Cancer-Related Post-Traumatic Stress Symptoms of Palestinian Breast Cancer Patients and Survivors from the Gaza Strip - Associations with Non-Cancer Traumatic Events and Centrality of Event

BACKGROUND: The aim was to investigate breast cancer-related post-traumatic stress symptoms in a sample of Palestinian breast cancer patients and survivors and to explore the associations with non-cancer traumatic events, e.g., witnessing war and combat, and centrality ofevent, i.e. the extent to which a memory for a stressful event forms a reference point for personalidentity. METHOD: Participants were 489 women (Age:18–68 yrs; response rate:76%) attendingtreatment or control visits for breast cancer (BC) during a 3-month period at the two main departments responsible for treating cancer patients in the Gaza Strip. Assessments included: Demographic and disease- and treatment-related factors, BC-related post-traumatic stress symptoms (Impact of Events Scale - Revised (IES-R-BC)), the most traumatic non-cancer event (MTNCE), MTNCE-related post-traumatic stress symptoms (IES-R-MTNCE), centrality of event (CES) for BC and MTNCE, and the order in which the BC and MTNCE were experienced. A cohort of 3343 Danish women treated for primary breast cancer served as comparison group. RESULTS: Palestinian breast cancer patients and survivors reported considerably higher levels of cancer-related posttraumatic stress symptoms than Danish women with comparable disease severity assessed at equivalent time points following their treatment. Hierarchical multivariate regression showed symptom severity (IES-R-BC) as independently associated with several factors, including: a) Having metastatic and recurrent cancer, b) having children, c) having been exposed to another non-cancer-related traumatic event (MTNCE), in particular other life-threatening events, d) the severity of post-traumatic stress symptoms associated with MTNCE, and e) centrality of both BC and the MTNCE. The final model explained 59% of the variance in IES-R-BC. CONCLUSIONS: Palestinian women report considerably higher levels of cancer-related post-traumatic stress than Danish women with comparable disease severity. Their distress associated with other non-cancer events, especially other life-threatening events, and the perceived centrality of such events were important independent predictors of cancer-related posttraumatic stress. RESEARCH IMPLICATIONS: Distress associated with non-cancer traumatic events and the extent to which such events are perceived as central to personal identity appear to be important risk factors for developing cancer-related post-traumatic stress. The results suggest that these factors be included when researching risk factors for cancer-related distress. CLINICAL IMPLICATIONS: The high cancer-related posttraumatic stress symptom level experienced by Palestinian women may in part be due to exposure to other non-cancer traumatic experiences, e.g. war and combat and other life-threatening events. Another reason could be uncertainty associated with the difficulties in receiving regular screening and prompt treatment after diagnosis in the occupied territories. Not only improved screening and treatment but also psychosocial support services for this group of patients are called for.