Psychological and clinical correlates of posttraumatic growth in cancer: A systematic and critical review

Patterns and predictors of symptom burden and posttraumatic growth among patients with cancer: a latent profile analysis

PURPOSE

The study identified different patterns of symptom burden and posttraumatic growth (PTG) among patients with cancer and to explored the effects of sociodemographic, disease-related, and family resilience factors, which could provide reference for the development of personalized nursing measures.

METHODS

A questionnaire survey was conducted with 329 patients with cancer who were undergoing treatment. Latent profile analysis (LPA) was used to explore the patterns of symptom burden and PTG among patients with cancer, and multiple logistic regression analysis was used to explore the influencing factors of different patterns.

RESULTS

Based on the fit indicators of LPA, a three-class pattern model of posttraumatic responses was shown to be optimal, including resisting, struggling, and growth groups. In the resisting group (34.34%), patients reported low symptom burden and low PTG; in the struggling group (19.15%), patients showed a high symptom burden and moderate PTG; in the growth group (46.51%), patients showed low symptom burden and high PTG. Moreover, patients with cancer with high levels of family resilience were more likely to fall into the struggling and growth groups. Specifically, those with lower scores in the optimistic attitude and higher scores in the family and social support dimension of family resilience were more likely to fall into the struggling group, whereas those with lower scores in the transcendence and spiritual belief dimensions of family resilience were more likely to fall into the resisting group. Additionally, patients with at least three children were more likely to fall into the struggling group.

CONCLUSIONS

This study showed heterogeneity in symptom burden and PTG patterns among patients with cancer. Patients' growth must include both psychological growth and the mitigated symptom burden. Family factors may be intervention targets to improve the growth patterns.

Can mindfulness facilitate posttraumatic growth in breast cancer patients? The mediating role of illness perceptions and positive emotions

The current observational study aimed to examine the relationship between mindfulness and posttraumatic growth (PTG) among patients with breast cancer. Additionally, it explores the mediating role of illness perceptions and positive emotions. A total of 697 women with breast cancer were recruited from four clinical sites as part of the Bounce project in Finland, Portugal, Italy, and Israel. The study measures were mindfulness (MAAS), illness perceptions (IPQ), positive affect (PANAS), and post-traumatic growth (PTGI) at three time points: near the time of diagnosis, 6 months, and 12 months post-diagnosis. A higher level of mindfulness was associated with perceptions of the illness as less chronic. Specifically, the perception of a limited timeline of breast cancer was associated with positive emotions, thus leading to enhanced PTG. Emphasis should be placed on promoting mindfulness, elaborating on illness perceptions, and maintaining positive affect as part of clinical interventions for PTG among breast cancer patients.

Posttraumatic growth and health-related quality of life in cancer survivors: Does fatigue moderate the link?

Interest in post-traumatic growth (PTG) as a predictor of health-related quality of life (HRQoL) is currently gaining attention. However, current evidence is still inconclusive on the nature of this relationship. The first objective of this study was to investigate the relationship between PTG and global HRQoL among cancer survivors. We further investigated the moderating role of fatigue in the association between PTG and global HRQoL. In the FiX study (Fatigue in Germany - Examination of prevalence, severity, and state of screening and treatment) cancer-related fatigue (EORTC QLQ-FA12), PTG inventory and global HRQoL (EORTC QLQ-C30) were assessed four years after cancer diagnosis in 1316 cancer-free survivors (mean age = 67.28, SD = 11.05, 51.4% female). Multiple linear regression analysis and moderation analysis were performed. The results showed that PTG had a convex quadratic relationship with global HRQoL (p < 0.001). Contrary to our hypothesis, fatigue did not moderate the relationship between PTG (linear and quadratic terms) and global HRQoL, neither when considering the overall PTG score nor for any PTG subdimension. In conclusion, PTG has a convex quadratic relationship with long-term global HRQoL that was not modified by persisting fatigue. Future statistical models investigating PTG and global HRQoL should take this non-linear relationship into account. Aiming to increase PTG might contribute to, but is likely not sufficient for high levels of global HRQoL in cancer survivors in the long run.

Promoting post-traumatic growth in cancer patients: a randomized controlled trial of guided written disclosure

Background

Cancer is a life-threatening disease that triggers not only vulnerability to distressing symptoms but also a meaning-making process that may lead to post-traumatic growth. As people often struggle to integrate cancer illness into their meaning system to reach an adaptive meaning, psychological interventions focused on a reappraisal of the illness experience can facilitate this process. This multicenter randomized controlled trial (RCT) was primarily aimed at assessing the efficacy of a writing intervention known as a guided disclosure protocol (GDP), compared to a generic writing intervention, in promoting post-traumatic growth in stage I-III breast and colon cancer patients at the end of their adjuvant chemotherapy.

Methods

Between January 2016 and August 2020 recruitment of eligible subjects took place during follow-up clinical consultations. Assessment occurred at baseline (T0), after the intervention (T1, 3 months from baseline), and at 6 months from baseline (T2). Both interventions consisted of three 20-min writing sessions to be performed once every two weeks. Change in post-traumatic growth was assessed using the Posttraumatic Growth Inventory, meaning with the Constructed Meaning Scale, and psychological distress with the Impact of Event Scale and the Hospital Anxiety and Depression Scale.

Results

In the five participating centers, 102 eligible patients were randomized and 72 participants completed follow-up evaluation. Most patients were women (79.4%), had breast cancer (68.6%), and stage I (27.5%), or stage II (44.1%) disease. Mean differences did not reach statistical significance for any of the dependent variables. However, an effect of the GDP, although not statistically relevant, was observed after the intervention in terms of enhanced post-traumatic growth and increased distress measured with the Impact of Event Scale.

Conclusion

This is the first RCT investigating the efficacy of a GDP in cancer patients having post-traumatic growth as the primary aim. Though GDP is a promising intervention in promoting post-traumatic growth, the lack of statistical significance of our findings may be due to the study being underpowered, hence this trial should be replicated with an adequate sample size, paying attention to supporting recruitment.

Clinical trial registration: ClinicalTrials.gov, identifier: 2015/0024360.

Scoping review protocol of post-traumatic growth (PTG) in Korean cancer survivors

INTRODUCTION

Cancer, a life-threatening chronic disease, is the leading cause of death in Korea, accounting for 27% of all deaths in 2020. Due to advancements in medical technology and early detection of cancer in Korea, the 5-year relative survival rate reached 70.7% (2015-2019), highlighting remarkable progress over the past decades. Although cancer has been seen as a traumatic event, cancer survivors also go through a subjective process of self-maturation, which is called post-traumatic growth (PTG). Because research on PTG among Korean cancer survivors has not been systematically synthesised, a scoping review on this topic will provide a better understanding of the positive psychological changes that occur as a patient moves through the illness trajectory of cancer from a Korean cultural perspective. The purpose of this study was to describe the protocol of a scoping review regarding PTG in Korean cancer survivors.

