A new report from the Childhood Cancer Survivor Study shows that the incidence of post-traumatic stress disorder (PTSD) among adult survivors of pediatric cancers was more than four times greater than that of their healthy siblings. However, the incidence of PTSD among survivors remained low overall-at 9 percent.

"The good news is that more than 90 percent of survivors of childhood cancer don't have PTSD, even though they went through a very difficult experience," said lead author Margaret Stuber, M.D., Jane and Marc Nathanson Professor of Psychiatry at the University of California, Los Angeles David Geffen School of Medicine. "However, some do have longstanding functional difficulties that require attention. Assessment for PTSD should therefore be considered part of the long-term health screening for childhood cancer survivors."

The Childhood Cancer Survivor Study is a comprehensive long-term follow-up study funded by the National Cancer Institute. In this analysis, PTSD symptoms, clinical distress, and functional impairment were compared between 6,542 adult childhood cancer survivors and 368 of their siblings. Nine percent of survivors and 2 percent of their siblings were found to have PTSD. Survivors who had been diagnosed before the age of four, and treated with radiation to the head, were at increased risk of PTSD.

Other factors also influenced PTSD incidence, including diagnosis and type of treatment. PTSD was more common among those who had been treated with intensive therapies, such as amputation, radiation, or multiple modalities. Compared to survivors of other cancers, PTSD was less common among survivors of neuroblastoma, which usually occurs in very young children, and Wilms' tumor, the therapy for which usually involves only surgery.

Dr. Stuber and her colleagues also found that PTSD was more common among unmarried individuals, survivors with less than a college education, individuals earning less than $20,000 per year, or who were unemployed, although the specific relationship between these factors and PTSD was unclear. She concluded, however, that these factors may help clinicians identify childhood cancer survivors who are at high risk of PTSD.