Current understanding and research of emotional distress in the cancer setting is based on seminal studies in the 1970's and early 1980's when Post Traumatic Stress Disorder (PTSD) was not an official psychiatric diagnosis and or just recently officially recognized, but poorly understood.  Current studies continue to use survey instruments, which were developed before PTSD was a recognized diagnosis and thus, continue to underappreciate the prevalence of PTSD and Acute Stress Disorder symptoms.  For example, the Hospital Anxiety and Depression Scale is a commonly used instrument, which does not speak to Post Traumatic Stress Disorder. 

This educational gap's persistence is partly due to diagnostic and research disagreement over the diagnosis of PTSD.  Some researchers argue for a criteria favoring acute, discreet traumatic experience such as injury in military combat or sexual assault, and discount more diffuse traumas such as the cancer experience, incarceration in a concentration camp, or a protracted genocide experience because of difficulty in identifying the discrete traumatic incident.  However, from the patient perspective, this is likely a misguided impediment to care and would represent an additional trauma if they were confronted with this type of invalidation of their suffering.  

Research suggests that previously traumatized patients are 14 fold more likely to develop PTSD from their cancer experience than patients without previous PTSD.  Traumatized patients have elevated risk of treatment avoidance, viewing authority figures as non-helpful, and are more likely to be distressed by their cancer experience.  This has implications for resource utilization and clinical outcomes.  PTSD was found to be the psychiatric symptom cluster with the most detrimental influence on healthcare related quality of life.  Detection and early intervention could have a significant effect on resource utilization, clinical outcomes, and emotional burden to treating staff. It is, therefore, imperative to have greater awareness of and sensitivity to potential PTSD symptoms in order to be better equipped to treat selected patients.