METHODS AND ANALYSIS

The scoping review framework suggested by Arksey and O'Malley and the manual refined by the Joanna Briggs Institute for scoping reviews will be used with the six framework guidelines developed by Levac et al. Searched databases will include Ovid-MEDLINE, PubMed, Embase, CINAHL, Cochrane Library and PsycInfo, as well as Korean databases, examining all articles published between 2012 and 2023 in Korean or English on PTG in Korean cancer survivors. Extracted data will be collated, charted and summarised.

ETHICS AND DISSEMINATION

Because the scoping review methodology undertakes a secondary analysis of collected data from previous research studies, this study does not require ethical approval. The results of this scoping review will be disseminated through presentations at conferences and publication in a scientific journal.

Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.

"I loved before, but now I love even more." Qualitative study of posttraumatic growth as a consequence of severe COVID-19 experience in Slovak adults

Introduction

The results indicate that post-traumatic growth does indeed occur after overcoming the severe form of COVID-19. It suggests that this posttraumatic growth most often occurred through a reassessment of priorities and an appreciation of life itself and loved ones. COVID-19 disease has been one of the most discussed and researched topics for several years, as it dramatically affects everyone's daily life.

Methods

The qualitative study presented here focuses on health psychology, especially post-traumatic growth after overcoming a severe form of the COVID-19 disease. We worked with adult people who had either been treated in the intensive care unit or had been hospitalized with severe pneumonia.

Results

Thematic analysis was used to determine categories and subcategories. The study presented here contributes to knowledge about the COVID-19 experience by mapping a Slovakian sample of adult participants.

Discussion

The results obtained by Thematic analysis help us better understand how people experience the disease, especially those who have overcome a severe form of the disease and thus had a borderline experience when their lives were directly threatened, as well as their overall health.

Primary brain tumor representation in the post-traumatic growth literature: A scoping review

Background

Post-traumatic growth (PTG) has been extensively explored within general oncology, yet little is known about the experience of PTG in neuro-oncology. This study aimed to determine the representation of patients with primary brain tumors (PBT) in the PTG literature.

Methods

PsycINFO, PubMed, and CINAHL were systematically searched from inception to December 2022. Search terms were related to personal growth and positive reactions to cancer. Articles were first screened by titles and abstracts, then full texts were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.

Results

A total of 382 articles met the inclusion criteria. Of those, 13 included patients with PBT. Over 100 000 cancer patients were represented, with 0.79% having a PBT. Most research focused on low-grade gliomas. PTG negatively correlated with post-traumatic stress symptoms and avoidant coping. In the sole longitudinal study, patients with PBT demonstrated improved PTG after 1 year. Three quasi-experimental studies investigated the effect of mindfulness-based interventions with mixed-cancer samples and demonstrated improvement in PTG.

Conclusions

The inclusion rate of patients with PBT in the PTG literature was significantly lower than the population prevalence rate (1.3% of cancer diagnoses). Relatively few studies focused exclusively on how patients with PBT experience PTG (k = 5), and those that did only included low-grade glioma. The experience of PTG in those with high-grade glioma remains unknown. Patients with PBT are scarcely included in research on PTG interventions. Few studies examined the relationship between PTG and medical, cognitive, or psychological characteristics. Our understanding of the PTG experience in neuro-oncology remains extremely limited.

Posttraumatic growth in palliative care settings: A scoping review of prevalence, characteristics and interventions

BACKGROUND

Posttraumatic growth refers to positive psychological change following trauma. However, there is a need to better understand the experience of posttraumatic growth in the palliative care setting as well as the availability and efficacy of interventions that target this phenomenon.

AIMS

To provide a review of the prevalence, characteristics and interventions involving posttraumatic growth in adults receiving palliative care and to collate recommendations for future development and utilisation of interventions promoting posttraumatic growth.

DESIGN

We performed a systematic scoping review of studies investigating posttraumatic growth in palliative care settings using the Arksey and O'Malley six-step scoping review criteria. We used the PRISMA guidelines for scoping reviews.

DATA SOURCES

Articles in all languages available on Ovid Medline [1946-2022], Embase [1947-2022], APA PsycINFO [1947-2022] and CINAHL [1981-2022] in November 2022.

RESULTS

Of 2167 articles located, 17 were included for review. These reported that most people report low to moderate levels of posttraumatic growth with a decline towards end-of-life as distress and symptom burden increase. Associations include a relationship between posttraumatic growth, acceptance and greater quality-of-life. A limited number of interventions have been evaluated and found to foster posttraumatic growth and promote significant psychological growth.

CONCLUSION

Posttraumatic growth is an emerging concept in palliative care where although the number of studies is small, early indications suggest that interventions fostering posttraumatic growth may contribute to improvements in psychological wellbeing in people receiving palliative care.

Post-traumatic growth in cancer survivors: What is its extent and what are important determinants?

Background/Objective

The aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors.

Methods

A sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change.

Results

Regarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG.

Conclusions

PTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.

Psychosocial interventions on the posttraumatic growth of adults with cancer: A systematic review and meta-analysis of clinical trials

BACKGROUND

It has been increasingly recognized that some people experience post-traumatic growth (PTG) as a result of struggling with cancer.

OBJECTIVE

This systematic review aims to identify psychosocial interventions that might facilitate PTG in adults with cancer.

METHODS

A search was conducted in PsycINFO, PubMed, Scopus, the Cochrane Library, and ProQuest up to 16 September 2022. The PRISMA guidelines were followed; all included interventional studies had to comprise 30 or more adults with cancer, using the Posttraumatic Growth Inventory, from 1994 forward.

RESULTS

A total of 2731 articles were retrieved, 1028 of those were screened and 37 unique trials were included (46 articles). A large number of studies were published since 2018 (52.4%), were randomized controlled trials (43.2%), and had group interventions (34.8%), including mainly female participants (83.8%) with a single cancer type (54.1%). Most interventions (75.7%) were moderately to highly effective in increasing PTG (d = 0.65, 95% CI 0.39-0.91) with the most effective interventions using Cognitive Behavioral Therapy (d = 1.24, 95% CI: 0.05-2.44), Mindfulness-based (d = 0.54, 95% CI = 0.14-0.94) and Education, Peer Support and Health Coaching interventions (d = 0.28, 95% CI: 0.1-0.46). Expression-based and Positive Psychology-based approaches also showed promising results. Notably, the majority of studies had a high risk of bias.

CONCLUSIONS

PTG facilitation is a promising field that should be pursued as it not only allows people with cancer to overcome their trauma but also results in them going over and above their pre-cancer state, enhancing resilience, health, and well-being.

Curvilinear prediction of posttraumatic growth on quality of life: a five-wave longitudinal investigation of breast cancer survivors

PURPOSE

Do cancer survivors experience positive changes (i.e., posttraumatic growth; PTG) resulting in better quality of life? The issue has yet to yield consistent notions. This longitudinal study extends the literature on the role of PTG by examining the curvilinear relationship between PTG and Health-Related Quality of Life (HRQoL), and explored whether PTG predicts subsequent HRQoL in a quadratic relationship across 2 years following surgery.

