A recent article in *Cancer* reported that more than 20% of patients with cancer also had symptoms of PTSD (post-traumatic stress disorder) a month after diagnosis, and that symptoms often persisted for years. It was also found that, even if PTSD was not present (as defined in the DSM-IV), many cancer survivors had a persistent fear of disease recurrence, which had a psychological impact on their lives.

Many patients who had sub-clinical signs of PTSD developed full-scale PTSD at a four-year follow up. Apart from the separate health impact of these psychological factors, many of the symptoms of PTSD, such as avoidance and cognitive difficulties, interfered with adherence to treatment of the cancers.

The underlying study reported in *Cancer* involved 469 patients with cancer diagnoses in the prior month. A PTSD diagnosis was made when a patient met criteria specified by the manual for psychiatric disorders (DSM-IV): traumatic exposure (cancer diagnosis), and response associated with at least one recurring symptom, three avoidance/numbing symptoms, and two arousal symptoms, all persisting for more than a month and resulting in significant distress or functional impairment.

One interesting conclusion was that patients with breast cancer were significantly less likely to develop PTSD. The reasons were not clear, but it may be a factor of the number of women with that diagnosis and the fact most patients had a family member or knew someone who also had breast cancer. Although the breast cancer diagnosis was traumatic, it seemed less so if he patient knew others with the same diagnosis.

The study had limitations, including the fact the patient population was from one academic medical center, and involved a relatively small number of patients, but it may lead to further research that will allow for earlier recognition and treatment of this less-known outcome of a cancer diagnosis.