Distress during Cancer Treatment and its Relation to Posttraumatic Stress Symptoms

This dissertation focuses on the psychological response to stress in cancer patients. Specifically, it examines the factors which increase the likelihood of experiencing distress and posttraumatic stress (PTSS), as well as the relationship between distress and PTSS. The dissertation is composed of three manuscripts, the first of which presents a review of the current literature on distress and PTSS in adult cancer patient populations. It indicates that distress is prevalent in cancer patient populations, and that increased levels of distress may be related to PTSS. Furthermore, risk and protective factors are identified, including older age and social support, which may serve as buffers for distress.

The second paper examines a sample of more than 1,100 cancer patients, across more than a dozen treatment centers. Hierarchical linear modeling techniques are used to examine how clinic-level factors might be related to individual distress levels. The third and final paper describes a conditional process model with distress levels as the predictor and PTSS as the outcome, where physical cancer symptoms mediate the relationship between the two and social support and age serve as moderators. Findings from this dissertation have potential implications for both future research and direct practice, within oncology settings. The studies serve as important next steps in a growing body of research.