Traumatic Dissociation Among Cancer Patients: A Scoping Review

Background and Purpose: There has been an increasing amount of interest in implementing principles of trauma-informed care into social work oncology practice. A history of traumatic experiences is correlated with cancer prevalence, and prior traumatic experiences can adversely impact adherence to cancer screening guidelines, treatment response, and psychosocial well-being. A cancer diagnosis can lead to symptoms of post-traumatic stress disorder (PTSD). Oncology social workers who support individuals through their trauma can help reduce physical and psychosocial burdens from cancer treatment. While the majority of knowledge of trauma-informed oncology care focuses on classic PTSD symptoms (e.g., hypervigilance, hyperarousal) far less is known about how symptoms of the dissociative sub-type of PTSD are understood among cancer patients. This study explores how symptoms of traumatic dissociation are recognized and addressed in the research literature about cancer patients.

Methods: A scoping literature review was selected as the appropriate methodological approach, as it is used in review studies that seek to address gaps in the literature where little to no research has been conducted. A comprehensive search of PubMed, PsycINFO, CINAHL, Health Source, and Web of Science was conducted in June, 2019. All articles published between 1980-May, 2019 of a non-review nature that were written in English, found in peer reviewed journals, and contained an implicit or explicit reference to dissociation in the context of cancer patients were included. Studies were analyzed to determine how dissociation was addressed in terms of breadth, depth, and context.

Results: Out of 1,265 articles, 71 met the inclusion criteria for a full review, and 24 were included in the narrative synthesis. A total of 307,314 cancer patients participated in the studies, ranging in age from 3-84 years-old. Aside from cancer, only traumatic experiences related to a prior history of sexual abuse were explicitly mentioned. Overall, only 83% (n=20) focused on dissociative symptoms within the context of cancer-related trauma only, 1 study focused on trauma related to both cancer and sexual abuse, and the remaining studies focused on trauma related to sexual abuse. Dissociative symptoms were assessed by validated instruments in 16 studies. Only two studies focused on interventions to treat dissociative symptoms, and both consisted of case reports.

Conclusions and Implications: The limited number of studies about pre-diagnosis trauma lead us to wonder to what extent oncology health and mental health clinicians routinely assess for pre-diagnostic trauma, or whether trauma research lags behind clinical best practices in trauma-informed cancer care. The paucity of studies addressing dissociative symptoms related to a sexual abuse history among cancer patients is especially concerning. Dissociative symptoms are connected to a history of childhood sexual trauma, and individuals who have experienced sexual trauma, particularly those diagnosed with breast, genitourinary, and rectal cancers may encounter triggers during their diagnostic work-ups, which often require invasive testing, and unfamiliar healthcare providers touching and/or staring at body parts involved in their sexual trauma. Ongoing study is recommended to assess how dissociative symptoms impact cancer patients, and to evaluate best practices of trauma-informed social work oncology care.