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Young adult cancer patient in bed

Cancer and young adults: Mental health support can mitigate long-term PTSD

Young adults are in the middle of a very exciting time of their lives: thinking about college or starting out in the workforce; developing lasting relationships with friends and romantic partners; maybe starting families or careers.

Getting a cancer diagnosis at this time is certainly not on the agenda.

“A diagnosis of cancer has the potential to stop everything. It can delay or even eliminate large portions of your timeline and life goals, such as when or how to start a family,” says Erin Brewer-Spritzer, clinical psychology trainee in Roswell Park Comprehensive Cancer Center’s Young Adult program. “It can get overwhelming quickly.”

Fortunately, young adults in this generation are just as comfortable talking about their mental health as their physical health, meaning they are more inclined to seek out support for dealing with their cancer-related stress earlier in the treatment process. The earlier help and support are requested, the stronger the safety net that can be stitched together for these patients from the start.

But it’s important to know that, much like their cancer treatment and outcomes, everyone’s level of stress and psychological trauma will be different, both during and after treatment.

Stress and trauma don’t have to last forever

“Being diagnosed with cancer can be very traumatic, but it doesn’t necessarily guarantee a person will be traumatized or develop post-traumatic stress disorder (PTSD),” Brewer-Spritzer says. “Because this is something you may experience, we’re building in this safety net throughout treatment, through follow-up visits, throughout survivorship, to buffer the impact of this medical experience.

"Will some people have PTSD and develop a trauma response? Yes, of course, but there are many people who can adaptively adjust to a diagnosis of cancer similar to how they adjust to other life stressors. For those who do experience symptoms of PTSD, there are ways to get help.”  

There’s also the additional stress of worrying about cancer recurring, about finding that it has returned or that the aggressive treatments used to save a person’s life might result in huge life changes, including potential infertility or significant body changes, such as the loss of a limb. All of this comes at a time when, just before their diagnosis, the patient was focused on being a young adult and getting started on their vision for their future.

Learn the triggers and how to address them

Methods for coping with this stress include understanding what is causing anxiety on any given day and learning how to respond to it.

For example, it can help to address the concept of “scanxiety,” or heightened stress and anxiety before a follow-up scan that will determine whether cancer treatment is working or not. “I tell patients to talk with their providers and see if they are able to schedule their scans earlier in the week. Sometimes the only real release from that stress will be the results.

"Statements with question marks have a way of feeling bigger and scarier than statements with periods,” Brewer-Spritzer says. “No matter what the results of the scans are, good or bad, there will be a plan. There will be an action and a way to move forward. You can feel helpless in the middle while you’re waiting. That alone can be triggering and re-traumatizing.”

She encourages people to be aware of how they’re feeling before and after scans and to give themselves the room and the time to address their mental health while waiting for the results. “There’s a push to try and present enough evidence as to why you don’t need to worry, but the fact that you’re a survivor of cancer is real. It’s valid.

"It’s ok to be scared by scary things. But if you’re not able to function three weeks before or after a scan, that might need some intervention. If it’s the day before and you feel like you need to take the day off and prepare for it, do it. Let’s take the heavy lifting off, let’s ramp up self-care.”

Talking to a psychologist or other mental health professional soon after diagnosis, or as soon as the stress and fear start to be overwhelming, can help people develop better coping mechanisms and tools to handle those trying times as they come. “Bad” scans or findings of cancer reoccurrence may make it feel as if months of healthy mental health practices are being undone in a single moment, but Brewer-Spritzer reminds patients that they’re not starting back at square one: they’ll have more techniques to use to get through the difficult days ahead.

Young Adult Program at Roswell Park

Find out more about the services provided by the Young Adult program.

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There’s no timeline or “right” way to deal with cancer-related stress

It's also possible someone will come through their cancer treatment feeling relatively untouched from a mental health perspective, only to have nightmares or notice their personality has changed months to years after treatment ends. This is an understandable outcome from a traumatic experience, as mental and physical health do not necessarily happen on the same timeline. For those who had traumatic experiences in their past, before cancer, or were living with anxiety, the diagnosis adds one more thing to contend with.

“In therapy, whatever distress you have outside of cancer, you can work through it in a way that’s emotionally safe,” Brewer-Spritzer says. “There’s sitting in the moment and bearing witness to the pain. My role is to take and hold the pain without being burdened. This is so hard on our young adult patients, especially those who don’t want to burden their loved ones with the hard moments of the cancer experience. They may want to protect the people they love by keeping in and not sharing all of the dark and hard moments.

"But keeping all of that on yourself may increase the effects of later trauma. Therapy is a time to let it out. Patients are holding enough; they don’t have to hold all of it.”

People might expect cancer patients of any age to feel relieved and magically better when they ring the bell or end their treatment. But it’s OK to not feel OK right away, or to have bad days again weeks, months or years after being in remission and well into survivorship.

“It’s normal to say this was a trauma and you’re still suffering, that it didn’t just end the day you rang the bell. The psychological impact of a cancer diagnosis and treatment can be long,” Brewer-Spritzer says. “Months to years later, you could still be going through this, because there’s a lot to process. If you feel this is something above and beyond being stressful, that it’s changed who you are or you’re not able to be yourself, it might be time to seek help and get the resources you need to move forward.”