The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT)

Factors associated with postpartum fatigue: an exploration of the moderating role of resilience

Background

Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue.

Methods

This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro.

Results

A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02).

Conclusion

Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

The Role of Resilience in the Relationship between Sociodemographic, Clinical Characteristics, and Social Support among Breast Cancer Patients in Serbia

BACKGROUND

The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families.

METHODS

This cross-sectional descriptive-analytical study was conducted from March to August 2023 at the "Dr. Radivoj Simonović" General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales-for assessing social support-and the Connor-Davidson Resilience Scale-for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients' sociodemographic and clinical characteristics and levels of social support.

RESULTS

The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support.

CONCLUSION

This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other.

Feasibility of DNA Methylation Age as a Biomarker of Symptoms and Resilience among Cancer Survivors with Multiple Chronic Conditions

This study aims to examine the feasibility of DNA methylation age as a biomarker for symptoms and resilience in cancer survivors with multiple chronic conditions (MCCs). We included ten participants from our parent study, an ongoing randomized control trial study. Participants' symptoms and resilience were assessed, and peripheral blood was collected. DNA methylation age calculation was performed using DNAge® analysis. Data were analyzed using Spearman's correlation analysis and the Mann-Whitney U test. Participants in the intervention group tended to have a decrease in DNA methylation age and age acceleration after completing an exercise program (mean difference = -0.83 ± 1.26). The change in DNA methylation age was significantly correlated with the change in resilience score (r = -0.897, p = 0.015). The preliminary results suggest that DNA methylation age can be a potential biomarker for improving resilience in cancer survivors with multiple chronic conditions. This finding is limited by the small sample size, and a larger study is needed.

Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity

CONTEXT

Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue.

OBJECTIVES

Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles.

METHODS

Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests.

RESULTS

Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement.

CONCLUSION

To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.

Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study

Background

Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization.

Methods

We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated.

Results

In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months.

Conclusion

The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.

The effects of trait resilience and rumination on psychological adaptation to breast cancer

This cross-sectional study examined the effect of trait resilience and specific types of rumination on positive psychological adaptation post-diagnosis among 201 breast cancer patients. They completed self-reported measures describing trait resilience, rumination, posttraumatic growth, and health-related quality of life. Hierarchical analysis showed that trait resilience significantly predicted higher quality of life and posttraumatic growth after controlling for demographic and clinical variables. Additionally, “intrusion” and “brooding” subtypes of rumination negatively predicted quality of life, with “instrumentality” positively predicting quality of life and posttraumatic growth, suggesting the importance of trait resilience and multidimensional rumination for positive psychological changes among breast cancer survivors.

The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study

The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.

Effects of an Interdisciplinary Integrative Oncology Group-Based Program to Strengthen Resilience and Improve Quality of Life in Cancer Patients: Results of a Prospective Longitudinal Single-Center Study

BACKGROUND

Patients with cancer receiving oncological treatment often suffer from a reduced quality of life (QoL) and resilience.

OBJECTIVES

The aim of this study was to evaluate the effect of an interdisciplinary integrative oncology group-based program on resilience and quality of life in patients with cancer during or after conventional oncological therapy.

METHODS

This prospective longitudinal single-center study evaluated the resilience (Resilience Scale), quality of life (EORTC-QLQ C30), anxiety, depression (Hospital Anxiety and Depression Scale), and distress levels (Distress Thermometer) of 60 patients with cancer who participated in a 10-week interdisciplinary integrative oncology group-based program during or after cancer treatment in outpatient clinics. An average of 12 (range 11-13) patients participated in each 10-week group. The program included recommendations for diet, stress management, relaxation, and exercise, as well as naturopathic self-help strategies and psychosocial support.

RESULTS

There were slight increases in global quality of life scores (week 0: 58.05 ± 20.05 vs week 10: 63.13 ± 18.51, n = 59, P = .063, d = -.25) and resilience scores (week 0: 63.50 ± 13.14 vs week 10: 66.15 ± 10.17, n = 52, P = .222, d = -.17) after the group program compared to before; however, these changes were not statistically significant and had small effect sizes. Patients with at least moderate anxiety symptoms (P = .022, d = .42) and low resilience (P = .006, d = -.54) benefited most from the program. The patients reported no relevant side effects or adverse events from the program.

CONCLUSIONS

No significant effects on global quality of life or resilience were found in the general sample; notably, patients with anxiety and low initial resilience benefited the most from the program.

Translation and psychometric evaluation of the Chinese version of the resilience scale for children with cancer

BACKGROUND

To test the psychometric properties of a traditional Chinese version of the Resilience Scale for Children (RS-10) and examine its factorial structure via a confirmatory factor analysis (CFA).

METHODS

One hundred and eighty-six Hong Kong Chinese children with cancer were recruited in the paediatric oncology units of two public acute-care hospitals in Hong Kong to participate in this cross-sectional study. The psychometric properties of the traditional Chinese version of the RS-10 were assessed, namely its content equivalence, convergent and discriminant validity, construct validity, internal consistency and test-retest reliability.

RESULTS

The newly translated traditional Chinese version of the RS-10 demonstrated adequate internal consistency (Cronbach's α = .83, McDonald's Ω = .80), excellent test-retest reliability (.89), good content equivalence (CVI = 96%) and appropriate convergent (r =  - .52, P = .01) and discriminant validity (r = .61, P = .01). The CFA results demonstrated that there was a good fit between the factor structure of the Chinese version of the RS-10 and the observed data (χ2/df = 2.34, TLI = .951, RMSEA = .053, CFI = .962, GFI = .948, SRMR = .052), thereby confirming the construct validity of this instrument.

