Stressful Events Reported by Childhood Cancer Survivors and Community Controls From the St. Jude Lifetime (SJLIFE) Cohort: A Mixed Method Study

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Abstract
Introduction: Characterizing stressful events reported by childhood cancer survivors experienced throughout the lifespan may help improve trauma‐informed care relevant to the survivor experience. Methods: Participants included 2552 survivors (54% female; 34 years of age) and 469 community controls (62% female; 33 years of age) from the St. Jude Lifetime (SJLIFE) cohort who completed the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders (PCL‐5) or the Posttraumatic Stress Disorder (PTSD) Checklist civilian version (PCL‐C) primer question in which participants identified their most stressful event. Demographic and clinical data were also obtained. Qualitative responses were analyzed using content analysis. Quantitative analyses included descriptive statistics for the sample, and frequencies of category reporting derived from qualitative analyses among survivors and controls. Results: Eleven categories of stressful events were observed: accidents and natural disasters, financial and home, acts of violence, social and relational, political and legal, occupational and educational, suicide, cancer and its treatment, illnesses and injuries, loved one's illnesses and injuries, and loved one's deaths. The most commonly reported category was loved ones’ deaths (39.7% and 36.7% in survivors and controls, respectively). Survivors more often reported illnesses and injuries (13.0% vs. 8.1%, p = 0.003) than community controls. Only 8.5% of survivors reported cancer and its treatment as their most stressful life event; survivors of bone tumors reported this more often compared to other diagnosis groups (17.3%, p < 0.0001). Conclusion: Adult survivors of childhood cancer identify events both related and unrelated to cancer or its treatment as their most stressful life events. Understanding individual survivors’ experiences may serve to better specify trauma‐informed care models.
Funding Information
  • National Institutes of Health (NCI T32 CA225590)
  • National Institutes of Health (NCI U01 CA195547)
  • National Institutes of Health (NCI P30 CA021765)

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