Genome-wide association study of posttraumatic stress disorder among childhood cancer survivors : results from the Childhood Cancer Survivor Study and the St. Jude Lifetime Cohort

Funding Information: This work was supported by the National Cancer Institute (CA55727, G.T. Armstrong, Principal Investigator). The St. Jude Lifetime Cohort study was supported by the National Cancer Institute (U01CA195547, M.M. Hudson/L.L. Robison, Principal Investigators). Support to St. Jude Children’s Research Hospital was also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and the American Lebanese-Syrian Associated Charities (ALSAC). Dr. Lu was supported by a research fellowship at the Dana-Farber Cancer Institute funded by the Swim Across America and the Grant of Excellence from the Icelandic Research Fund (163362-051 to Dr. Valdimarsdóttir). Open access funding provided by Karolinska Institute. Publisher Copyright: © 2022, The Author(s).Genetic influence shapes who develops posttraumatic stress disorder (PTSD) after traumatic events. However, the genetic variants identified for PTSD may in fact be associated with traumatic exposures (e.g., interpersonal violence), which appear heritable as well. Childhood cancer survivors (CCS) are at risk for PTSD, but genetic influences affecting cancer are unlikely to overlap with those affecting PTSD. This offers a unique opportunity to identify variants specific to PTSD risk. In a genome-wide association study (GWAS), 3984 5-year survivors of childhood cancer of European-ancestry from the Childhood Cancer Survivor Study (CCSS) were evaluated for discovery and 1467 survivors from the St. Jude Lifetime (SJLIFE) cohort for replication. Childhood cancer-related PTSD symptoms were assessed using the Posttraumatic Stress Diagnostic Scale in CCSS. GWAS was performed in CCSS using logistic regression and lead markers were replicated/meta-analyzed using SJLIFE. Cross-associations of identified loci were examined between CCS and the general population. PTSD criteria were met for 671 participants in CCSS and 161 in SJLIFE. Locus 10q26.3 was significantly associated with PTSD (rs34713356, functionally mapped to ECHS1, P = 1.36 × 10–8, OR 1.57), and was replicated in SJLIFE (P = 0.047, OR 1.37). Variants in locus 6q24.3-q25.1 reached marginal significance (rs9390543, SASH1, P = 3.56 × 10–6, OR 0.75) in CCSS and significance when meta-analyzing with SJLIFE (P = 2.02 × 10–8, OR 0.75). Both loci were exclusively associated with PTSD in CCS rather than PTSD/stress-related disorders in general population (P-for-heterogeneity < 5 × 10–6). Our CCS findings support the role of genetic variation in PTSD development and may provide implications for understanding PTSD heterogeneity.Peer reviewe

Providing Effective Mental Health Support for Oncology Health-Care Workers in the COVID-19 Era: Responding Quickly but Carefully

Abstract Oncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from posttraumatic stress disorder and mental illness, because traditional mental health interventions may pathologize healthy stress reactions and risk retraumatizing HCWs under acute duress. Further, HCWs are experiencing protracted forms of acute stress as the pandemic continues, including moral injury, and require mental health interventions that are flexible and can adapt as the acuity of stressors changes. Previously developed frameworks to support people experiencing acute stress, such as Psychological First Aid, are particularly relevant for HCWs in the ongoing pandemic. Acute stress interventions like Psychological First Aid are guided by the Stress Continuum Model, which conceptualizes stress reactions on a continuum, from a zone of normal readiness and expectable consequences to a zone of more persistent and extreme reactions such as posttraumatic stress disorder and major depression. Key principles of the Stress Continuum Model include the expectation that emotional reactivity does not lead to psychiatric problems, that interventions need to be appropriately targeted to symptoms along the stress continuum, and that people will return to normal recovery. Various core actions to reduce acute stress include delivering practical assistance, reducing arousal, mobilizing support, and providing targeted collaborative services. This nonpathologizing approach offers a valuable framework for delivering both individual and organizational-level interventions during the coronavirus disease 2019 pandemic.</jats:p

Availability of therapeutic sexual aids for cancer survivors: A survey of major cancer centers.

134 Background: Treatment-related sexual dysfunction is a distressing problem for many cancer survivors. Cancer treatment guidelines recommend therapeutic aids for sexual health rehabilitation (e.g., vaginal dilators, moisturizers, vacuum erection device). However, survivors often don't know how or where to access sexual aids or may be uncomfortable procuring them. 25 NCI-designated Cancer Centers/NCCN-member institutions were surveyed about availability of sexual aids and resources for survivors. Methods: Using phone and internet, potential sources of aids/resources at each center (e.g, custom boutiques, specialty retail shops) were identified. Relevant retail staff at each center were approached by phone and using a structured script, study staff queried about the availability of aids/resources. Separate calls were made regarding aids for men and women. Additional inquiry included access to aids elsewhere at the cancer center and recommendations for accessing resources if none were available. Results: Of the 25 cancer centers contacted, 23 responded about men and 22 responded about women. Two centers never responded to multiple attempts. Of the centers contacted, 87% reported having no sexual aids for men and 72% had no aids for women. One center carried a vacuum device and two had penile support rings. Six centers had some aids for women, most commonly reported were personal lubricants, moisturizers and dilators. One center stood out, having several types of aids for men and women. Additional recommendations were limited to suggesting a local pharmacy or doing an internet search. Conclusions: In contrast to other widely available cancer care products, e.g., wigs and prosthetics, availability of sexual aids and resources at major cancer centers is very low. The stark absence of sexual aids underscores the cultural taboos around cancer-related sexual dysfunction. Efforts to improve availability of sexual aids for survivors would likely promote sexual health rehabilitation and validate this under addressed aspect of cancer survivorship. </jats:p