METHODS

Women with breast cancer (N = 359; Mage = 47.5) were assessed at five waves over two years. On every measurement occasion, PTG measured by the posttraumatic growth inventory and HRQoL measured by SF-36 were assessed. The five waves reflect major medical demands and related challenges in the breast cancer trajectory, in which 1-day, 3 months, 6 months, 12 months, and 24 months after surgery were adopted as the survey timing. In a series of hierarchical linear modeling (HLM) analyses, the time-lagged predictions of PTG (i.e., linear, quadratic) on HRQoL were examined, controlling demographic and medical covariates.

RESULTS

The results revealed that the quadratic term of PTG consistently significantly predicted physical and mental health quality of life (PCS and MCS), while the linear term of PTG did not significantly predict PCS or MCS.

CONCLUSION

With multi-wave longitudinal data, this study demonstrated that the relationship between PTG and HRQoL is curvilinear, and this finding extends to PTG's prediction of subsequent HRQoL. The quadratic relationship has critical implications for clinical assessment and intervention. Details are discussed.

Feasibility and preliminary effect of a couple-based posttraumatic growth intervention for colorectal cancer couples: A randomized controlled pilot study

BACKGROUND

Colorectal cancer (CRC) causes severe physical and psychological impacts on the patients as well as their spousal caregivers. To facilitate the psychological adaptation of the CRC suffered couples, a couple-based posttraumatic growth (PTG) intervention was developed based on the PTG affective-cognitive processing model. The feasibility, acceptability and preliminary effect of this intervention were tested.

METHODS

A pre-post randomized controlled pilot trail was conducted for Chinese couples coping with CRC. Participants in the intervention group were provided five weekly sessions consecutively, while those in the control group were treated with usual care during the testing period. Outcomes were described as positive changes (PTG, benefit finding [BF]), marital satisfaction, quality of life and anxiety and depression. Qualitative method was also used to evaluate the programme participating sense of the couples.

RESULTS

The rate of programme recruitment and programme retention amounts to 78.6% and 87.5%, respectively. The participants have reported overall satisfaction for the programme attendance and have suggested detailed diet guidance. Significant effects were revealed in the outcomes for the CRC couples, including PTG, marital satisfaction, BF, physical and mental health and anxiety and depression.

CONCLUSION

The study confirmed the feasibility and preliminary positive effect of the couple-based PTG intervention for the CRC couples. However, in order to extend it in more general applications, large-scale researches are warranted.

PRACTICAL IMPLICATION

The couple-based intervention is effective for couples coping with CRC. Clinicians should take the components of the intervention into consideration in their practice work for the CRC couples.

Predictors of post traumatic growth in allogeneic hematopoietic stem cell transplantation survivors: a cross-sectional survey

AIMS

Given the increasing number of Hematopoietic Stem Cell Transplantations (HSCT) performed world-wide, the increasing likelihood of survival following HSCT, and the profound physical, psychosocial, and emotional impact of HSCT on survivors, their carers and families, it is important to identify factors that may contribute to or support post-traumatic growth (PTG) after transplant. In this study, we aimed to investigate the prevalence of PTG in an Australian cohort of long-term allogeneic HSCT survivors and describe associations between PTG and relevant clinical, sociodemographic and psychological variables.

METHODS

This was a large, multi-centre, cross sectional survey of Australian HSCT-survivors inviting all those transplanted in New South Wales between 2000 and 2012. Respondents completed the PTG Inventory (PTGI), the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, and the Fear of Cancer Recurrence Scale. Data was analysed using independent t-tests, one-way analysis of variance, and pearson's correlations, and hierarchical multiple regression adjusted for potential confounders and to ascertain independent associations of explanatory variables with PTG.

RESULTS

Of 441 respondents, 99% reported some level of PTG with 67% reporting moderate to high levels of PTG. Female gender, younger age, complementary therapy use, anxiety, psychological distress and psychosocial care, and higher quality of life were associated with higher levels of PTG. Importantly, we also found that PTG was not associated with either chronic GVHD or post-HSCT morbidity.

CONCLUSIONS

In this study - the largest study of PTG in long-term allogeneic HSCT survivors - we found that growth appears ubiquitous, with 99% of survivors reporting some degree of PTG and 67% reporting moderate-high levels of PTG. Importantly, we found no association with GVHD or chronic physical post-HSCT morbidity, or adverse financial, occupational or sexual impacts. This suggests that it is the necessity for and experience of, HSCT itself that foments personal growth. Accordingly, healthcare professionals should be alert to the profound and wide-ranging impact of HSCT - and the degree to which survivor's may experience PTG. Identifying interventions that may assist HSCT survivors cope and building their resilience is of utmost importance.

Relationship between rumination and post-traumatic growth in mobile cabin hospital nurses: The mediating role of psychological resilience

Psychological resilience helps individuals to actively respond to various emergencies, but its mediating role between the rumination and post-traumatic growth (PTG) of nurses remains unknown. Our study aimed to explore the extent to which psychological resilience mediates the association between rumination and PTG among nurses working in mobile cabin hospitals. This cross-sectional survey was conducted on 449 medical team members working in mobile cabin hospitals to support the prevention and control of coronavirus disease 2019 in Shanghai, China in 2022. Pearson correlation analysis was applied to assess the correlation between rumination, psychological resilience, and PTG. Structural equation models were used to examine the mediating role of psychological resilience between rumination and PTG. Our study results showed that deliberate rumination directly promoted psychological resilience and PTG and had positive effects on PTG through the mediating effect of psychological resilience. Invasive rumination had no direct effect on PTG. However, it had a negative effect on PTG through the mediating effect of psychological resilience. Together the results of this study indicate that the mediating effect of psychological resilience was significant in the association of rumination and PTG among mobile cabin hospital nurses, with a higher individual psychological resilience level helping nurses to achieve PTG. Therefore, targeted interventions should be implemented to improve nurses' psychological resilience and guide their rapid growth.