CONCLUSIONS

The traditional Chinese version of the RS-10 was found to be a reliable and valid tool for assessing the resilience of Hong Kong Chinese children with cancer. The newly developed traditional Chinese version of the RS-10 is an appropriate clinical research tool for evaluating the effectiveness of nursing interventions in enhancing the resilience of and promoting mental well-being in children with cancer. Trial registration NCT03544190.

External application of liver compresses to reduce fatigue in patients with metastatic cancer undergoing radiation therapy, a randomized clinical trial

BACKGROUND

Liver compresses are frequently used in integrative medicine as supportive therapy during cancer treatment in order to reduce fatigue. We performed a pilot study to test whether the external application of yarrow liver compresses impacts fatigue in patients with metastatic cancer undergoing radiation therapy.

METHODS

A randomized prospective pilot trial was performed including patients with brain metastasis or bone metastasis of solid tumors. Patients underwent either palliative radiation therapy (RT) of the metastatic lesions (control group) over two weeks or the same RT with additional external application of yarrow liver compresses once daily during RT. The primary objective was improvement on the general fatigue subscale of the multidimensional fatigue inventory (MFI-20) at the end of treatment, where a mean difference of two points is considered clinically relevant. Secondary objectives included psychological distress, quality of life and qualitative analysis with self-established visual analogue scales (VAS). Mean differences in general fatigue at the end of treatment compared to baseline were analyzed using the ANCOVA test.

RESULTS

From 09/2017 to 08/2019 a total of 39 patients were randomized. Due to drop outs 24 patients (12 per group) were available for analysis. Patients in the intervention group received a mean number of 10.5 (range, 7-14) applications of yarrow liver compresses. The mean improvement at the end of therapy on the general fatigue subscale of the MFI-20 was 2 points in favor of the intervention group (p = 0.13), and all other MFI-20 subscales showed at least a trend towards improvement in favor of the intervention group. Likewise, psychological distress and VAS data was improved, the latter reaching statistical significance for the symptoms fatigue, tension and lack of drive. Major toxicities were not observed.

CONCLUSIONS

External application of liver compresses appears to reduce fatigue within a clinical relevant range in patients with metastatic cancer undergoing radiation therapy.

TRIAL REGISTRATION

ISRCTN, ICTRP DRKS00012999.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors

OBJECTIVE

The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer.

METHODS

Four databases were systematically searched from inception to August 2020. Both qualitative and quantitative studies that examined factors associated with psychological resilience in a sample of patients with advanced cancer undergoing palliative care were included.

RESULTS

A total of 15 studies met the criteria, of which 10 were qualitative and five were quantitative. Nine studies included a definition of psychological resilience, from which five common themes of buffering, adaptation, resources, recovery, and growth were derived. The quantitative studies found association between resilience and hope, independence, social support, fatigue, emotional distress, and coping strategies. The qualitative studies reported additional sources of resilience such as spirituality, social support, prior experience dealing with illness and life adversity, meaning-making, reconciling with life's finiteness, acceptance of illness, control, determination, positive attitude, dignity, engagement with palliative care and quality of life being supported by palliative care.

CONCLUSIONS

More research is needed for developing an overarching definition of psychological resilience in palliative advanced cancer patients that acknowledges and appreciates the contextual sensitivity of this concept among different cultural groups. Further studies are also needed to examine a holistic range of bio-psycho-socio-spiritual factors associated with psychological resilience among these patients and their families.

Components and Related Factors of Nursing Interventions for Improving Resilience in Cancer Patients Undergoing Chemotherapy

Resilience is considered an effective concept for cancer patients, but nursing interventions for improving resilience have not been studied adequately yet. We aimed to explore the components and related factors of nursing interventions for promoting resilience among cancer patients receiving chemotherapy (NIPRPC). This cross-sectional study included 68 facilities from 396 cancer hospitals in Japan. Participants were 377 nurses who worked at the outpatient chemotherapy center or cancer ward. They completed self-administered questionnaires including the NIPRPC items and Resilience Scale for Nurses, etc. We conducted factor, correlational, and regression analysis. Based on the exploratory factor analysis, six-dimensional factor components: “Support for patients during the present situation and increasing their self-affirmation”, “Support for self-help”, “Support for utilizing the cancer medical team”, “Support for obtaining family cooperation”, “Support for maintaining regular lifestyle during chemotherapy”, and “Support for interacting with cancer patients and utilizing necessary information”. The strong related factors for all six factors were the resilience of the nurses and the number of collaborations with multiple occupations. Our findings will help nurses improve the psychosocial quality of life of cancer patients and address their needs related to cancer chemotherapy treatment.

Relationships among resilience, depressive symptoms, self-esteem, and quality of life in children with cancer

OBJECTIVE

To examine the interrelationships among resilience, self-esteem, and depressive symptoms and determine whether resilience was a factor associated with quality of life for Hong Kong Chinese children with cancer.

METHODS

We used a cross-sectional study design. Participants were 138 Hong Kong Chinese children (aged 7-14 years) who were admitted to the pediatric oncology units of an acute public hospital. The resilience, depressive symptoms, self-esteem, and quality of life of participating children were assessed. The primary outcome was the association between resilience and quality of life in children with cancer.

RESULTS

In total, 72 boys and 66 girls were recruited for this study (mean age 10.6 years). The mean levels of resilience, depressive symptoms, self-esteem, and quality of life were 23.4, 30.0, 23.0, and 63.6, respectively. There was a statistically significant strong positive correlation between resilience and quality of life (r = 0.60, p < 0.01), indicating that greater resilience was associated with better quality of life. Children with cancer from single-parent families, those diagnosed with a brain tumor, and those who received multiple treatments reported significantly lower levels of resilience, self-esteem, and quality of life, and greater depressive symptoms than other children (all p's < 0.001). Results of a multiple regression analysis revealed that resilience (p < 0.001) was a strong factor associated with quality of life among children with cancer.

CONCLUSIONS

It is essential that healthcare professionals implement interventions to boost the resilience of children with cancer, thereby enhancing their quality of life.

Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a non-clinical population in Sweden

Background

The Connor-Davidson Resilience Scale (CD-RISC) is the most widely used scale which assesses psychological resilience. Although it is recommended to be applied as a unidimensional scale, its factor structure, reliability, as well as discriminant and predictive validity need to be assessed when used in a new context. Moreover, the original five-factor structure has not been replicated in previous investigations. This study aimed to explore psychometric properties of the scale in a Swedish context.

Methods

Construct validity of the five-factor model of CD-RISC was assessed using Exploratory and Confirmatory Factor Analyses. Its discriminant validity was assessed in relation to a measure of emotion regulation (Brief Version of the Difficulties in Emotion Regulation Scale) using a Confirmatory Factor Analysis. Predictive validity of CD-RISC was assessed in relation to measures of physical and mental health-related quality of life (The 12-Item Short Form Survey) using hierarchical multiple regression analyses. A population based sample cohort was employed (N = 2599).

Results

Exploratory and Confirmatory Factor Analyses suggested a 22-item unidimensional model of CD-RISC. Psychological resilience was found to be independent from the measure of emotion regulation. It was shown to predict both physical and mental health-related quality of life, being especially strongly associated with mental health aspects.

Conclusions

The study showed that the Swedish version of CD-RISC is an instrument with high discriminant and predictive validity, although the original factor structure does not apply in this context. CD-RISC can thus be used to identify individuals with a higher need of psychosocial support, especially relating to mental health needs.

Quality of Life in Patients With Non-Small Cell Lung Cancer: Structural Equation Modeling

BACKGROUND

Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non-small cell lung cancer (NSCLC) patients have not been studied sufficiently.

OBJECTIVE

The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients.

METHODS

Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records.

RESULTS

Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths.

CONCLUSION

This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL.

IMPLICATIONS FOR PRACTICE

Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.

Positive psychological changes after breast cancer diagnosis and treatment: The role of trait resilience and coping styles

Purpose: This study aimed to examine the relationships among trait resilience, coping styles, and perceived positive psychological changes in women's lives after breast cancer diagnosis and treatment.Design: The study adopted a cross-sectional design.Sample/Method: A total of 201 participants diagnosed with stage I-IV breast cancer were recruited. The average time since diagnosis was 39.14 months. Four rating scales were used to assess the participants' trait resilience, coping styles, perceived growth, and health-related quality of life. These are the Connor-Davidson Resilience Scale (CD-RISC), the Mini-Mental Adaptation to Cancer Scale (Mini-MAC), the Chinese Posttraumatic Growth Inventory (PTGI), and the Functional Assessment of Cancer Therapy Scale-Breast (FACT-B).Findings: Hierarchical analysis showed that trait resilience significantly predicted high levels of perceived growth and health-related quality of life. This effect was moderated by Positive-Acceptance coping. The study also found that Negative-Affect coping had a direct effect on lowering health-related quality of life but had no influence on perceived growth.Conclusions: These findings highlight the facilitating effect of trait resilience and Positive-Acceptance coping on the psychological well-being and perceived growth among breast cancer outpatients.Implications: Trait resilience may be a protective, even facilitating factor of cancer adaptation. The knowledge that trait resilience offers a way to enhance wellness after cancer diagnosis and treatments may be useful in a clinical setting.

Resilience and quality of life (QoL) of head and neck cancer and brain tumour survivors in Pakistan: an analytical cross-sectional study protocol

BACKGROUND

Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.

METHOD AND ANALYSIS

A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD of QoL and resilience will range from 16.5 to 40.8 for head and neck cancer, and 12.7 to 34.1 for brain tumour, at 5% level of significance, with 2.5 precision. QoL will be assessed by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-H&N35 and EORTC QLQ-BN20 and resilience will be evaluated by Wagnild and Young's 14-item scale. Mean±SD will be reported for resilience and QoL scores. Unadjusted and adjusted β-coefficients, with 95% CI, will be reported by using multiple linear regression analysis. Correlation analysis will also be performed using Pearson or Spearman rank correlation coefficients. A p value of <0.05 will be considered significant.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Aga Khan University Pakistan's Ethical Review Committee. Written informed consent will be taken from the participants by trained research assistants. A trained psychologist will provide on-spot counselling to the participants and those identified with severe depression will be referred to a psychiatrist. The study materials will be kept under lock and key and the electronic data base will be password protected and will only be accessed by the research team. The study findings will be disseminated through publications conferences and workshops and research briefs.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov registry (NCT03466762).

The Resilience of Indigenous Women of the U.S. Who Experience Cancer: Transcending Adversity

Almost no research specifically explores resilience among Indigenous women of the U.S. who experience cancer. A qualitative descriptive study included a sample of 43 Indigenous women from the Northern Plains region of the U.S. Almost 90% (88%, n=37) of participants indicated personal growth in response to having cancer, indicating they valued relationships (n=3), had a stronger faith (n=5), were grateful and living in moment (n=21), were healthier (n=5), and helped others (n=6) in response to their cancer experience. Results indicate that factors that promote and facilitate resilience are critical for culturally responsive practice with Indigenous women.

Development and validation of the Family Resilience (FaRE) Questionnaire: an observational study in Italy

OBJECTIVE

Develop and validate an instrument to assess family resilience and, more specifically, the family dynamics and resources, estimating the adaptation flexibility to cancer disease. Cohesion, communication, coping style and relational style were considered as critical functional areas in the construction of the instrument.

DESIGN

Two cross-sectional studies. Study 1: identification of factorial structure of the questionnaire in two samples with different cancer sites. Study 2: validation of the questionnaire in patients with cancer in two different phases of their therapeutic pathway.

PARTICIPANTS AND SETTING

A total of 213 patients with a histologically confirmed non-metastatic breast or prostate cancer and 209 caregivers were recruited for the two studies from an oncological hospital in Italy.

