The Impact of Childhood Trauma on Long-Term Health for Breast Cancer Survivors

Childhood trauma can increase a breast cancer survivor’s chance of experiencing more severe and longer-lasting treatment-related anxiety, depression and fatigue, as well as reduced cognitive function, years after cancer treatment has ended, according to a preliminary study led by Jamie Myers, PhD, FAAN, research associate professor at the University of Kansas School of Nursing.

Adverse childhood experiences (ACEs) include abuse, neglect and other traumatic events like parental separation and living with people who struggle with mental health issues. These experiences are known to increase risk for various diseases, including heart disease and cancer. However, researchers have only begun to explore the long-term impact of ACEs on cancer survivors’ mental and physical health.

Dr. Myers reached out to Lori Ranallo, MSN, APRN, a nurse practitioner at The University of Kansas Cancer Center’s Breast Cancer Survivorship Clinic, and the Masonic Cancer Alliance, the outreach arm of the cancer center. 

“We wanted to find out if it was feasible to evaluate and assess ACEs within the population Lori supports,” Dr. Myers says. “We also explored whether there was a relationship between having had these adverse childhood experiences and more significant anxiety, depression, fatigue, cognitive impairment and sleep disturbance.”

Using questionnaires composed of validated instruments and with input from the cancer center’s Patient and Investigator Voices Working Together Rapid Reactor Team (PIVOT), the researchers gathered data from women who were at least three years postdiagnosis and receiving survivorship care. Participants answered questions about ACEs, such as exposure to violence, substance use issues or family separation.

Patients also were asked to rate their anxiety, depression, fatigue, cognitive function and sleep on validated forms provided by the National Institutes of Health’s PROMIS (Patient-Reported Outcomes Measurement Information System) format. Because the researchers hypothesized that women who were more resilient – better able to bounce back from adversity – would report fewer long-term health problems, the participants also rated their resilience according to the Brief Resilience Scale.

Additionally, study participants agreed to have their blood screened for biomarkers associated with adverse childhood experiences, which may lead to a prolonged stress response in the body that research has shown can cause changes such as chronic inflammation. Such inflammation is linked to cognitive decline as well as to depression, anxiety, fatigue and sleep disturbances, Dr. Myers explains.

The average age of the 120 women who participated in the study was 63, and the average time since diagnosis was nearly 15 years. The study found that for these women, higher ACE scores were correlated with greater fatigue, anxiety and depression, as well as with reduced cognitive function. Overall, the study also found that breast cancer survivors with higher resilience scores reported higher cognitive function and less anxiety, depression and fatigue. 

Expanding the Scope

Now that the researchers have demonstrated the feasibility of such a study, they want to do another study evaluating more patients over time and including more variety in both the stages of disease represented and in the social and economic backgrounds of participants. As they expand the study, they also expect to be able to get more meaningful results about the blood biomarkers.

In the meantime, the study has implications for the care of patients. Providers may want to conduct assessments for adverse childhood experiences for patients receiving survivorship care for breast cancer. 

“That would lead us down the path of intervention research, where we could develop something to enhance people’s resilience or design interventions to help make sure that survivorship is better, with better quality of life,” Dr. Myers says.