Hematopoietic Cell Transplantation Patient-Caregiver Dyad Perspectives on Participation in a Digital Storytelling Intervention: A Qualitative Approach

Storytelling has long been considered an effective means of communication, allowing the teller to process their emotions in light of particular life challenges. Effects on the listener also have been demonstrated to be beneficial, especially if the listener is faced with a similar life challenge. Less is known regarding the potential effects of storytelling on listening dyads and opportunities for joint processing following exposure to relevant stories. We sought to study these phenomena in the context of hematopoietic cell transplantation (HCT), a demanding medical procedure requiring intensive informal caregiving and thus great patient-caregiver entwinement. The purpose of this qualitative descriptive study was to explore participants' perceptions of a 4-week web-based digital storytelling (DST) intervention using both quantitative ratings of acceptability and qualitative coding of interviews conducted after intervention completion. A total of 202 participants (101 HCT patient-caregiver dyads) were recruited from the Mayo Clinic Arizona and randomized into either a DST arm or an Information Control (IC) arm. Participants in the DST arm rated the acceptability of the intervention and were asked to participate in a 30-minute phone interview to discuss their experience with the DST intervention. All interviews were recorded and transcribed verbatim and imported into NVivo 12 for coding and analysis, using a combination of deductive and inductive approaches to organize the data, create categories, and develop themes and subthemes. A total of 38 participants (19 HCT patient-caregiver dyads) completed the post-intervention interviews. Patients were 63% male and 82% White, 68% received allogeneic HCT, and their mean age was 55 years. The median time from HCT was 25 days (range, 6 to 56 days). Caregivers were mostly patients' spouses (73%) and female (69%), with a mean age of 56 years. In general, the 4-week web-based DST intervention was well accepted and liked by both patients and caregivers regarding the duration, dyadic participation, and convenience of participating in the intervention at home. Patients and caregivers who completed the DST intervention indicated that they were satisfied with the intervention (mean score, 4.5 of 5), were likely to recommend it to others (mean score, 4.4), would watch more stories (mean score, 4.1), and that the experience was worth their time (mean score, 4.6). Major themes that emerged from the qualitative analysis included (1) building communal connection through engaging with the stories; (2) positive emotional growth after HCT; (3) value of gaining the other's perspective; and (4) impact of open communication on the patient-caregiver relationship. A web-based DST intervention provides an attractive format through which to deliver a nonpharmacologic psychosocial intervention to HCT patient-caregiver dyads. Watching the emotional content in digital stories may help patients and caregivers cope with psychoemotional challenges together and provide an opportunity for emotional disclosure. Further work on determining optimal paths to disclosure is warranted.

Roles of benefit finding in psychological and inflammatory adjustments in persons with colorectal cancer: a prospective analysis on the multidimensionality of benefit finding

OBJECTIVE

This study examined the unique associations of different dimensions of the resilience factor, benefit finding, on concurrent and prospective psychological and biological adjustment outcomes over the first year after a colorectal cancer diagnosis.

METHODS AND MEASURES

Individuals newly diagnosed with colorectal cancer (n = 133, mean age = 56 years old, 59% female, 46% Hispanic) completed questionnaires assessing the multidimensional aspects of benefit finding around 4 months post-diagnosis (T1). Psychological (depressive symptoms and life satisfaction) and biological [C-reactive protein (CRP) and interleukin-10 (IL-10)] adjustments were assessed at T1 and one-year post-diagnosis (T2).

RESULTS

Structural equation modeling revealed that at T1, greater reprioritization was concurrently related to higher depressive symptoms (p=.020). Lower acceptance, lower empathy, and greater positive self-view predicted higher life satisfaction at T2 (ps<.010). Additionally, lower empathy and greater family valuation predicted higher CRP at T2 (ps<.004), whereas greater positive self-view predicted higher IL-10 at T2 (p=.039). Greater overall benefit finding was associated with lower IL-10 at T1 (p=.013).

CONCLUSION

Various aspects of benefit finding differentially relate to psychological and inflammatory markers during the first year after diagnosis in persons with colorectal cancer. Interventions designed to specifically enhance positive self-view may promote both the psychological and biological health of individuals with cancer.

Relationship between posttraumatic growth and help-seeking behavior in use of psychosocial support services among patients with cancer

PURPOSE

Cancer survivors who used psychosocial support services often report posttraumatic growth (PTG). This refers to positive psychological changes that may occur as the five domains as a result of the challenges they face. Opposing relationship also might exist. This study aimed to examine the relationship between PTG and help-seeking behavior (HSB).

METHODS

In total, 710 participants completed an online survey at Time1. Of those, 395 who reported not using any psychosocial support services at Time1 were asked to participate in the Time2 survey and completed a questionnaire. The participants provided demographic information, the experiences of using psychosocial support services, and the overall and five domains of PTG.

RESULTS

Those who experienced HSB at Time1 reported a higher PTG, and two of the PTG domains, Appreciation of Life and New Possibilities, than those who did not used services. Mixed ANOVAs showed the main effects of the HSB on the overall PTG, Appreciation of Life, and New Possibilities. Hierarchical logistic regression analyses showed that Appreciation of Life at Time1 was significantly related to the engaging in HSB at Time2.

CONCLUSION

Those who received psychosocial support services reported a higher PTG. Participants may have also engaged in HSB because they had experienced PTG. People who are likely to seek help and experience PTG may share common characteristics.

IMPLICATIONS FOR CANCER SURVIVORS

Support for those who do not fit the existing PTG and the use of psychosocial support services should also be considered.

Posttraumatic growth in colorectal cancer survivors: A systematic review

OBJECTIVE

The diagnosis of cancer is an adverse event; nevertheless, it can also exert positive changes on survivors, such as posttraumatic growth (PTG). This review aims to integrate researches on PTG in colorectal cancer (CRC) survivors, including manifestations and prevalence of PTG, factors associated with PTG and interventions on PTG.

METHODS

A systematic search was implemented on six databases to identify studies on PTG in CRC survivors published in English or Chinese from October 1995 to May 2022. We also performed a manual search for additional studies from the article reference lists.

RESULTS

Thirty-one studies were included. The results were integrated based on the PTG theoretical framework and PTG affective-cognitive processing model. PTG manifests in CRC survivor-caregiver dyads in five domains, including personal growth, appreciation of life, relating to others, new possibilities and spiritual change. Factors correlated with PTG can be integrated into levels of personality, event cognitions, appraisal mechanisms, emotional states, coping and social environmental context. Elements of interventions can be integrated according to the affective-cognitive processing PTG model. Existing interventions are effective in promoting PTG in CRC survivors.

CONCLUSION

We provide a systematic perspective on studies targeting PTG in CRC survivors. PTG manifested in survivor-caregiver dyads. Factors associated with PTG in CRC survivors are significant, and the interventions are effective. An intervention programme based on the affective-cognitive processing model and focused on CRC survivor-caregiver dyads would be significant for the dyads facing cancer.

Benefit finding in men affected by prostate cancer prior to and following radical prostatectomy - a cross-sectional study with a stratified sample

BACKGROUND

Benefit finding (BF) - the occurrence of positive life-changes in the aftermath of traumatic live events - has been repeatedly reported in prostate cancer (PCa) survivors, but it remains unclear in which way BF might vary over time. The current study aimed to investigate the extent of BF and associated factors in different phases of the survivorship continuum.

METHODS

In this cross-sectional study, men affected by PCa who were either already treated with radical prostatectomy or going to be treated with radical prostatectomy at a large German PCa center were included. These men were stratified into four groups (prior to surgery, up to 12 months after surgery, 2-5 years and ≥ 6-10 years after surgery). BF was assessed using the German version of the 17-item Benefit Finding Scale (BFS). The items are rated on a five-point Likert scale ranging from 1 to 5. A total mean score ≥ 3 was considered as moderate-to-high BF. Associations with clinical and psychological factors were assessed in men presenting before and in those who participated after surgery. Multiple linear regression was applied to identify intendent determinants of BF.

