{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:25:45Z","timestamp":1777695945840,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>A diagnosis of acute leukemia (AL) represents a sudden, life-threatening event that places family caregivers (FCs) at high risk for traumatic stress. While traumatic stress symptoms have been documented among FCs later in the cancer trajectory, little is known about how these responses unfold during the immediate peri-diagnostic period, when acute stress disorder (ASD) may emerge, and early intervention could be most impactful. We conducted a qualitative study using a constructivist grounded theory approach to examine early traumatic stress responses among FCs of adults and children with newly diagnosed AL. Semi-structured interviews were conducted with 18 caregivers within the first six months of diagnosis as part of two clinical trials at major cancer centres in Toronto, Canada, and were analyzed iteratively using constant comparative methods. Caregivers described a coherent trajectory of traumatic stress responses across three phases. The anticipatory phase was characterized by prolonged uncertainty, helplessness, and mounting fear during diagnostic investigations. The acute phase, beginning at diagnosis, involved an abrupt shift toward emotional numbing, deliberate avoidance of catastrophic thoughts, and a narrowed focus on immediate tasks, often described as operating on \u201cautopilot.\u201d In the post-acute phase, as patients stabilized and discharge approached, caregivers reported increased emotional access, including grief, anger, and recognition of their own trauma, alongside emerging concerns about long-term caregiving and life disruption. These findings suggest that FCs of individuals with newly diagnosed AL exhibit a phased pattern of traumatic stress responses, marked by an early, adaptive dissociative coping response followed by delayed emotional processing, underscoring the importance of phase-sensitive psychosocial care in oncology.<\/jats:p>","DOI":"10.3390\/curroncol33050255","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:43:51Z","timestamp":1777448631000},"page":"255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phased Traumatic Stress Responses Among Caregivers of Children and Adults Recently Diagnosed with Acute Leukemia: A Grounded Theory Study"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9561-9599","authenticated-orcid":false,"given":"Carmine","family":"Malfitano","sequence":"first","affiliation":[{"name":"Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada"},{"name":"Centre for Psychology and Emotional Health, Toronto, ON M5R 2A5, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5437-831X","authenticated-orcid":false,"given":"Stephanie M.","family":"Nanos","sequence":"additional","affiliation":[{"name":"Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada"},{"name":"Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-4494","authenticated-orcid":false,"given":"Luigi","family":"Grassi","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy"},{"name":"Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosangela","family":"Caruso","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy"},{"name":"Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6626-6974","authenticated-orcid":false,"given":"Gary","family":"Rodin","sequence":"additional","affiliation":[{"name":"Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. Available online: https:\/\/psychiatryonline.org\/doi\/book\/10.1176\/appi.books.9780890425787.","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/jts.20253","article-title":"Correlates of acute stress disorder in cancer patients","volume":"20","author":"Kangas","year":"2007","journal-title":"J. Trauma. Stress"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1093\/ije\/dyq112","article-title":"Acute stress reaction and completed suicide","volume":"39","author":"Gradus","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/13811110903478997","article-title":"Post-traumatic stress disorder and suicide risk: A systematic review","volume":"14","author":"Krysinska","year":"2010","journal-title":"Arch. Suicide Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.cpr.2009.05.001","article-title":"Post-traumatic stress disorder and suicidal behavior: A narrative review","volume":"29","author":"Panagioti","year":"2009","journal-title":"Clin. Psychol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4088\/JCP.09r05072blu","article-title":"Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review","volume":"71","author":"Bryant","year":"2011","journal-title":"J. Clin. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/S2215-0366(17)30014-7","article-title":"Post-traumatic stress disorder and cancer","volume":"4","author":"Cordova","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1176\/appi.psy.43.4.259","article-title":"Stress response syndromes and cancer: Conceptual and assessment issues","volume":"43","author":"Gurevich","year":"2002","journal-title":"Psychosomatics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100141","DOI":"10.1016\/j.aggp.2025.100141","article-title":"Traumatic stress in caregivers of adult patients with cancer: A scoping review","volume":"2","author":"Klekovkina","year":"2025","journal-title":"Arch. Gerontol. Geriatr. Plus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108154","DOI":"10.1016\/j.leukres.2025.108154","article-title":"Juggling two worlds: Exploring the experiences of caregivers of patients with acute leukemia","volume":"108","author":"Stern","year":"2026","journal-title":"Leuk. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carmassi, C., Foghi, C., Dell\u2019Oste, V., Bertelloni, C.A., Fiorillo, A., and Dell\u2019Osso, L. (2020). Risk and protective factors for PTSD in caregivers of adult patients with severe medical illnesses: A systematic review. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17165888"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e70230","DOI":"10.1002\/pon.70230","article-title":"Psychosocial interventions to relieve traumatic stress symptoms in family caregivers of children with cancer: A scoping review","volume":"34","author":"Nanos","year":"2025","journal-title":"Psycho-Oncology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/pon.2092","article-title":"Traumatic stress in acute leukemia","volume":"22","author":"Rodin","year":"2013","journal-title":"Psycho-Oncology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e065422","DOI":"10.1136\/bmjopen-2022-065422","article-title":"Traumatic stress symptoms in family caregivers of patients with acute leukaemia: Protocol for a multisite mixed methods, longitudinal, observational study","volume":"12","author":"Jibb","year":"2022","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1002\/pon.3851","article-title":"Post-traumatic stress disorder symptoms in family caregivers of adult patients with acute leukemia from a dyadic perspective","volume":"24","author":"Jia","year":"2015","journal-title":"Psycho-Oncology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1002\/pon.4488","article-title":"Traumatic stress in patients with acute leukemia: A prospective cohort study","volume":"27","author":"Rodin","year":"2018","journal-title":"Psycho-Oncology"},{"key":"ref_17","unstructured":"Nanos, S.M., Jibb, L., Alexander, S., Hilberdink, C., Schultebraucks, K., Rydall, A., Zimmermann, C., Nissim, R., Hales, S., and Rodin, R. (2026). The Alarming Prevalence of Traumatic Stress in Caregivers of Pediatric & Adult Family Members with Cancer: Baseline Results from a Multimethod Longitudinal Study, Canadian Association of Psychosocial Oncology."},{"key":"ref_18","first-page":"1066","article-title":"A qualitative study of Emotion and Symptom-focused Engagement (EASE): An integrated psychotherapeutic and early palliative care intervention for patients with acute leukemia","volume":"33","author":"Hunt","year":"2025","journal-title":"Support. Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.leukres.2012.12.007","article-title":"\u201cAbducted by the illness\u201d: A qualitative study of traumatic stress in individuals with acute leukemia","volume":"37","author":"Nissim","year":"2013","journal-title":"Leuk. Res."},{"key":"ref_20","first-page":"2435","article-title":"Finding new bearings: A qualitative study on the transition from inpatient to ambulatory care of patients with acute myeloid leukemia","volume":"22","author":"Nissim","year":"2014","journal-title":"Support. Care Cancer"},{"key":"ref_21","unstructured":"Charmaz, K. (2014). Constructing Grounded Theory, Sage Publications. [2nd ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e27677","DOI":"10.1002\/pbc.27677","article-title":"Prevalence of anxiety, depression, and posttraumatic stress disorder in parents of children with cancer: A meta-analysis","volume":"66","author":"Zabih","year":"2019","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_23","first-page":"137","article-title":"Dyadic coping: A systemic-transactional view of stress and coping among couples: Theory and empirical findings","volume":"47","author":"Bodenmann","year":"1997","journal-title":"Eur. Rev. Appl. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1002\/pon.3289","article-title":"Couples facing advanced cancer: Examination of an interdependent relational system","volume":"22","author":"Lo","year":"2013","journal-title":"Psycho-Oncology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ejon.2013.09.003","article-title":"A literature review on the mutual impact of the spousal caregiver\u2013cancer patient dyads: Communication, reciprocal influence, and caregiver\u2013patient congruence","volume":"18","author":"Li","year":"2014","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_26","unstructured":"Lebow, J., Chambers, A., and Breunlin, D. (2017). The Biobehavioral Family Model. Encyclopedia of Couple and Family Therapy, Springer."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wood, B.L., Woods, S.B., Sengupta, S., and Nair, T. (2021). The biobehavioral family model: An evidence-based approach to biopsychosocial research, residency training, and patient care. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.725045"},{"key":"ref_28","unstructured":"World Health Organization (2013). Guidelines for the Management of Conditions Specifically Related to Stress, World Health Organization."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e70310","DOI":"10.1002\/pon.70310","article-title":"The Emotion and Symptom-Focused Engagement (EASE) Psychotherapeutic Intervention for Parents of Children With Acute Leukemia: A Feasibility Trial","volume":"34","author":"Jibb","year":"2025","journal-title":"Psycho-Oncology"},{"key":"ref_30","first-page":"163","article-title":"Emotion And Symptom-focused Engagement (EASE): A randomized phase II trial of an integrated psychological and palliative care intervention for patients with acute leukemia","volume":"28","author":"Rodin","year":"2020","journal-title":"Support. Care Cancer"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/5\/255\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:18:52Z","timestamp":1777454332000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/5\/255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["curroncol33050255"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33050255","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}