OUTCOME MEASURES

The Resilience Scale for Adults and the Family Resilience (FaRE) Questionnaire, developed by the researchers, were administered to all patients and caregivers who gave consent.

RESULTS

In study 1, the 60-item version of the FaRE Questionnaire underwent discriminant and construct validity, internal consistency and factorial analysis. Comparisons between patient and caregiver populations showed that patients perceived higher levels of family resources (p=0.048) and that patients with prostate cancer perceived less social support compared with patients with breast cancer (p=0.002). Factor analysis demonstrated four domains: communication and cohesion, perceived social support, perceived family coping, and religiousness and spirituality. In study 2, the validity and factorial structure of the final scale, composed of 24 items, were confirmed. The Cronbach alpha of all subscales was above 82. Normative values for patients with breast cancer can provide indications of family resilience levels.

CONCLUSIONS

Preliminary findings showed acceptable psychometric properties for the FaRE Questionnaire to evaluate family resilience in oncological patients and their caregivers. Further research should test its sensibility to change to assess its use as a psychoemotional monitoring tool and its validity in other medical contexts.

Going to extremes: determinants of extraordinary response and survival in patients with cancer

Research into factors affecting treatment response or survival in patients with cancer frequently involves cohorts that span the most common range of clinical outcomes, as such patients are most readily available for study. However, attention has turned to highly unusual patients who have exceptionally favourable or atypically poor responses to treatment and/or overall survival, with the expectation that patients at the extremes may provide insights that could ultimately improve the outcome of individuals with more typical disease trajectories. While clinicians can often recount surprising patients whose clinical journey was very unusual, given known clinical characteristics and prognostic indicators, there is a lack of consensus among researchers on how best to define exceptional patients, and little has been proposed for the optimal design of studies to identify factors that dictate unusual outcome. In this Opinion article, we review different approaches to identifying exceptional patients with cancer and possible study designs to investigate extraordinary clinical outcomes. We discuss pitfalls with finding these rare patients, including challenges associated with accrual of patients across different treatment centres and time periods. We describe recent molecular and immunological factors that have been identified as contributing to unusual patient outcome and make recommendations for future studies on these intriguing patients.

Resilience and associated factors among Chinese patients diagnosed with oral cancer

Background

Resilience has been linked to psychological adaptation to many challenging life events. The present study aims to explore the level of resilience in oral cancer patients and the key factors associated with resilience, and to evaluate the relationship between resilience and anxiety.

Methods

A multiple center cross-sectional study was carried out for Chinese patients with oral cancer between May 2016 and October 2017 in the Stomatology Hospital of China Medical University and Department of Stomatology, Shengjing Hospital of China Medical University. Two hundred and thirty oral cancer patients replied to the questionnaires on resilience, hope, perceived social support, optimism, perceived stress and anxiety which were measured with Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Perceived Stress Scale-10 (PSS-10) and Zung Self-Rating Anxiety Scale (SAS), respectively. Univariate one-way ANOVA/t-test, Pearson’s r and hierarchical linear regression analysis were conducted to explore the influence factors of resilience and the relationship between resilience and anxiety.

Results

The level of resilience was 67.93 ± 12.65. Resilience was positively correlated with hope, optimism and perceived social support, and negatively correlated with perceived stress. Hierarchical linear regression analysis showed that hope (β = 0.386, P < 0.01), optimism (β = 0.190, P < 0.01) and education (β = 0.175, P < 0.01) were positively associated with resilience. The three variables in combination could explain 48.9% of the total variance in resilience. Higher level of resilience was associated less anxiety symptoms (X² = 39.216, p = 0.000); and there was linear trend between resilience level and anxiety level among patients with oral cancer (X² = 35.624, p = 0.000).

Conclusion

Patients with oral cancer in China had moderate level of resilience. Hope, optimism and education were positively and significantly associated with resilience, indicating that higher level of hope, optimism and education may improve resilience in oral cancer patients, which in turn may help alleviate anxiety symptoms in patients.

Resilience in Cancer Patients

Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events. Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer. Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress. Results: Biological, personal, and most importantly social factors contribute to cancer patients' resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed. Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care.

Association of resilience with health-related quality of life and depression in multiple myeloma and its precursors: results of a German cross-sectional study

OBJECTIVES

To investigate the relation between resilience, health-related quality of life (HRQOL) and depression in multiple myeloma (MM) and its premalignant stages. MM is one of the most frequent haematological disorders. It is regularly preceded by asymptomatic stages of the disease namely monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM). Survivors have to cope with mental and physical impairment in terms of HRQOL and depression. The concept of resilience refers to a person's ability to adapt to adversity.

DESIGN

Cross-sectional study.

SETTING

MM outpatient department at a University Hospital in Germany (tertiary care).

PARTICIPANTS

292 consecutive patients from our MM outpatient department.

OUTCOME MEASURES

HRQOL, depression and psychological resilience were assessed with validated questionnaires.

RESULTS

Regression analyses were performed to determine associations between resilience, HRQOL and depression. 98 patients (33.6%) had a new diagnosis of active MM, 106 patients (36.3%) were already treated for MM and 88 patients had the diagnosis of a precursor (MGUS or SMM; 30.1%) of MM. Multivariate linear regression analyses revealed a strong positive impact of resilience on physical (b 7.20; 95% CI 4.43 to 9.98; p<0.001) and mental (b 12.12; 95% CI 9.36 to 14.87; p<0.001) HRQOL. Ordered logistic regression analysis showed that the odds for higher depression severity were lowered for individuals with a high level of resilience in comparison to the individuals with a low level of resilience (OR 0.11; 95% CI 0.06 to 0.19; p<0.001).