RESULTS

2,298 men affected by PCa (mean age at survey: 69.5,SD = 8.2; median follow-up: 3 years (25th -75th percentile 0.5-7)) were included. 49.6% of men reported moderate-to-high BF. The mean BF score was 2.91 (SD = 0.92). BF reported by men before surgery did not differ significantly from BF reported by men in the years after surgery (p = 0.56). Higher BF prior to and following radical prostatectomy was associated with higher perceived severity of the disease (pre-surgery: ß = 0.188, p = 0.008; post-surgery: ß = 0.161, p = < 0.0001) and higher cancer-related distress (pre-surgery: ß ? 0.155, p = 0.03; post-surgery: ß = 0.089, p < 0.0001). Post radical prostatectomy BF was also associated with biochemical recurrence during follow-up (ß = 0.089, p = 0.001), and higher quality of life (ß = 0.124, p < 0.001).

CONCLUSIONS

Many men affected by PCa perceive BF already soon after diagnosis. The subjective perception of threat or severity associated with the diagnosis of PCa is an essential factor for higher levels of BF, probably more important than objective indicators of the severity of the disease. The early onset of BF and the high degree of similarity of BF reported across the different phases of survivorship suggests that BF is, to a large extent, a dispositional personal characteristic and a cognitive strategy of positively coping with cancer.

Posttraumatic Growth Inventory-Expanded: Factor Structure, Test-Retest Reliability, and Validity in Trauma-Exposed and Bereaved Adults

Posttraumatic growth (PTG) is a positive psychological change experienced after trauma and it has gained global recognition in recent years. The present study aimed to validate a South Korean version of the Posttraumatic Growth Inventory-Expanded (K-PTGI-X) for use with trauma-exposed and bereaved samples. A national sample comprising South Korean adults was used for the analysis. As a result, the 4-factor bi-factor model was best supported in both the trauma and bereaved groups in terms of personal strength, new possibilities, spiritual-existential change, and being able to relate to others. Additionally, the K-PTGI-X showed satisfying reliability, concurrent validity, and discriminant validity. Lastly, regarding the group differences, women showed higher rates of PTG than men and the bereaved group exhibited higher spiritual and existential growth in the PTG than the trauma group. Given these results, implications for adaptation in various fields when assessing and encouraging PTG in practical settings are discussed.

"What does not kill you… mutates and tries again." A study on personality determinants of post-traumatic growth during the COVID-19 pandemic

Introduction. The COVID-19 pandemic was recognized as a collective trauma and as a major threat to mental health. Recent literature focused on the stress symptomatology or post-traumatic stress disorder associated to the COVID-19 exposure. The concept that people have a natural inclination toward growth, even under stressful and threatening events, gathered less attention. Previous research has analyzed antecedents of post-traumatic growth (PTG) with non-conclusive results. Methods. The present research aimed at including findings on PTG from personality traits, i.e., sense of control and self-mastery, and distal condition of nurturance and support received by others, i.e., cognitive and affective well-being. Analyses were based on 4934 interviews with adults (Mage = 57.81 years, 55.5% women) from the Swiss Household Panel study. Results. Relationships over time emerged between sense of control and self-mastery on PTG and worries, measured after two years, via the mediation of cognitive and affective well-being. Conclusion. Results come from a large study in a design seldom employed in this type of research and can inform both research and interventions.

Mediating role of spirituality on the relationships between posttraumatic stress and posttraumatic growth among patients with cancer: A cross-sectional study

Objective

This study explores the impact of posttraumatic stress (PTS) on posttraumatic growth (PTG) and verifies the mediating effect of spirituality among patients with cancer.

Methods

This study used a cross-sectional correlational design. This study surveyed 141 hospitalized patients over 20 years of age diagnosed with cancer. Participants were recruited by convenience sampling from a regional hospital in Taiwan. Data were collected from January to April 2021. Measurements included sociodemographic and disease-related information and data from the following self-report questionnaires: Posttraumatic Stress Reaction Index-Short Form, Posttraumatic Growth Inventory, and Spiritual Health Scale-Short Form. Structural equation modeling and bootstrapping were used to analyze the mediating effect of spiritual health on PTS and PTG.

Results

PTS and spirituality were negatively correlated, spirituality, and PTG were positively correlated, and PTS had no correlation with PTG. Spirituality fully presented a mediating role between PTS and PTG.

Conclusions

Patients' spirituality should be regarded as an important variable that can impact stress appraisal and improve the patient's PTG when a diagnosis of cancer is received. Assessing spiritual health at regular intervals and integrating spiritual care with clinical care could decrease PTS and improve PTG for patients with cancer.

Determinants of Post-Traumatic Growth and Quality of Life in Ghanaian Breast Cancer Survivors

This study assessed the psychosocial factors associated with post-traumatic growth (PTG) and health-related quality of life (HRQoL) in women breast cancer survivors. Women (N = 128) completed questionnaires on social support, religiosity, hope, optimism, benefit-finding, PTG and HRQoL. Structural equation modeling was used to analyze the data. Results showed that perceived social support, religiosity, hope, optimism, and benefit finding were positively associated with PTG. Religiosity and PTG were positively associated with HRQoL. The results suggest that interventions aimed at increasing religiosity, hope, optimism, and perceived support can help survivors cope better with breast cancer.

Walking activity and emotional distress among breast cancer survivors: the parallel mediating effects of posttraumatic growth and body image

PURPOSE

Although the antidepressant effects of physical activity have been well established, the underlying psychological mechanisms are understudied among cancer survivors. The present study aims to examine the parallel mediating effects of posttraumatic growth and body image on the association between walking activity and emotional distress (anxiety and depression) among Chinese breast cancer survivors.

METHODS

Chinese breast cancer survivors (n = 235) completed a cross-sectional questionnaire that assessed walking activity, anxiety, depression, posttraumatic growth, and body image over the past week. Path analysis was conducted to test the hypothesized mediation model.

RESULTS

The hypothesized model was supported: walking activity was positively associated with posttraumatic growth and body image satisfaction, which were then negatively associated with anxiety and depression. After controlling for the mediators, the direct effect of physical activity on depression was still significant, whereas the direct effect of physical activity on anxiety was no longer significant.

CONCLUSION

Our findings suggest that posttraumatic growth and body image may be essential psychological pathways underlying the association between walking activity and emotional distress among Chinese breast cancer survivors. Researchers and health practitioners should consider supplementing physical activity interventions with mental health services that facilitate psychological growth and a positive body image to enhance the potential psychological benefits of physical activity.

Factors associated with posttraumatic growth among spouses of women diagnosed with gynaecological cancer: A cross-sectional study

AIM

The aim of this study was to explore the factors that are associated with posttraumatic growth among spouses of women diagnosed with gynaecological cancer.

DESIGN

A cross-sectional descriptive study.

