Positive and negative outcomes of childhood cancer: is there a connection between posttraumatic stress and growth in childhood cancer survivors?
Main Article Content
Abstract
Traumatic experiences can produce both posttraumatic stress (PTS) and posttraumatic growth (PTG). The relationship of PTS and PTG is not clear and can take form of positive, negative, curvilinear (“inverted U” shape) and no association. Specific form of the relationship may be influenced by the trauma type and age. This study aims to review research of the relationship of PTS and PTG in a sample of childhood cancer survivors. Database search resulted in 11 studies meeting inclusion criteria. The results of studies included in this review are organized according to four mentioned options. Although all of these options were supported by some studies, the most convincing amount of evidence was found for the options of weakly positive and no relationship between PTS and PTG. This result points out the possibility of co-existence of PTS and PTG which has important clinical application particularly in potential need for psychosocial support also in those who are able to find positive aspects of their traumatic experience.
Keywords:
posttraumatic stress, posttraumatic growth, childhood cancer survivors
Article Details
How to Cite
KOUTNÁ, Veronika; BLATNÝ, Marek.
Positive and negative outcomes of childhood cancer: is there a connection between posttraumatic stress and growth in childhood cancer survivors?.
Medical Research Archives, [S.l.], v. 5, n. 12, dec. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1665>. Date accessed: 23 apr. 2024.
doi: https://doi.org/10.18103/mra.v5i12.1665.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ CK (eds). Childhood cancer by site: Incidence, Survival and Mortality. In: SEER Cancer Statistics Review 1975-2012. Bethesda, MD: National Cancer Institute; 2012. https://seer.cancer.gov/archive/csr/1975_2012/results_merged/sect_28_childhood_cancer.pdf. Accessed October 10, 2017.
2. Oeffinger KC, Robison LL. Childhood Cancer Survivors, Late Effects, and a New Model for Understanding Survivorship. JAMA. 2007;297(24):2762-2764. doi:10.1001/jama.297.24.2762.
3. Lown EA, Phillips F, Schwartz LA, Rosenberg AR, Jones B. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer. 2015;62(S5):S514-S584. doi:10.1002/pbc.25783.
4. Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ. Standards for the Psychosocial Care of Children With Cancer and Their Families: An Introduction to the Special Issue. Pediatr Blood Cancer. 2015;62(S5):S419-S424. doi:10.1002/pbc.25675.
5. Patenaude AF, Kupst MJ. Psychosocial Functioning in Pediatric Cancer. J Pediatr Psychol. 2005;30(1):9-27. doi:10.1093/jpepsy/jsi012.
6. Eiser C, Hill JJ, Vance YH. Examining the psychological consequences of surviving childhood cancer: systematic review as a research method in pediatric psychology. J Pediatr Psychol. 2000;25(6):449-460. doi:10.1093/jpepsy/25.6.449.
7. Blatný M, Kepák T, Vlčková I, et al. Quality of Life of Childhood Cancer Survivors: Handicaps and Benefits. Československá psychologie. 2011;55(2):112-125.
8. Barakat LP, Alderfer MA, Kazak AE. Posttraumatic Growth in Adolescent Survivors of Cancer and Their Mothers and Fathers. J Pediatr Psychol. 2006;31(4):413-419. doi:10.1093/jpepsy/jsj058.
9. Lehmann V, Gronqvist H, Engvall G, et al. Negative and positive consequences of adolescent cancer 10 years after diagnosis: An interview-based longitudinal study in Sweden. Psychooncology. 2014;23(11):1229-1235. doi:10.1002/pon.3549.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association; 1994.
11. Bruce M. A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev. 2006;26(3):233-256. doi:10.1016/j.cpr.2005.10.002.
12. Taïeb O, Moro MR, Baubet T, Revah-Lévy A, Flament MF. Posttraumatic stress symptoms after childhood cancer. Eur Child Adolesc Psychiatry. 2003;12(6):255-264. doi:10.1007/s00787-003-0352-0.
13. Noll RB, Kupst MJ. Commentary: The psychological impact of pediatric cancer hardiness, the exception or the rule? J Pediatr Psychol. 2007;32(9):1089-1098. doi:10.1093/jpepsy/jsm049.
14. Tedeschi RG, Calhoun LG. “Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.” Psychol Inq. 2004;15(1):1-18. doi:10.1207/s15327965pli1501_01.