CONCLUSIONS

Resilience may be a protective factor in the disease trajectory of MM and its precursors. As a next step, future research should focus on longitudinal assessments at various time points to elucidate the role of resilience in one of the most frequent haematological malignancies.

Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury

Traumatic brain injury (TBI) causes physical and cognitive-behavioral impairments that reduce participation in employment, leisure, and social relationships. Demographic and injury-related factors account for a small proportion of variance in participation post-injury. Personal factors such as resilience may also impact outcomes. This study aimed to examine the association of resilience alongside demographic, injury-related, cognitive, emotional, and family factors with participation following TBI. It was hypothesized that resilience would make an independent contribution to participation outcomes after TBI. Participants included 245 individuals with mild-severe TBI [Mage = 44.41, SDage = 16.09; post traumatic amnesia (PTA) duration M 24.95 days, SD 45.99] who completed the Participation Assessment with Recombined Tools-Objective (PART-O), TBI Quality of Life Resilience scale, Family Assessment Device General Functioning Scale, Rey Auditory Verbal Learning Test, National Adult Reading Test, and Hospital Anxiety and Depression Scale an average 4.63 years post-injury (SD 3.02, R 0.5-13). Multiple regression analyses were used to examine predictors of PART-O scores as the participation measure. Variables in the model accounted for a significant 38% of the variability in participation outcomes, F(13, 211) = 9.93, p < 0.05, R2 = 0.38, adjusted R2 = 0.34. Resilience was a significant predictor of higher participation, along with shorter PTA duration, more years since injury, higher education and IQ, and younger age. Mediation analyses revealed depression mediated the relationship between resilience and participation. As greater resilience may protect against depression and enhance participation this may be a focus of intervention.

Family Resilience in the Oncology Setting: Development of an Integrative Framework

Resilience is a concept that has received burgeoning interest in the last decades. Researchers have been fascinated by the ability of some individuals to bounce back from an adverse event and adapt to extremely challenging situations. More recently family resilience, namely the potential resources of the family’s system, has been considered due to numerous individual studies highlighting the crucial influence of relationships with significant others in mediating adaptation and recovery. In this article, a brief overview of the theoretical literature on individual and family resilience is presented. Following, current empirical literature on resilience in the context of oncology is evaluated. Although family resilience is considered a dynamic process unique to each family unit, some common resources and strengths that can help families face significant adversities, such as cancer, can be identified. This said to date there is no family resilience framework applied specifically to the cancer trajectory. Drawing from previous studies, we sought to provide a clinical resilience model for families living with cancer, with the aim of mapping those resources that can empower families to deal with prolonged adversity. This framework can serve as general guideline for health professionals in assessing family strengths, promoting specific family processes and facilitating adaptation to the cancer experience.

Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer

AIMS AND OBJECTIVES

To investigate the prevalence of cancer-related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer.

BACKGROUND

Cancer-related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer-related fatigue have been examined, but the underlying psychological mechanisms are not well understood.

DESIGN

A cross-sectional study.

METHODS

Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer-related fatigue, and the mediating effect of positive affect.

RESULTS

The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer-related fatigue, explaining 15.4% of variance in cancer-related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer-related fatigue.

CONCLUSIONS

Cancer-related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer-related fatigue.

RELEVANCE TO CLINICAL PRACTICE

Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours.

The relationship between resilience and quality of life in patients with a drainage enterostomy

Impact and adjustment to a drainage enterostomy are measured mainly through health indicators. To investigate the relationship between resilience and adaptation to the placement of a drainage enterostomy. Prospective observational study with a sample of 125 patients (64 men/36 women) with a temporary or permanent drainage enterostomy and a mean age of 66.72 years. High quality of life (mean, 80.5) and resilience (mean, 79.57) scores and a positive relationship between both were found. There seems to be a positive relationship with general quality of life and health-related quality of life. The logistic regression model shows that the main predictor as regards health-related quality of life is resilience.

Body Composition Early Identifies Cancer Patients With Radiotherapy at Risk for Malnutrition

CONTEXT

The side effects of radiotherapy (RT) and the occurrence of comorbidity often result in appetite loss in patients, which leads to serious nutritional problems, significantly affecting the patients' treatment results and disease prognosis.

OBJECTIVES

We aimed to investigate changes in the body composition of patients with cancer from the time they received RT to three months after completion of RT.

METHODS

A total of 101 cancer patients who received RT, which included head or neck cancer, chest or breast cancer, and abdominal or pelvic cancer patients, were recruited. A longitudinal study design was adopted, in which the body composition analyzer In Body3.0 was used to obtain patient data at six different time points. The data were analyzed through generalized estimating equation.

RESULTS

All patients with cancer had the lowest body mass index at the end of RT. For head or neck cancer patients, their total body water and muscle mass decreased significantly in the fourth week of RT and at the end of RT. For chest or breast cancer patients, their body fat mass changed significantly in the second and fourth weeks of RT (β = -0.57, P = 0.0233; β = -3.23, P = 0.0254). For abdominal or pelvic cancer patients, their total body weight and muscle mass decreased significantly in the second week of RT and at the end of RT (β = -1.07, P = 0.0248; β = -5.13, P = 0.0017; β = -1.37, P = 0.0245; β = -6.50, P = 0.0016); their body fat mass increased significantly in the third month after RT (β = 4.61, P = 0.0072).

CONCLUSION

Body composition analysis can be used to promptly and effectively monitor changes in the nutritional status of patients with cancer during the cancer treatment period; changes in the body composition at different repetitions differ between patients with dissimilar cancers.

Social Support Is a Predictor of Lower Stress and Higher Quality of Life and Resilience in Brazilian Patients With Colorectal Cancer

BACKGROUND

The well-being of patients undergoing chemotherapy treatment for colorectal cancer (CRC) is affected by psychological effects associated with cancer treatment. However, little is known about the impact of these psychological factors in Brazilian patients with CRC.

