Cancer as Trauma: Multidimensional Determinants of PTSD Across the Disease Course. A narrative integrative review

Cittim B. Palomares-Palomares^1*Eduardo Rios-Garcia²Juan-Manuel Hernandez-Martinez²Jennifer Gomez-Gloria¹Luis Angel Llamas-Alonso¹Marcela Hernandez-Ortega³Luis Lara-Mejía²Georgina Alvarez-Rayon⁴Narjust Florez⁵Oscar Arrieta^2*

• ¹Universidad Autonoma de Baja California - Campus Ensenada, Ensenada, Mexico
• ²National Institute of Cancerology (INCAN), Mexico City, Mexico
• ³Universidad Anahuac Mexico Centro de Investigacion en Ciencias de la Salud, Huixquilucan de Degollado, Mexico
• ⁴Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
• ⁵Dana-Farber Cancer Institute, Boston, United States

Background: Post-traumatic stress disorder (PTSD) is a significant psychological response of cancer diagnosis, treatment, and survivorship. This review synthesizes evidence on the psychological, socioemotional, and biomedical determinants of cancer-related PTSD, emphasizing how these factors interact across the disease trajectory. Methods: We conducted a narrative integrative review of PubMed, PsycINFO, and Scopus. Eligible studies included articles published between 2015 and March 2025 reporting adults with cancer assessed for PTSD using validated instruments across different study designs. Based on findings on prevalence, predictors, and assessment tools a biopsychosocial model was structured. Results: 23 studies met inclusion criteria, mainly from the United States and China, with breast cancer as the most frequently studied diagnosis. Reported PTSD prevalence ranged widely, from 0% to 72.5%, depending on the instruments and cutoffs used. Psychological determinants included affective comorbidities, fear of recurrence, maladaptive coping, and prior psychiatric history. Socioemotional determinants involved social support, communication quality, demographic variables, and cultural factors. Medical-biological determinants related to treatment aggressiveness, symptom burden, disease stage, and inflammation. Younger age, female sex, and limited social support consistently elevated risk. PTSD was associated with lower quality of life, reduced adherence to treatment, and poorer survivorship outcomes. Conclusions: Cancer-related PTSD reflects the continuous interaction of psychological, socio-emotional, and medical-biological factors across the cancer journey. These findings underscore the need for culturally sensitive assessment tools and for adapting interventions to the specific demands of each phase of care. Increasing trauma-informed awareness among multidisciplinary teams can enhance early identification of at-risk patients and support patient-centered care.