15. Park CL. Overview of theoretical perspectives. In: Medical Illness and Positive Life Change: Can Crisis Lead to Personal Transformation?. Washington: American Psychological Association; 2009:11-30. doi:10.1037/11854-001.
16. Zoellner T, Maercker A. Posttraumatic growth in clinical psychology - A critical review and introduction of a two component model. Clin Psychol Rev. 2006;26(5):626-653. doi:10.1016/j.cpr.2006.01.008.
17. Calhoun LG, Tedeschi RG. The Foundations of Posttraumatic Growth: An Expanded Framework. In: Handbook of Posttraumatic Growth: Research & Practice. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2006:3-23.
18. Duran B. Posttraumatic Growth as Experienced by Childhood Cancer Survivors and Their Families. J Pediatr Oncol Nurs. 2013;30(4):179-197. doi:10.1177/1043454213487433.
19. Parry C, Chesler MA. Thematic Evidence of Psychosocial Thriving in Childhood Cancer Survivors. Qual Health Res. 2005;15(8):1055-1073. doi:10.1177/1049732305277860.
20. Levine SZ, Laufer A, Hamama-Raz Y, Stein E, Solomon Z. Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. J Trauma Stress. 2008;21(5):492-496. doi:10.1002/jts.20361.
21. Yi J, Kim MA. Postcancer Experiences of Childhood Cancer Survivors: How Is Posttraumatic Stress Related to Posttraumatic Growth? J Trauma Stress. 2014;27(4):461-467. doi:10.1002/jts.21941.
22. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471. doi:10.1007/BF02103658.
23. Butler LD, Blasey CM, Garlan RW, et al. Posttraumatic Growth Following the Terrorist Attacks of September 11, 2001: Cognitive, Coping, and Trauma Symptom Predictors in an Internet Convenience Sample. Traumatology. 2005;11(4):247-267. doi:10.1177/153476560501100405.
24. Klosky JL, Krull KR, Kawashima T, et al. Relations between posttraumatic stress and posttraumatic growth in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Health Psychol. 2014;33(8):878-882. doi:10.1037/hea0000076.
25. Park CL. The notion of growth following stressful life experiences Problems and prospects. Psychol Inq. 2004;15(1):69-76.
26. Coyne JC, Tennen H. Positive Psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine. Ann Behav Med. 2010;39(1):16-26. doi:10.1007/s12160-009-9154-z.
27. Tennen H, Affleck G. Assessing positive life change: In search of meticulous methods. In: Medical Illness and Positive Life Change: Can Crisis Lead to Personal Transformation?. Washington, DC, US: American Psychological Association; 2009:31-49. doi:10.1037/11854-002.
28. Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic review of benefit finding and growth. J Consult Clin Psychol. 2006;74(5):797-816. doi:10.1037/0022-006X.74.5.797.
29. Tedeschi RG, Calhoun LG. The foundations of posttraumatic growth: New considerations. Psychol Inq. 2004;15(1):1-18.
30. Shakespeare-Finch J, Lurie-Beck J. A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. J Anxiety Disord. 2014;28(2):223-229. doi:10.1016/j.janxdis.2013.10.005.
31. Shand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology. 2015;24(6):624-634. doi:10.1002/pon.3719.
32. Barskova T, Oesterreich R. Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disabil Rehabil. 2009;31(21):1709-1733. doi:10.1080/09638280902738441.
33. Meyerson DA, Grant KE, Carter JS, Kilmer RP. Posttraumatic growth among children and adolescents: A systematic review. Clin Psychol Rev. 2011;31(6):949-964. doi:10.1016/j.cpr.2011.06.003.
34. Zebrack B, Kwak M, Salsman J, et al. The relationship between posttraumatic stress and posttraumatic growth among adolescent and young adult (AYA) cancer patients. Psychooncology. 2015;24(2):162-168. doi:10.1002/pon.3585.
35. Phipps S, Long AM, Ogden J. Benefit Finding Scale for Children: preliminary findings from a childhood cancer population. J Pediatr Psychol. 2007;32(10):1264-1271. doi:10.1093/jpepsy/jsl052.
36. Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA. Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors. Psychooncology. 2013;22(10): 2235-44. doi:10.1002/pon.3286.
