suggests that the incidence of PTSD is low, supporting a more targeted approach focused on children at highest risk.

    This study included children ages 7 through 18 and compared PTSS in young cancer survivors and healthy children. Along with the cancer patients, the volunteers included 108 cancer-free children referred by participating cancer patients. Investigators used several common self-reporting tools to measure PTSD, anxiety and defensiveness. The study did not include information about disease severity or treatment intensity since earlier research suggested that the perceived threat posed by the illness was a more powerful predictor of PTSS than objective measures of disease.

    “By extension, the perceived threat is more a function of individual disposition or personality,” Phipps said.

    Few patients in either group met the criteria for PTSD. The study is the latest to question whether PTSD is a good model for understanding how a cancer diagnosis impacts young patients and their families.

    In a separate study with the same volunteers, Phipps and his colleagues reported that after race and ethnicity were taken into account, cancer patients were just as optimistic as the other children surveyed.

    Investigators also found optimism helped children cope with their diagnosis. When compared to their more pessimistic counterparts, optimistic cancer patients reported less pain and greater self esteem.

    Both the patients and parents also reported fewer family and behavior problems. Researchers said the findings suggest pessimistic children might benefit from early intervention with cognitive-behavioral therapy or other strategies designed to foster positive expectations.

    The study was published in the October 1 online edition of the Journal of Pediatric Psychology. The research also confirmed the usefulness of the Youth Life Orientation Test (YLOT) as a tool for measuring optimism and pessimism in young cancer patients. The test, which relies on self-reporting, was developed in 2005.

    This is not the first St. Jude study to report stress is not a widespread problem among young cancer patients or their families.

    In the latest study, however, Phipps and his colleagues did find small differences in stress symptoms between a subset of cancer survivors and healthy children. Phipps said patients who suffered a relapse were moderately more likely than healthy children to report PTSS.

    Cancer survivors were also less likely than their healthy counterparts to report intrusive thoughts or to re-experience a traumatic event. Investigators said the finding is an indication of just how few survivors have symptoms. In contrast, survivors were more likely than healthy children to show evidence of numbing and avoidance behaviors. The researchers said the finding might either reflect a stress response to cancer or might be a coping mechanism.

    But overall, researchers found a child’s coping style was a better predictor of symptoms than a cancer diagnosis. Children identified with a low anxious or repressive adaptive style, which is characterized by low anxiety and high defensiveness, had lower PTSS scores than children identified as highly anxious.

    A highly anxious adaptive style was also associated with a greater likelihood of such symptoms as intrusive thoughts, re-experiencing events, avoidance, numbing and arousal.

    The work also suggests that childhood cancer survivors might be more vulnerable than their healthy counterparts to the effects of stress later in life. Research indicates stress symptoms increase with each traumatic event.

    “A subsequent trauma carries a heightened risk of PTSD,” the researchers wrote in Psycho-Oncology. “A similar finding has been recently reported in parents of children with cancer and discussed in terms of a second hit in a two-stage process,” they noted.

    Other authors of the Psycho-Oncology study were Nichole Jurbergs, PhD, and Alanna Long, both of Behavioral Medicine.

    Both studies were supported by the National Institutes of Health, the National Cancer Institute and ALSAC.

    November 2009