Survivors of childhood sexual abuse diagnosed with cancer: managing the impact of early trauma on cancer treatment.

The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psychosocial clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.