METHODS

A convenience sample of 312 spouses of women diagnosed with gynaecological cancer was recruited from two comprehensive hospitals in China, from March 2018 to March 2020. Demographic characteristics, cancer-related characteristics, posttraumatic growth, perceived social support and coping were assessed using self-reported questionnaires. Descriptive statistics and multiple linear regression analysis were performed. The methods were guided by the STROBE checklist.

RESULTS

The mean score of posttraumatic growth was 46.7 (standard deviation = 16.7). The associated factors of posttraumatic growth were spouses' age, perceived social support, problem-focused coping, dysfunctional coping (e.g. denial) and cancer treatment received by partners, which accounted for 34% of total posttraumatic growth score.

PATIENT OR PUBLIC CONTRIBUTION

All participants contributed to the conducting of this study by completing self-reported questionnaires.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors

Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.

The role of resilience in daily experiences of posttraumatic growth, affect, and HIV/AIDS stigma among people living with HIV

This study investigated the intraindividual variability in daily posttraumatic growth (PTG) versus posttraumatic depreciation (PTD), positive and negative affect (PA and NA), and HIV/AIDS stigma among people living with HIV (PLWH). In particular, we examined whether this variability derives from participants' resilience operationalized on a trait level. The participants included 67 PLWH, who completed a baseline questionnaire on resilience, measured with the Brief Resilience Scale. Following this, they completed the shortened versions of the following inventories over five consecutive days: the Posttraumatic Growth and Posttraumatic Depreciation Inventory V Expanded version Inventory, the Positive and Negative Affect Schedule - Expanded Form, and the Berger HIV Stigma Scale. Hierarchical linear modeling (HLM) was utilized to analyze the study results. We observed significant intraindividual variability in PTG, PTD, PA, NA, and perceived HIV/AIDS stigma. Resilience was related to PTG, PTD, PA, and NA but not to stigma. Moreover, higher resilience was associated with higher, stabler PA and lower, stabler NA. Our results highlight the need of further studies on the daily functioning of PLWH. Specifically, while health status is important, it does not appear to be the predominant source of everyday distress for PLWH. Consequently, psychological counselling for PLWH should concentrate more on the life of the person as a whole and not only on coping with HIV infection.

Meaning in life, meaning-making and posttraumatic growth in cancer patients: Systematic review and meta-analysis

Introduction

The purpose of this systematic review and meta-analysis is to assess the association between meaning in life (MiL), meaning-making and posttraumatic growth (PTG) in the context of cancer.

Methods

A systematic search was conducted in eighteen electronic databases. The screening and selection process followed the PRISMA guidelines. For the purpose of the meta-analysis, the correlation coefficients between meaning in life and posttraumatic growth were extracted from the included studies. The effect size (r) was calculated using the restricted maximum-likelihood estimator, a random-effects model. Heterogeneity was assessed through the Q statistic, I² index and forest plot, while publication bias was analyzed with the use of the funnel plot and Egger's test.

Results

889 records were considered according to the inclusion criteria. A total of nine articles, published between 2006 and 2021, were included in the systematic review. More than half were published in the last five years. The sample was mostly diagnosed with breast cancer. The meta-analysis included five articles (N = 844) and the results indicate a significant moderate correlation between meaning in life and posttraumatic growth (r = 0.43, 95% IC [0.36, 0.50]).

Discussion

In conclusion, there is a clear association between meaning in life and posttraumatic growth in cancer patients. Future research should explore this relationship further, in order to better assist and guide meaning centered interventions that can potentiate a positive adjustment and possibly growth from the cancer experience.

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.

Psychosocial predictors of fear of cancer recurrence in a cohort of gynecologic cancer survivors

OBJECTIVE

To describe fear of cancer recurrence in a cohort of women with gynecologic cancers and to identify psychosocial predictors of elevated fear of recurrence.

METHODS

Survey data from an ongoing cohort study of gynecologic cancer survivors were used (n = 154). Relationships between fear of cancer recurrence measured by the 6-item Cancer Worry Scale in the most recent survey and psychosocial factors (cancer-related distress, depression, anxiety, hopelessness, and posttraumatic growth) assessed 6-18 months prior were examined using univariate and multivariate linear regression models, adjusting for age, cancer stage, cancer type, and time since diagnosis.

RESULTS

Most participants were ≥60 years old, diagnosed with early-stage cancer, and 2-5 years post-diagnosis. The mean score on the Cancer Worry Scale was 10.31 (SD = 3.01), and 46 individuals (30.0%) scored ≥12, indicating high fear of recurrence. In univariate analyses, greater distress (p = 0.007), anxiety (p = 0.006), hopelessness (p = 0.007), and posttraumatic growth (p = 0.0006) were significantly associated with higher scores on the Cancer Worry Scale. The associations of hopelessness and posttraumatic growth with higher Cancer Worry Scale scores remained significant after adjustment for covariates.

CONCLUSIONS

Fear of recurrence is frequent among gynecologic cancer survivors. Women who reported more distress, hopelessness, anxiety and, surprisingly, more post-traumatic growth reported more fear. These results contribute to our understanding of which cancer survivors are most at risk of elevated fear of recurrence and highlight the importance of continued focus on psychosocial well-being among cancer survivors.

Post-traumatic Growth in Cancer Patients: A Correlational Study in Turkey

This study aims to evaluate the factors that influence post-traumatic growth (PTG), including religious coping and resilience. This descriptive and correlational study involved 111 cancer patients, followed up at a hematology inpatient clinic of a university hospital in Turkey. Religious coping scale, resilience scale, and PTG inventory were used for data collection. PTG was positively associated with negative religious coping and was negatively associated with age. PTG scores were higher for patients without children, who were recently diagnosed, had higher knowledge about the disease, and used negative religious coping.

Posttraumatic growth in palliative care patients and its associations with psychological distress and quality of life

OBJECTIVES

Posttraumatic growth (PTG) refers to positive psychological changes resulting from individuals' inner struggles with traumatic events such as life-threatening illness. Although palliative care patients are confronted with their own mortality, little is known about their PTG experience. This study investigates whether PTG is an empirically relevant concept for palliative patients by assessing the prevalence and areas of growth, and examining associations with psychological distress and quality of life.

METHODS

Participants were recruited in Switzerland. Using validated questionnaires, we assessed PTG (Posttraumatic Growth Inventory, PTGI), psychological distress (Hospital Anxiety and Depression Scale), and quality of life (McGill-Quality of Life Questionnaire - Revised). We performed descriptive analyses, Spearman correlations, and linear regressions.

RESULTS

Fifty-five patients completed the PTGI, 44% of whom experienced no/low growth, 47% moderate growth, and 9% high/very high growth. Participants experienced the greatest positive changes in terms of appreciating life and relating to others. We found significant negative bivariate correlations between PTG and psychological distress (r = -0.33) and between PTG and depression (r = -0.47). Linear regressions showed that PTG is associated with depression (β = -0.468; p = 0.000), but not with anxiety or quality of life (adjusted R² = 0.219).

