MONDAY, Nov. 20, 2017 (HealthDay News) -- People usually imagine post-traumatic stress disorder (PTSD) as happening to war veterans or assault victims.

But new research shows the trauma of a cancer scare often leaves survivors with the condition.

Many may not want to admit how they feel, the study's lead author said.

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"Many cancer patients believe they need to adopt a 'warrior mentality,' and remain positive and optimistic from diagnosis through treatment to stand a better chance of beating their cancer," explained Caryn Mei Hsien Chan of the National University of Malaysia.

"To these patients, seeking help for the emotional issues they face is akin to admitting weakness," she said.

In their study, Chan and her colleagues tracked outcomes for 469 adults with different types of cancer. The research showed that nearly 22 percent had symptoms of PTSD six months after their cancer diagnosis. And about 6 percent still had the condition four years after diagnosis.

And while overall rates of PTSD did seem to decrease over time, a third of patients who had the condition six months after their cancer diagnosis had either persistent or worsening PTSD four years later, the study found.

Reporting Nov. 20 in the journal Cancer, Chan noted that many patients live in fear that their cancer will return, and may believe that any lump or bump, pain or ache, fatigue or fever indicates a return of the disease.

PTSD can have a real impact on cancer care, she added. Some survivors may skip visits with doctors to avoid triggering memories of their cancer experience, leading to delays in seeking help for new symptoms or even refusal of treatment for unrelated conditions.

Counseling and support are key. For example, the study found that breast cancer patients were 3.7 times less likely to have PTSD six months after diagnosis than patients with other types of cancers. This may be because the breast cancer patients received support and counseling in the first year after cancer diagnosis.

"We need psychological evaluation and support services for patients with cancer at an initial stage and at continued follow-ups because psychological well-being and mental health -- and by extension, quality of life -- are just as important as physical health," Chan said in a journal news release.

"There needs to be greater awareness that there is nothing wrong with getting help to manage the emotional upheaval -- particularly depression, anxiety and PTSD -- post-cancer," she added.

More information

The U.S. National Institute on Mental Health has more about PTSD.