(118) The Intersection of Oncology and Sexual Violence: The Need For Trauma-Informed Care
Abstract:
Background:
Sexual violence survivors may experience cancer care, including imaging, examinations, tests and procedures, as triggering and re-traumatizing.1 In this case report we examine specific triggers within oncologic care, barriers to treatment adherence, and explore the utility of incorporating trauma-informed strategies.
Case:
A 35 year old female, G4P4, presents to gynecologic care for abnormal uterine bleeding in the setting of prior abnormal pap smears with loss to follow-up. Subsequent cold knife cone procedure is performed yielding a diagnosis of stage IB2 squamous cell carcinoma of the cervix. Her treatment course includes chemotherapy and internal brachytherapy and is complicated by frequent missed appointments and is ultimately referred to a psycho-oncology social worker to assist with adherence. During social work assessment, the patient shares a prominent sexual trauma history and states she ‘zones out’ during internal brachytherapy sessions and avoids such treatment all together.
Discussion: In this case, the patient struggled to navigate the healthcare landscape long before trauma history was uncovered, highlighting the importance for clinicians to consider formalized trauma screening in the oncologic setting, as well as the role for an interdisciplinary oncology team. Current literature cites radiotherapy as a high-risk trigger for childhood sexual assault survivors as it involves the complexity of “undressing, being touched in “private areas,” and having to lie perfectly still throughout or risk injury.”2 This patient’s dissociation provides a lens to understanding non-compliance in the setting of life-saving cancer care. Given the association of peritraumatic dissociation and the development of PTSD, and the understanding that PTSD is more common in survivors of cancer than the general population, providers must have a low threshold for further evaluating patients who display an avoidance pattern of coping including missed appointments.3,4
Conclusion: Oncologic treatment non-adherence should be evaluated as a manifestation of PTSD, especially in high risk settings of gynecologic and breast cancers, and highlights the importance of screening for trauma history.
References: 1Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on sensitive practice for health care practitioner: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada.
2Schnur, J. B., Dillon, M. J., Goldsmith, R. E., & Montgomery, G. H. (2018). Cancer treatment experiences among survivors of childhood sexual abuse: A qualitative investigation of triggers and reactions to cumulative trauma. Palliative & supportive care, 16(6), 771.
3Pacella, M., Irish, L., Ostrowski, S., Sledjeski, E., Ciesla, J., Fallon, W., Spoonster, E., & Delahanty, D. (2011). Avoidant coping as a mediator between peritraumatic dissociation and posttraumatic stress disorder symptoms. Journal of Traumatic Stress, 24(3), 317–325.
4Swartzman, S., Booth, J., Munro, A., & Sani, F. (2017). Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depression and Anxiety, 34(4), 327–339.