Prevalence and predictors of post-traumatic stress symptoms in adolescent and young adult cancer survivors: a 1-year follow-up study Minyoung Kwak 1 *, Brad J. Zebrack 1 , Kathleen A. Meeske 2 , Leanne Embry 3 , Christine Aguilar 3 , Rebecca Block 4 , Brandon Hayes-Lattin 4 , Yun Li 5,6 , Melissa Butler 7 and Steven Cole 8 1 School of Social Work, University of Michigan, Ann Arbor, MI, USA 2 Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA 3 University of Texas Health Science Center, San Antonio, TX, USA 4 Oregon Health and Sciences University, Portland, OR, USA 5 Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA 6 Cancer Surveillance and Outcomes Research Team, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA 7 Department of Behavioral Science, University of Michigan, Dearborn, MI, USA 8 HopeLab Foundation, Redwood City, CA, USA *Correspondence to: School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, 48109-1106, USA. E-mail: mykwak@umich. edu Received: 30 March 2012 Revised: 24 September 2012 Accepted: 10 October 2012 Abstract Objectives: Post-traumatic stress symptoms (PTSS) have been identified as a meaningful indicator of distress in cancer survivors. Distinct from young adult survivors of childhood cancer, young people diagnosed with cancer as adolescents and young adults (AYAs) face unique psychosocial issues; however, there is little published research of PTSS in the AYA population. This study examines prevalence and predictors of PTSS among AYAs with cancer. Methods: As part of a longitudinal study of AYAs with cancer, 151 patients aged 15–39 years completed mailed surveys at 6 and 12 months post-diagnosis. Severity of PTSS was estimated at 6 and 12 months post-diagnosis. Multiple regression analyses were conducted to investigate the predictive effects of socio-demographic and clinical characteristics on changes in PTSS over time. Results: At 6 and 12 months, respectively, 39% and 44% of participants reported moderate to severe levels of PTSS; 29% had PTSS levels suggestive of post-traumatic stress disorder. No significant differences in severity of PTSS between 6 and 12 months were observed. Regression analyses suggested that a greater number of side effects were associated with higher levels of PTSS at 6 months. Currently receiving treatment, having surgical treatment, diagnosis of a cancer type with a 90–100% survival rate, remaining unemployed/not in school, and greater PTSS at 6 months were associated with higher levels of PTSS at 12 months. Conclusions: Post-traumatic stress symptoms were observed as early as 6 months following diagnosis and remained stable at 12-month follow-up. The development of early interventions for reducing distress among AYA patients in treatment is recommended. Copyright © 2012 John Wiley & Sons, Ltd. Introduction Diagnosis and treatment of cancer constitute stressful and life-threatening events. A growing body of literature has examined traumatic qualities of cancer that relate to post- traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) [1–3]. The experience of cancer includes multiple and chronic stressors related to threatening life and bodily integrity, such as diagnosis, severity of cancer, invasive procedures, treatment side effects, risk of relapse, and interference with physical and social functioning [4,5]. For cancer patients, these stressors may emerge repeatedly for an extended period. Because of these unique characteristics of cancer as both acute (e.g. diagnosis) and chronic (e.g. treatment) stressors, symptoms of post- traumatic stress may emerge differentially over the course of cancer. Post-traumatic stress symptoms include re-experiencing of the traumatic event, such as intrusive memories and nightmares; avoidance of thoughts, feelings, and reminders related to the trauma and emotional numbing; and persistent arousal, such as hyper-vigilance and insomnia [6]. In addition to exposure to a traumatic event, a diagnosis of PTSD requires the presence of the above-described PTSS symptoms, along with two additional criteria: PTSS persist for at least 1 month after trauma; and PTSS symptoms manifest physical symptoms and significant impairment to individuals’ functioning [6]. When patients suffer from these symptoms, they may have difficulties in attending to appointments or understanding information related to medical care during visits [7]. This study focuses on the prevalence and predictors of PTSS over 1 year among adolescents and young adults (AYAs) recently diagnosed with cancer, an understudied population who may be receiving inadequate psychosocial care. Adolescents and young adults who are diagnosed with cancer during their teenage or young adult years are at risk for distress because they face unique challenges resulting from coping with both their current developmental stage and a life-threatening illness [8–11]. For example, AYAs Copyright © 2012 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (2012) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3217