OBJECTIVE

The aim of this study was to determine whether perceived stress, social support, and resilience are associated with quality of life in urban Brazilian patients receiving chemotherapy treatment for CRC.

METHODS

This was a cross-sectional study conducted with 144 Brazilian CRC patients in an ambulatory oncology clinic. The participants completed 5 questionnaires: Demographics, Perceived Stress Scale 14, Social Support Satisfaction Scale, Resilience Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (C30 and CR29). Confirmatory factor analysis modeling and Cronbach's α were used to examine construct validity and internal consistency. We used the MPlus 3.0 to construct and validate the structural model.

RESULTS

There was a moderate and positive effect of resilience on the physical, social, and emotional aspects of quality of life. Social support had a strong and positive direct effect on quality of life (ie, social, physical, social, and emotional). Social support had a negative effect on stress perception. Resilience was also negatively related to stress perception.

CONCLUSIONS

Family support and professional social support are important factors for Brazilian CRC patients. Resilience is an important ally for patients. It is important for nurses to consider this when developing educational and psychological interventional strategies to reduce stress and ultimately improve quality of life in this population.

IMPLICATION FOR PRACTICE

Psychological factors that improve quality of life should be evaluated in patients undergoing treatment for cancer.

Positive factors associated with quality of life among Chinese patients with renal carcinoma: a cross-sectional study

Quality of life and positive psychological variables has become a focus of concern in patients with renal carcinoma. However, the integrative effects of positive psychological variables on the illness have seldom been reported. The aims of this study were to evaluate the quality of life and the integrative effects of hope, resilience and optimism on the quality of life among Chinese renal carcinoma patients. A cross-sectional study was conducted at the First Hospital of China Medical University. 284 participants completed questionnaires consisting of demographic and clinical characteristics, EORTC QLQ-C30, Adult Hope Scale, Resilience Scale-14 and Life Orientation Scale-Revised from July 2013 to July 2014. Pearson's correlation and hierarchical regression analyses were performed to explore the effects of related factors. Hope, resilience and optimism were significantly associated with quality of life. Hierarchical regression analyses indicated that hope, resilience and optimism as a whole accounted for 9.8, 24.4 and 21.9% of the variance in the global health status, functioning status and symptom status, respectively. The low level of quality of life for Chinese renal carcinoma patients should receive more attention from Chinese medical institutions. Psychological interventions to increase hope, resilience and optimism may be essential to enhancing the quality of life of Chinese cancer patients.

Differential effects of circadian typology on sleep-related symptoms, physical fatigue and psychological well-being in relation to resilience

Various physiological and psychological functions are influenced by circadian typology (CT), which was reported to be related to resilience. However, few studies have assessed the effects of CT in relation to resilience. The aim of the present study was to assess the influence of CT on sleep-related symptoms, physical fatigue and psychological well-being in relation to resilience. The present study included a total of 1794 healthy hospital employees, and they completed the Morningness-Eveningness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale and World Health Organization Quality of Life Scale Abbreviated Version. Subjects with evening type showed lower sleep quality, more daytime sleepiness and physical fatigue than neither types and morning types. Additionally, evening types were more depressed and anxious and reported a poorer quality of life. CT was found to be a significant predictor of sleep quality, but CT was minimally associated with physical fatigue and psychological well-being in the regression analysis. Instead, resilience was substantially related to all of the variables measured. In conclusion, CT independently predicts sleep quality, but the effects of CT on physical fatigue and psychological well-being are negligible compared to those of resilience.

Associations of perceived social support and positive psychological resources with fatigue symptom in patients with rheumatoid arthritis

Objective

This study aimed to assess the association between perceived social support (PSS) and fatigue and the roles of hope, optimism, general self-efficacy and resilience as mediators or moderators on PSS-fatigue association among Rheumatoid Arthritis (RA) patients in China.

Methods

A multi-center, cross-sectional study was conducted withinpatients diagnosed with RA in northeast China, in which 305 eligible inpatients were enrolled. The Multidimensional Fatigue Inventory, Multidimensional Scale of Perceived Social Support, Herth Hope Index, Life Orientation Test Revised, General Self-Efficacy Scale and Ego-Resiliency Scale were completed. The associations of PSS, hope, optimism, general self-efficacy and resilience with fatigue and the moderating roles of these positive psychological constructs were tested by hierarchical linear regression. Asymptotic and resampling strategies were utilized to assess the mediating roles of hope, optimism, general self-efficacy and resilience.

Results

The mean score of the MFI was 57.88 (SD = 9.50). PSS, hope, optimism and resilience were negatively associated with RA-related fatigue, whereas DAS28-CRP was positively associated. Only resilience positively moderated the PSS-fatigue association (B = 0.03, β = 0.13, P<0.01). Hope, optimism and resilience may act as partial mediators in the association between PSS and fatigue symptoms (hope: a*b = -0.16, BCa 95%CI: -0.27, -0.03; optimism: a*b = -0.20, BCa 95%CI: -0.30, -0.10; resilience: a*b = -0.12, BCa 95%CI: -0.21–0.04).

Conclusions

Fatigue is a severe symptom among RA patients. Resilience may positively moderate the PSS-fatigue association. Hope, optimism and resilience may act as partial mediators in the association. PSS, hope, optimism and resilience may contribute as effective recourses to alleviate fatigue, upon which PSS probably has the greatest effect.

Resilience and Associated Factors among Mainland Chinese Women Newly Diagnosed with Breast Cancer

Purpose

Resilience is the individual’s ability to bounce back from trauma. It has been studied for some time in the U.S., but few studies in China have addressed this important construct. In mainland China, relatively little is known about the resilience of patients in clinical settings, especially among patients with breast cancer. In this study, we aimed to evaluate the level of resilience and identify predictors of resilience among mainland Chinese women newly diagnosed with breast cancer.