37. Wilson JZ, Marin D, Maxwell K, et al. Association of Posttraumatic Growth and Illness-Related Burden With Psychosocial Factors of Patient, Family, and Provider in Pediatric Cancer Survivors. J Trauma Stress. 2016;29(5):448-456. doi:10.1002/jts.22123.
38. Tillery R, Howard Sharp KM, Okado Y, Long A, Phipps S. Profiles of Resilience and Growth in Youth with Cancer and Healthy Comparisons. J Pediatr Psychol. 2016;41(3):290-297. doi:10.1093/jpepsy/jsv091.
39. Tremolada M, Bonichini S, Basso G, Pillon M. Post-traumatic Stress Symptoms and Post-traumatic Growth in 223 Childhood Cancer Survivors: Predictive Risk Factors. Front Psychol. 2016;7:1-12. doi:10.3389/fpsyg.2016.00287.
40. Koutná V, Jelínek M, Blatný M, Kepák T. Predictors of Posttraumatic Stress and Posttraumatic Growth in Childhood Cancer Survivors. Cancers. 2017;9(3):26. doi:10.3390/cancers9030026.
41. Gunst DCM, Kaatsch P, Goldbeck L. Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer. 2016;24(11):4607-4615. doi:10.1007/s00520-016-3303-2.
42. Steinberg AM, Brymer MJ, Decker KB, Pynoos RS. The University of California at Los Angeles post-traumatic stress disorder reaction index. Curr Psychiatry Rep. 2004;6(2):96-100. doi:10.1007/s11920-004-0048-2.
43. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol Assess. 1997;9(4):445-451. doi:10.1037/1040-3590.9.4.445.
44. Michel G, Taylor N, Absolom K, Eiser C. Benefit finding in survivors of childhood cancer and their parents: Further empirical support for the Benefit Finding Scale for Children. Child Care Health Dev. 2010;36(1):123-129. doi:10.1111/j.1365-2214.2009.01034.x.
45. Calhoun LG, Cann A, Tedeschi RG, McMillan J. A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. J Trauma Stress. 2000;13(3):521-527. doi:10.1023/A:1007745627077.
46. Taku K, Calhoun LG, Cann A, Tedeschi RG. The Role of Rumination in the Coexistence of Distress and Posttraumatic Growth Among Bereaved Japanese University Students. Death Stud. 2008;32(5):428-444. doi:10.1080/07481180801974745.
47. Sumalla EC, Ochoa C, Blanco I. Posttraumatic growth in cancer: Reality or illusion? Clin Psychol Rev. 2009;29(1):24-33. doi:10.1016/j.cpr.2008.09.006.
48. Stuber ML, Kazak AE, Meeske K, et al. Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics. 1997;100(6):958-964.
49. National Coalition for Cancer Survivorship. Defining Cancer Survivorship. http://www.canceradvocacy.org/news/defining-cancer-survivorship/. Published 2014. Accessed November 10, 2017.
50. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
51. Kangas M. DSM-5 Trauma and Stress-Related Disorders: Implications for Screening for Cancer-Related Stress. Front Psychiatry. 2013;4(OCT):2-4. doi:10.3389/fpsyt.2013.00122.
2. Oeffinger KC, Robison LL. Childhood Cancer Survivors, Late Effects, and a New Model for Understanding Survivorship. JAMA. 2007;297(24):2762-2764. doi:10.1001/jama.297.24.2762.
3. Lown EA, Phillips F, Schwartz LA, Rosenberg AR, Jones B. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer. 2015;62(S5):S514-S584. doi:10.1002/pbc.25783.
4. Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ. Standards for the Psychosocial Care of Children With Cancer and Their Families: An Introduction to the Special Issue. Pediatr Blood Cancer. 2015;62(S5):S419-S424. doi:10.1002/pbc.25675.
5. Patenaude AF, Kupst MJ. Psychosocial Functioning in Pediatric Cancer. J Pediatr Psychol. 2005;30(1):9-27. doi:10.1093/jpepsy/jsi012.
6. Eiser C, Hill JJ, Vance YH. Examining the psychological consequences of surviving childhood cancer: systematic review as a research method in pediatric psychology. J Pediatr Psychol. 2000;25(6):449-460. doi:10.1093/jpepsy/25.6.449.
7. Blatný M, Kepák T, Vlčková I, et al. Quality of Life of Childhood Cancer Survivors: Handicaps and Benefits. Československá psychologie. 2011;55(2):112-125.