SIGNIFICANCE OF RESULTS

Over half of our patients experienced moderate to very high growth, indicating that PTG is an empirically relevant psychological process in palliative care. PTG is associated with lower levels of depression, possibly as those experiencing growth are more able to process past traumas and build a more positive outlook on one's life and self. By contrast, the relative independence of anxiety and PTG points to the likely coexistence of positive and negative psychological responses to trauma. The lack of association between PTG and quality of life points to the uniqueness of the PTG concept in capturing how people access deeper meaning and greater appreciation of life along the path toward posttraumatic self-reconstruction.

Beneficial Effects of Spiritual Experiences and Existential Aspects of Life Satisfaction of Breast and Lung Cancer Patients in Poland: A Pilot Study

Spiritual and existential issues are important factors for oncology patients' well-being. This study aimed to examine the beneficial role of spiritual experience, hope, and meaning in life for life satisfaction in patients diagnosed with breast and lung cancer. It was hypothesized that spiritual experiences and life satisfaction are indirectly related through hope, as well as meaning in life mediates the relationship between hope and life satisfaction. It was a pilot study with a sample consisting of 4 men and 46 women, 24-83 years of age oncology patients. The following measures were used: Cantril Ladder, Purpose in Life Test, Herth Hope Index as well as Daily Spiritual Experiences Scale. A sample of Polish patients with breast and lung cancer confirmed the beneficial effects of spiritual experiences and existential aspects of life for their life satisfaction. According to obtained results, hope was indirectly related to life satisfaction through meaning in life. Also, spiritual experiences were positively indirectly related to life satisfaction through the pathway of hope and meaning in life. Theoretical and practical implications of the achieved results were discussed.

Relationships between satisfaction with life, posttraumatic growth, coping strategies, and resilience in cancer survivors: A network analysis approach

OBJECTIVE

Cancer survivors' satisfaction with life should be seen through the psychological factors related to a person's capabilities to face and handle the situation. This study aimed to (1) examine the relationships of satisfaction with life, posttraumatic growth, resilience and coping strategies in a global network model, (2) find the bridge indicators between satisfaction with life and the other constructs, and (3) test for the invariance of the network structures across several moderating variables.

METHODS

In a heterogeneous sample of 696 cancer survivors (69% female; mean age = 53.1 ± 15.44 years; median time from being diagnosed = 4 years; breast cancer was the most frequent type of cancer) their satisfaction with life, resilience, coping strategies and posttraumatic growth was measured. In order to account for their complexity, the relationships between the constructs were explored using a network analysis approach.

RESULTS

The network analysis shows that satisfaction with life is strongly connected to resilience, moderately connected to coping strategies, and has a weak connection with posttraumatic growth. In the separate networks, the relationships between the psychological constructs were examined in greater detail. Besides some exceptions observed in the degree of disability, the networks were invariant across gender, age, years since being diagnosed, cancer type and treatment type.

CONCLUSION

The findings suggest that interventions focused on cancer survivors' coping strategies and resilience could help increase their satisfaction with life. However, further replication of the proposed and/or modified model is needed.

The nature and content of rumination for head and neck cancer survivors

Introduction

Head and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.

Methods

Twenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46–83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.

Results

Four themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).

Conclusion

This study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.

The relation between coping style and posttraumatic growth among patients with breast cancer: A meta-analysis

Posttraumatic growth (PTG) has been correlated with coping style among patients with breast cancer. However, to date, there is no consensus on the extent to which coping style is associated with PTG in patients with breast cancer. Therefore, we performed a meta-analysis to quantitatively synthesize previous findings. Based on the PRISMA method, this study employed a random effects model using the Stata software (version 16.0) to calculate the pooled correlation coefficient and examined a range of moderators: cancer stage, publication type, participants’ age, and coping style measurement tools. Relevant studies, published from inception to 9 March 2022, were identified through a systematic search in PubMed, Embase, Web of Science, PsycINFO, WANFANG DATA, Chinese National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (VIP) databases. Finally, 20 studies involving 3,571 breast cancer patients were included in this investigation. The results showed a high positive relation between confrontation coping and PTG and a moderate positive relation between avoidance coping and PTG (confrontation: r = 0.456; avoidance: r = 0.291). Additionally, a moderate negative relation was identified between acceptance–resignation coping and PTG (r = –0.289). Publication type and coping style measurement tools moderated the relation between coping style and PTG among breast cancer patients. The findings indicated that breast cancer patients should either confront the disease or avoid coping with it according to their disease state, which would facilitate better growth. More studies, especially, large prospective studies, are warranted to verify our findings.

Sub-groups (profiles) of individuals experiencing post-traumatic growth during the COVID-19 pandemic

Objective

Some people experience post-traumatic growth (PTG), entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups (profiles) of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.

Method

For this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population completed an online questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.

Results

We identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal (e.g., resilient group), increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal (e.g., stressed group) and greater use of rumination.

Conclusion

The two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG.

Trajectories of posttraumatic growth and posttraumatic depreciation: A one-year prospective study among people living with HIV

Objective

Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) are considered two sides of growth after trauma. Nevertheless, previous studies pointed out that in trauma living with a life-threatening illness, they may be experienced as two independently and share distinct predictors. In our study we aimed to find the different trajectories of PTG and PTD among a sample of people living with HIV (PLWH) and to investigate its predictors out of psychological resilience, and gain and loss of resources from the conservation of resources theory (COR).

Methods

We designed a longitudinal study that consisted of three measurements at 6-month intervals, and we recruited, respectively, 87, 85 and 71 PLWH. Each time participants filled out the following questionnaires: the expanded version of the PTG and PTD Inventory (PTGDI-X), the Brief Resilience Scale (BRS), the Conservation of Resources Evaluation (COR-E), and a survey on sociodemographic and medical data.

Results

We observed two separate trajectories of PTG and PTD within participants and found that each of the trajectories were related to different predictors from the studied variables. More specifically, we found a positive relationship between resilience and a descending PTD trajectory that stabilized over time. Gain of resources generally predicted a PTG trajectory, while loss of resources predicted the dynamics of PTD.

Conclusions

Including two parallel constructs, i.e., PTG and PTD, confirmed the independence of their mechanisms in growth processes among PLWH. The initial insight concerning the role of resilience and resources in PTG/PTD processes may inspire more effective planning for psychological help for PLWH, and it may stimulate studies on growth after trauma to further examine the two sides of this phenomenon.

Posttraumatic stress and growth in adolescent childhood cancer survivors: Links to quality of life

Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.