Methods

A cross-sectional descriptive study was conducted with 213 mainland Chinese women newly diagnosed with breast cancer between November 2014 and June 2015. Participants were assessed with the Connor-Davidson Resilience Scale (CD-RISC), Social Support Rating Scale (SSRS), Medical Coping Modes Questionnaire (MCMQ, including 3 subscales: confrontation, avoidance, and acceptance-resignation), Herth Hope Index (HHI), and demographic and disease-related information. Descriptive statistics, bivariate analyses and multiple stepwise regression were conducted to explore predictors for resilience.

Results

The average score for CD-RISC was 60.97, ranging from 37 to 69. Resilience was positively associated with educational level, family income, time span after diagnosis, social support, confrontation, avoidance, and hope. However, resilience was negatively associated with age, body mass index (BMI), and acceptance-resignation. Multiple stepwise regression analysis indicated that hope (β = 0.343, P<0.001), educational level of junior college or above (β = 0.272, P<0.001), educational level of high school (β = 0.235, P<0.001), avoidance (β = 0.220, P<0.001), confrontation (β = 0.187, P = 0.001), and age (β = -0.108, P = 0.037) significantly affected resilience and explained 50.1% of the total variance in resilience.

Conclusions

Women with newly diagnosed breast cancer from mainland China demonstrated particularly low resilience level, which was predicted by hope educational level, avoidance, confrontation, and age.

The Impact of Hope and Resilience on Multiple Factors in Neurosurgical Patients

The purpose of the present article is to outline and review the impact of stable psychological characteristics on the emotional and functional outcomes of neurosurgical patients. Neurosurgical patients face adversity as inherent to their diagnoses and, consequently, experience emotional distress. Despite commonalities in diagnoses, diverse outcomes are seen post-neurosurgery, which are influenced by psychological factors. Therefore, an understanding of neurosurgical patients’ behavior, thoughts, and feelings surrounding their diagnoses, informed by psychological concepts, is important for both neuropsychology and neurosurgery.

Gender Differences in Predictors of Quality of Life at the Initiation of Radiation Therapy

PURPOSE/OBJECTIVES

To evaluate gender differences in quality of life (QOL), demographic, clinical, and symptom characteristics.


DESIGN

Prospective, observational.


SETTING

Two radiation oncology departments in northern California.


SAMPLE

185 patients before initiation of radiation therapy (RT).


METHODS

At their RT simulation visit, patients completed a demographic questionnaire, a measure of QOL, and symptom-specific scales. Backward elimination regression analyses were conducted to determine the significant predictors of QOL
.

MAIN RESEARCH VARIABLES

QOL, gender, and 20 potential predictors
.

FINDINGS

In women, depressive symptoms, functional status, age, and having children at home explained 64% of the variance in QOL. In men, depressive symptoms, state anxiety, number of comorbidities, being a member of a racial or ethnic minority, and age explained 70% of the variance in QOL
.

CONCLUSIONS

Predictors of QOL differed by gender. Depressive symptom score was the greatest contributor to QOL in both genders.
.

IMPLICATIONS FOR NURSING

Nurses need to assess for QOL and depression at the initiation of RT. Knowledge of the different predictors of QOL may be useful in the design of gender-specific interventions to improve QOL.

Effects of social support, hope and resilience on quality of life among Chinese bladder cancer patients: a cross-sectional study

Background

Improvement of quality of life has been one of goals in health care for people living with bladder cancer. Meanwhile, positive psycho-social variables in oncology field have increasingly received attention. However, the assessment of quality of life of bladder cancer patients and the integrative effects of positive psycho-social variables has limited reporting. The aim of this study was to assess quality of life as well as the integrative effects of social support, hope and resilience on quality of life among Chinese bladder cancer patients.

Methods

A cross-sectional study was conducted at the First Hospital of China Medical University in Liaoning Province, China. A total of 365 bladder cancer patients eligible for this study completed questionnaires on demographic variables, FACT-BL, Perceived Social Support Scale, Adult Hope Scale, and Resilience Scale-14 during July 2013 to July 2014.

Results

The average score of FACT-BL was 87.60 ± 16.27 (Mean ± SD). Hierarchical regression analyses indicated that social support, hope and resilience as a whole accounted for 30.3 % variance of quality of life. Under standardized estimate (β) sequence, social support, hope and resilience significantly and positively associated with quality of life, respectively.

Conclusions

Quality of life for bladder cancer patients was at a low level in China, which should receive more attention in Chinese medical institutions. More importantly, efforts to increase social support, hope and resilience might be useful to support the quality of life among Chinese bladder cancer patients.

The Associations of Psychological Stress with Depressive and Anxiety Symptoms among Chinese Bladder and Renal Cancer Patients: The Mediating Role of Resilience

Background

The prevalence of depressive and anxiety symptoms and their associated factors in bladder and renal cancer patients are not well evaluated in China. Given the growing attention to positive psychological constructs in the field of oncology, it is necessary to explore the effects of these constructs on depressive and anxiety symptoms. This study aims to explore the associations of psychological stress with depressive and anxiety symptoms among Chinese bladder and renal cancer patients and the mediating role of resilience in these relationships.

Methods

A cross-sectional study was conducted at the First Affiliated Hospital of China Medical University in Liaoning province. 327 bladder cancer patients and 268 renal cancer patients completed questionnaires on demographic variables, the Center for Epidemiologic Studies Depression Scale, Zung Self-Rating Anxiety Scale, Resilience Scale-14, and Perceived Stress Scale-10 during the period from July 2013 to July 2014. Hierarchical linear regression analyses were performed to explore the mediating role of resilience.

Results

The prevalence of depressive and anxiety symptoms was 78.0% and 71.3% in bladder cancer patients, and 77.6% and 68.3% in renal cancer patients. Psychological stress was positively related to depressive and anxiety symptoms, while resilience was negatively related to these symptoms. Resilience partially mediated the relations of psychological stress with depressive and anxiety symptoms.

