11/23/2017 10:06 EST | Updated 11/23/2017 11:06 EST

1 In 5 Cancer Patients Experienced PTSD After Their Diagnosis: Malaysian Study

"It's comparable to the death of a close friend or relative"

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A new Malaysian study finds that over 20 per cent of cancer patients experience post-traumatic stress disorder at some point after their diagnosis.

Hearing a cancer diagnosis, whether you're a loved one or the patient, can make you feel like your whole world is imploding.

But receiving a cancer diagnosis can be so difficult for the patient that a new study finds that 20 per cent of patients experience post-traumatic stress disorder (PTSD) months, and even years later.

Researchers from the National University of Malaysia, which published its findings in the journal Cancer, found that six months after patients received their cancer diagnoses, 21 per cent had PTSD. That number fell to six per cent at the four-year mark.

PTSD is commonly associated with traumatic and high-level stress events such as being involved in a car crash, violent crimes, natural disasters or chronic abuse. These symptoms include physical pain, tension, recurring thoughts and feelings and avoiding places and situations that remind them of the triggering event.

Many cancer patients believe they need to adopt a 'warrior mentality.'Caryn Mei Hsien Chan, study's lead author

"Many cancer patients believe they need to adopt a 'warrior mentality', and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer," said the study's lead author Caryn Mei Hsien Chan in a statement.

"To these patients, seeking help for the emotional issues they face is akin to admitting weakness."

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For cancer patients who adopt a 'warrior mentality', admitting the need for emotional help can be akin to admitting weakness, the study's lead author says.

"There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval — particularly depression, anxiety, and PTSD — post-cancer," she said.

She and her colleagues looked at one referral centre in Malaysia to examine an initial 469 patients one month after their diagnosis, then at the six-month-period and then a final follow-up with them after four years. The study eventually focused on 245 people, after patients either died or dropped out of the study.

Over a third of patients initially diagnosed with PTSD following their cancer diagnosis still experienced symptoms four years later.

An impact beyond mental health

When cancer patients are experiencing PTSD, symptoms can manifest by avoidance of oncology appointments or not sticking with regular treatment schedules. Part of that is brought on by patients wanting to avoid flashbacks.

Geertruida H. de Bock, a researcher at Netherland's University Medical Center Groningen, who wasn't involved in the study, explained that PTSD can happen anytime during or after treatment.

"It's comparable to the death of a close friend or relative," he said in an email to Reuters when asked about the study.

The Canadian Mental Health Association (CMHA) says cancer can create on a high level of stress, changes in appearance and emotional ups and downs, so patients are at a higher risk for developing depression. In the U.K., one in five cancer patients reported moderate to severe mental health issues.

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There are over a million people in Canada suffering from cancer and that number is expected to rise. So it's imperative for doctors to routinely screen patients for PTSD following their cancer diagnosis.

Dr. Charles Raison, a professor of psychiatry at the University of Wisconson-Madison, told MD Magazine that older studies with cancer patients found that cancer patients turned to alcohol to deal with their stress — so proper treatment is critical to prevent compounding problems.

This (study's findings) underscores the importance of building better programs for longer-term support for cancer patients.Dr. Fremonta Meyer, coauthor of study

CMHA notes on its website that patients already battling a mental health problem can actually interfere with cancer treatment. The group said, for example, older women who had been diagnosed with both breast cancer and depression were significantly less likely to receive optimal treatment.

"This (study's findings) underscores the importance of building better programs for longer-term support for cancer patients," Dr. Fremonta Meyer, co-author of the study said to STAT.

"We'll miss people who are really continuing to suffer emotionally," said the psychiatrist at the Dana-Farber Cancer Institute.

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There are groups across North America offering cancer survivorship programs and charities like Wellspring which offer mental health services, the study reccomends more like these.

Across North America, there are already cancer survivorship programs that have been offering mental health services for anxiety, depressing and PTSD.

And in Canada, the charity Wellspring offers psychological help, stress management and coping techniques to cancer patients in Alberta and in Southern Ontario, reported the Toronto Star.

Do we do as well as we should in following up on anxiety and depression? Probably not.Dr. Alan Valentine, University of Texas

Although he wasn't involved in the study, Dr. Alan Valentine, chairman of the department of psychiatry at Houston's University of Texas MD Anderson Cancer Center, explained that doctors have a lot to learn when it comes to cancer's psychological impacts.

"Do we do as well as we should in following up on anxiety and depression? Probably not," he told STAT, adding that he feels like many people might be overlooked.