Social Support Is Linked to Post-Traumatic Growth among Tunisian Postoperative Breast Cancer Women

The struggle with breast cancer (BC) is often associated with positive changes after diagnosis and treatment, that are being referred to as posttraumatic growth (PTG). We aimed to examine PTG and its relationship with psychosocial (i.e., psychological distress, spiritual well-being, social support), sociodemographic and cancer-related variables in Tunisian women operated on for breast cancer. This was a cross-sectional study. Seventy-nine (79) postoperative BC women were administered the Post-Traumatic Growth Inventory, the Spiritual Well-being Scale, the Depression, Anxiety and Stress Scales, and the Multidimensional Scale of Perceived Social Support. The changes most frequently reported by participants were discovering that they were stronger than they thought they were (70.0%), having stronger religious faith (65.0%), and being better able to accept the way things work out (63.8%). Multivariate analysis showed that anxiety and social support remained significantly associated with PTG, while no significant relationship has been found for spiritual well-being. Overall, the present study adds to the existing body of research by identifying factors related to women’ s experience of PTG in a previously unexplored Arab Muslim cultural context, Tunisia. We believe that our findings may help inform strategies aiming at promoting positive psychological changes after experiencing BC, at least in our context.

Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11

A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.

Investigating PTG in Cancer Patients: The Role of Time Dimension in the Experience of Personal Growth

This study explored the experience of growth related to being a cancer patient by implementing a thematic analysis. An online questionnaire was completed by 69 patients narrating their growth experience related to cancer. Collected narratives were analyzed by running a deductive thematic analysis, starting from the five domains of the Post-Traumatic Growth Inventory (PTGI) and searching for the presence or absence of topics. Descriptive statistics and correlational analysis were performed. The five factors of the PTGI were identified in the narratives. The thematic analysis we performed defined a further theme that we labeled the “time dimension”, which saturated 37.7% of the entire sample. The presences of four sub-themes related to the “time dimension” were also found: “tracing a new temporal rhythm”, “the value of deserved time”, “facing the caducity of life” and “a view on the future”. Each sub-theme significantly correlated with the theme of the “time dimension”. This emergent theme does not correlate in our results with other domains of personal growth in cancer previously described in the scientific literature, emerging as an independent variable not significantly associated with other domains of post-traumatic growth. Our results suggest further investigation in the role of the time dimension in the practical and emotional experience of growth with regard to cancer.

Psychological Well-Being Increment as Post-Traumatic Growth in Women with Breast Cancer: A Controlled Comparison Design Using Propensity Score Matching

The aim of this study was to confirm post-traumatic growth with respect to the psychological well-being of women with breast cancer compared to women without disease. Propensity score was used to match the two groups according to age, religious beliefs, education level, monthly income, and marital status. A psychological well-being scale with six factors was used, including positive relations with others (PR), autonomy (AU), environmental mastery (EM), personal growth (PG), purpose in life (PL), and self-acceptance (SA). A total 178 women with vs. 178 women without breast cancer were compared by matching with propensity scores, using factorial invariance tests to reduce measurement errors. The results showed that women with breast cancer had significantly higher psychological well-being for all the six factors (Δχ2 = 37.37, p < 0.001) and higher variability in terms of PR, AU, and PL than women without breast cancer (Δχ2 = 45.94, p < 0.001). Furthermore, women with breast cancer exhibited a significantly higher association between PG and PL and a significantly lower association between PG and EM than women without breast cancer (Δχ2 = 44.49, p < 0.001). This implies that psychological well-being could assess broader and more subtle post-traumatic growth in women with breast cancer and that growth was more associated with internal life value than with external environmental control.

Post-traumatic growth 5 years after cancer: identification of associated actionable factors

BACKGROUND

The number of cancer survivors is growing increasingly worldwide. The long-term negative consequences of the disease are now better known. Cancer may also foster positive outcomes. Some survivors consider life after cancer as the start of a new life and experience positive changes called post-traumatic growth (PTG) measured by a scale developed by Tedeschi and Calhoun.

OBJECTIVE

The purpose of this article was to explore actionable factors affecting PTG, particularly those in relation with health care management and those that reflected health behavior changes.

METHODS

This study included the 1,982 participants in the VICAN cohort who responded to the questionnaire on living conditions 2 and 5 years after diagnosis. Factors associated with a moderate or high PTG (score ≥ 63) were identified using logistic regressions.

RESULTS

Factors positively associated with moderate or high PTG were being satisfied with the time spent by health care team on information (OR:1.35 [1.08;1.70]), increased physical activity (OR:1.42 [1.04;1.95]) and healthier diet (OR:1.85 [1.44;2.36]) since diagnosis, and having benefited from psychological support at diagnosis (OR:1.53 [1.16;2.01]).

CONCLUSION

High PTG is positively associated with health behavior and time spent on information. Our findings suggest that appropriate clinical and educational interventions can help foster growth after the experience of cancer. Even if we do not know what causes what, it is admitted that the interventions leading to an increase of physical activity, for example, are good from all points of view.

Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates?

PURPOSE

Cancer is a stressful life event that can lead to specific posttraumatic reactions. Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are two main posttraumatic reactions that are related to each other, and both have different correlates.

METHODS

The linearity of the relationship between PTG and PTSS and the different socio-demographic, cancer-related, emotional, and psychological correlates were analyzed in patients with cancer (N = 126).

RESULTS

The relationship between PTG and PTSS was found to be more curvilinear than linear. PTSS was more strongly related to psychological factors (e.g., anxious preoccupation, hope-helplessness, and resilience) while PTG was strongly related to existential factors (e.g., self-transcendence and religiosity).

CONCLUSION

The results show that cancer-related PTSS and PTG are specifically related constructs which are related differently to particular correlates. Specifically, the greatest differences were observed in the psychological variables. In the early phases, therapeutic interventions focused on variables related to PTSS can lead to the reduction of PTSS. In follow-up phases, the therapeutic intervention focused on the increase of the level of variables related to PTG can help the development of PTG.

Posttraumatic Growth, Positive Psychology, Perceived Spousal Support, and Psychological Complications in Head and Neck Cancer: Evaluating Their Association in a Longitudinal Study

Despite head and neck cancer (HNC) association with various negative impacts, collective evidence is accumulating regarding the positive impacts of positive psychology on cancer survivors. However, data on how positive psychology is related to the psychological complications of HNC across time are lacking. This longitudinal study examined the trends of positive psychology (e.g., posttraumatic growth [PTG], hope, and optimism), perceived spousal support, and psychological complications (e.g., depression, anxiety, and posttraumatic stress symptoms) and determined the association between them, psychological complications, and PTG across two timelines among a cohort of HNC patients. A total of 175 HNC respondents exhibited an increasing trend of positive psychology and perceived spousal support while reporting a decreasing trend of psychological complications between baseline and follow-up assessments. A greater degree of hope and perceived spousal support contributed to a higher degree of PTG across time. Conversely, a higher severity of anxiety symptoms was associated with a lower degree of PTG over time. Female gender had a moderating effect on the association between severity of anxiety symptoms and PTG, but did not moderate the association between hope, perceived spousal support and PTG. This study indicates the pivotal role of incorporating psychosocial interventions into the treatment regimen to enhance the degree of hope and perceived spousal support and reduce the severity of anxiety symptoms, which, in turn, will facilitate the development of PTG in HNC patients.