8. Barakat LP, Alderfer MA, Kazak AE. Posttraumatic Growth in Adolescent Survivors of Cancer and Their Mothers and Fathers. J Pediatr Psychol. 2006;31(4):413-419. doi:10.1093/jpepsy/jsj058.
9. Lehmann V, Gronqvist H, Engvall G, et al. Negative and positive consequences of adolescent cancer 10 years after diagnosis: An interview-based longitudinal study in Sweden. Psychooncology. 2014;23(11):1229-1235. doi:10.1002/pon.3549.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association; 1994.
11. Bruce M. A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev. 2006;26(3):233-256. doi:10.1016/j.cpr.2005.10.002.
12. Taïeb O, Moro MR, Baubet T, Revah-Lévy A, Flament MF. Posttraumatic stress symptoms after childhood cancer. Eur Child Adolesc Psychiatry. 2003;12(6):255-264. doi:10.1007/s00787-003-0352-0.
13. Noll RB, Kupst MJ. Commentary: The psychological impact of pediatric cancer hardiness, the exception or the rule? J Pediatr Psychol. 2007;32(9):1089-1098. doi:10.1093/jpepsy/jsm049.
14. Tedeschi RG, Calhoun LG. “Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.” Psychol Inq. 2004;15(1):1-18. doi:10.1207/s15327965pli1501_01.
15. Park CL. Overview of theoretical perspectives. In: Medical Illness and Positive Life Change: Can Crisis Lead to Personal Transformation?. Washington: American Psychological Association; 2009:11-30. doi:10.1037/11854-001.
16. Zoellner T, Maercker A. Posttraumatic growth in clinical psychology - A critical review and introduction of a two component model. Clin Psychol Rev. 2006;26(5):626-653. doi:10.1016/j.cpr.2006.01.008.
17. Calhoun LG, Tedeschi RG. The Foundations of Posttraumatic Growth: An Expanded Framework. In: Handbook of Posttraumatic Growth: Research & Practice. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2006:3-23.
18. Duran B. Posttraumatic Growth as Experienced by Childhood Cancer Survivors and Their Families. J Pediatr Oncol Nurs. 2013;30(4):179-197. doi:10.1177/1043454213487433.
19. Parry C, Chesler MA. Thematic Evidence of Psychosocial Thriving in Childhood Cancer Survivors. Qual Health Res. 2005;15(8):1055-1073. doi:10.1177/1049732305277860.
20. Levine SZ, Laufer A, Hamama-Raz Y, Stein E, Solomon Z. Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. J Trauma Stress. 2008;21(5):492-496. doi:10.1002/jts.20361.
21. Yi J, Kim MA. Postcancer Experiences of Childhood Cancer Survivors: How Is Posttraumatic Stress Related to Posttraumatic Growth? J Trauma Stress. 2014;27(4):461-467. doi:10.1002/jts.21941.
22. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471. doi:10.1007/BF02103658.
23. Butler LD, Blasey CM, Garlan RW, et al. Posttraumatic Growth Following the Terrorist Attacks of September 11, 2001: Cognitive, Coping, and Trauma Symptom Predictors in an Internet Convenience Sample. Traumatology. 2005;11(4):247-267. doi:10.1177/153476560501100405.
24. Klosky JL, Krull KR, Kawashima T, et al. Relations between posttraumatic stress and posttraumatic growth in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Health Psychol. 2014;33(8):878-882. doi:10.1037/hea0000076.
25. Park CL. The notion of growth following stressful life experiences Problems and prospects. Psychol Inq. 2004;15(1):69-76.
26. Coyne JC, Tennen H. Positive Psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine. Ann Behav Med. 2010;39(1):16-26. doi:10.1007/s12160-009-9154-z.
27. Tennen H, Affleck G. Assessing positive life change: In search of meticulous methods. In: Medical Illness and Positive Life Change: Can Crisis Lead to Personal Transformation?. Washington, DC, US: American Psychological Association; 2009:31-49. doi:10.1037/11854-002.
28. Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic review of benefit finding and growth. J Consult Clin Psychol. 2006;74(5):797-816. doi:10.1037/0022-006X.74.5.797.
29. Tedeschi RG, Calhoun LG. The foundations of posttraumatic growth: New considerations. Psychol Inq. 2004;15(1):1-18.
30. Shakespeare-Finch J, Lurie-Beck J. A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. J Anxiety Disord. 2014;28(2):223-229. doi:10.1016/j.janxdis.2013.10.005.