Conclusions

The high prevalence of depressive and anxiety symptoms among Chinese bladder and renal cancer patients should receive more attention from medical institutions and government agencies. In addition to reducing depressive and anxiety symptoms, resilience development should be included in depression and anxiety prevention and treatment strategies in China.

Relationship between Resilience, Psychological Distress and Physical Activity in Cancer Patients: A Cross-Sectional Observation Study

OBJECTIVE

Psychological distress remains a major challenge in cancer care. The complexity of psychological symptoms in cancer patients requires multifaceted symptom management tailored to individual patient characteristics and active patient involvement. We assessed the relationship between resilience, psychological distress and physical activity in cancer patients to elucidate potential moderators of the identified relationships.

METHOD

A cross-sectional observational study to assess the prevalence of symptoms and supportive care needs of oncology patients undergoing chemotherapy, radiotherapy or chemo-radiation therapy in a tertiary oncology service. Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), social support was evaluated using the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) and both psychological distress and activity level were measured using corresponding subscales of the Rotterdam Symptom Checklist (RSCL). Socio-demographic and medical data were extracted from patient medical records. Correlation analyses were performed and structural equation modeling was employed to assess the associations between resilience, psychological distress and activity level as well as selected socio-demographic variables.

RESULTS

Data from 343 patients were included in the analysis. Our revised model demonstrated an acceptable fit to the data (χ2(163) = 313.76, p = .000, comparative fit index (CFI) = .942, Tucker-Lewis index (TLI) = .923, root mean square error of approximation (RMSEA) = .053, 90% CI [.044.062]). Resilience was negatively associated with psychological distress (β = -.59), and positively associated with activity level (β = .20). The relationship between resilience and psychological distress was moderated by age (β = -0.33) but not social support (β = .10, p = .12).

CONCLUSION

Cancer patients with higher resilience, particularly older patients, experience lower psychological distress. Patients with higher resilience are physically more active. Evaluating levels of resilience in cancer patients then tailoring targeted interventions to facilitate resilience may help improve the effectiveness of psychological symptom management interventions.

Resilience, ageing, and quality of life in long-term diagnosed HIV-infected patients

Resilience is a predictor of emotional well-being and psychological adjustment in people living with HIV infection. We report the results of a cross-sectional study in which we evaluated resilience and its association with perception of ageing, coping strategies, quality of life, and emotional status in a group of long-term diagnosed HIV-infected patients. The analysis included 151 consecutive participants (57.6% men). Resilience was moderately high to high in 65 (43%) participants, moderately low to moderate in 57 (37.7%), and very low in 29 (19.2%). Univariate and multivariate analyses were performed. Two factors of perception of ageing (good cognitive self-concept and good subjective perception of social relationships), the use of positive reframing as a coping strategy and better emotional status remained associated with high resilience. Our findings suggest that successful ageing is possible in people living with HIV infection. Resilience seems to play a key role in the ageing process.

A Comparative Study on Resilience, Perceived Social Support and Hopelessness Among Cancer Patients Treated with Curative and Palliative Care

AIM

Psychological distress is common among patients affected by cancer. In this study, we examined the relationship between resilience, social support, and hopelessness among cancer patients treated with curative and palliative care.

PATIENTS AND METHODS

Sixty cancer patients in the age range of 18-65 years were randomly selected and divided into two groups based on their treatment intent namely, curative care (n = 30) and palliative care (n = 30). Both groups were assessed by the following instruments: Bharathiar University Resilience Scale, Multidimensional Scale of Perceived Social Support and Beck Hopelessness Scale.

RESULTS

Resilience was significantly associated with less hopelessness and higher levels of perceived social support.

CONCLUSION

Cancer patients are found to be resilient, and the role of social support and hopelessness on promoting resilience cannot be ignored.

Resilience in schizophrenia: A comparative study between a remote island and an urban area in Japan

The resilience levels between patients with schizophrenia residing in a rural island and a metropolitan area in Tokyo, Japan, was compared and the factors associated with resilience were explored. The Resilience Scale (RS) and EuroQol were assessed, together with biological markers and multiple demographic variables. No significant difference was found in the RS scores between the two groups (40 subjects each). However, longer duration of illness and higher EuroQol score were significantly associated with a greater RS score, which indicates that potentially successful adaptation and subjective perspectives appear more pertinent than the degree of urbanicity in determining resilience levels.

Resilience in adult cancer care: an integrative literature review

PROBLEM IDENTIFICATION

In cancer care, empirical research and theory development on resilience has primarily been the domain of pediatric settings. This article aims to (a) describe current scientific perspectives on the concept of resilience, (b) summarize quantitative research on resilience in adult cancer care, and (c) identify implications for cancer nursing.

LITERATURE SEARCH

An integrative literature review using PubMed, CINAHL®, and PsycINFO databases was performed and full-text, peer-reviewed articles published since 2003 were included.

DATA EVALUATION

To summarize quantitative research, 252 articles were retrieved yielding 29 eligible studies, of which 11 articles were evaluated and synthesized. Appropriate articles were reviewed and data were extracted and tabulated for synthesis.

SYNTHESIS

Resilience is a dynamic process of facing adversity related to a cancer experience. It may be facilitated through nursing interventions after people affected by cancer have been confronted with the significant adversity posed by diagnosis, treatment, (long-term) symptoms, and distress.

CONCLUSIONS

Resilience in adult cancer care is an under-researched area. Studies confirm the association with improved health outcomes (e.g., psychological well-being, mental and physical health).

IMPLICATIONS FOR RESEARCH

Resilience is an important issue for adult cancer care. Researchers must carefully define a conceptual framework for developing nursing interventions aimed at furthering resilience in adult cancer care.