31. Shand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology. 2015;24(6):624-634. doi:10.1002/pon.3719.
32. Barskova T, Oesterreich R. Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disabil Rehabil. 2009;31(21):1709-1733. doi:10.1080/09638280902738441.
33. Meyerson DA, Grant KE, Carter JS, Kilmer RP. Posttraumatic growth among children and adolescents: A systematic review. Clin Psychol Rev. 2011;31(6):949-964. doi:10.1016/j.cpr.2011.06.003.
34. Zebrack B, Kwak M, Salsman J, et al. The relationship between posttraumatic stress and posttraumatic growth among adolescent and young adult (AYA) cancer patients. Psychooncology. 2015;24(2):162-168. doi:10.1002/pon.3585.
35. Phipps S, Long AM, Ogden J. Benefit Finding Scale for Children: preliminary findings from a childhood cancer population. J Pediatr Psychol. 2007;32(10):1264-1271. doi:10.1093/jpepsy/jsl052.
36. Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA. Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors. Psychooncology. 2013;22(10): 2235-44. doi:10.1002/pon.3286.
37. Wilson JZ, Marin D, Maxwell K, et al. Association of Posttraumatic Growth and Illness-Related Burden With Psychosocial Factors of Patient, Family, and Provider in Pediatric Cancer Survivors. J Trauma Stress. 2016;29(5):448-456. doi:10.1002/jts.22123.
38. Tillery R, Howard Sharp KM, Okado Y, Long A, Phipps S. Profiles of Resilience and Growth in Youth with Cancer and Healthy Comparisons. J Pediatr Psychol. 2016;41(3):290-297. doi:10.1093/jpepsy/jsv091.
39. Tremolada M, Bonichini S, Basso G, Pillon M. Post-traumatic Stress Symptoms and Post-traumatic Growth in 223 Childhood Cancer Survivors: Predictive Risk Factors. Front Psychol. 2016;7:1-12. doi:10.3389/fpsyg.2016.00287.
40. Koutná V, Jelínek M, Blatný M, Kepák T. Predictors of Posttraumatic Stress and Posttraumatic Growth in Childhood Cancer Survivors. Cancers. 2017;9(3):26. doi:10.3390/cancers9030026.
41. Gunst DCM, Kaatsch P, Goldbeck L. Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer. 2016;24(11):4607-4615. doi:10.1007/s00520-016-3303-2.
42. Steinberg AM, Brymer MJ, Decker KB, Pynoos RS. The University of California at Los Angeles post-traumatic stress disorder reaction index. Curr Psychiatry Rep. 2004;6(2):96-100. doi:10.1007/s11920-004-0048-2.
43. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol Assess. 1997;9(4):445-451. doi:10.1037/1040-3590.9.4.445.
44. Michel G, Taylor N, Absolom K, Eiser C. Benefit finding in survivors of childhood cancer and their parents: Further empirical support for the Benefit Finding Scale for Children. Child Care Health Dev. 2010;36(1):123-129. doi:10.1111/j.1365-2214.2009.01034.x.
45. Calhoun LG, Cann A, Tedeschi RG, McMillan J. A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. J Trauma Stress. 2000;13(3):521-527. doi:10.1023/A:1007745627077.
46. Taku K, Calhoun LG, Cann A, Tedeschi RG. The Role of Rumination in the Coexistence of Distress and Posttraumatic Growth Among Bereaved Japanese University Students. Death Stud. 2008;32(5):428-444. doi:10.1080/07481180801974745.
47. Sumalla EC, Ochoa C, Blanco I. Posttraumatic growth in cancer: Reality or illusion? Clin Psychol Rev. 2009;29(1):24-33. doi:10.1016/j.cpr.2008.09.006.
48. Stuber ML, Kazak AE, Meeske K, et al. Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics. 1997;100(6):958-964.
49. National Coalition for Cancer Survivorship. Defining Cancer Survivorship. http://www.canceradvocacy.org/news/defining-cancer-survivorship/. Published 2014. Accessed November 10, 2017.
50. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
51. Kangas M. DSM-5 Trauma and Stress-Related Disorders: Implications for Screening for Cancer-Related Stress. Front Psychiatry. 2013;4(OCT):2-4. doi:10.3389/fpsyt.2013.00122.