Resilience in women with breast cancer: A systematic review

Journey towards resiliency: A systematic review and meta-synthesis of cancer patients' experiences

PURPOSE

This systematic review and meta-synthesis seeks to explore cancer patients' journey towards resiliency. The secondary aim of this review is to identify unique resilience protective factors among cancer patients.

METHODS

A thorough search was conducted in eight electronic databases and the grey literature for published or unpublished qualitative and mixed methods studies. Studies that explored resilience among cancer patients were included. The studies were appraised using the Critical Appraisal Skill Programme Checklist. The overall certainty of evidence was further evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation's Confidence in Evidence from Reviews of Qualitative Research. Themes identified were synthesized using Sandelowski and Barroso's meta-synthesis method.

RESULTS

A total of 34 studies comprising 987 cancer patients were included in this review. Three themes and nine subthemes were generated from the meta-synthesis. The themes were: (1) Confronting the cancer diagnosis, (2) personal adaptations to cancer, and (3) drawing strength from others. The findings highlighted how individuals overcame cancer adversities through resilience, which is influenced by various factors, including life experiences, social-cultural stigmas, spirituality, social support networks, coping strategies, motivation, acceptance of illness, positive mindset, and engagement with healthcare facilities.

CONCLUSIONS

This review highlights the role of resilience in a cancer patient's journey. It emphasizes on the importance of building resilience in both cancer patients and survivors to effectively overcome the challenges of their cancer diagnosis. These insights are essential for developing interventions that promote resilience and improve existing psychosocial oncology services. Future research should focus on longitudinal studies to better understand how resilience evolves and pinpoint factors that can further influence one's resilience.

A randomized controlled trial of the effectiveness of a one-to-one peer support intervention on resilience, social support, and salivary cortisol in recently diagnosed women with breast cancer

PURPOSE

Peer support has been suggested as a way to help women diagnosed with breast cancer to better cope with their situation, but studies on its effectiveness have conflicting results. This randomized controlled trial aimed to study the effectiveness of a one-to-one peer support intervention on psychological resilience, social support, and salivary cortisol among breast cancer patients.

METHODS

The sample consisted of 121 newly diagnosed women at Onkologikoa Hospital. Patients who were prescribed chemotherapy were randomly assigned to Intervention Group 1 (IG1) or Control Group 1 (CG1). Similarly, those prescribed adjuvant radiotherapy were assigned to IG2 or CG2. Women in IG1 received 8 biweekly social support sessions from volunteer survivors who had successfully overcome breast cancer, while IG2 received 6 biweekly sessions. CG1 and CG2 only received standard care. Resilience, social support, and salivary cortisol were assessed at baseline (T1) and at the end of the intervention (T2).

RESULTS

We found a non-significant, yet a small to moderate size increase in resilience from T1 to T2 in IG1 (p = 0.246; dDc = 0.47). Upon regression analysis, we observed that this increase was determined by changes in cortisol (β = -0.658, p = 00.010), affective support (β = -0.997, p = 00.014), and emotional support (β = 0.935, p = 00.008). We also found a significant decrease in resilience levels in CG2 from T1 to T2 (p = 0.003; dDc = 0.88).

CONCLUSION

The present study suggests that peer support can exert a protective psychological influence on women diagnosed with breast cancer, and further indicates an exciting avenue for future intervention development in the breast cancer care continuum.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05077371.

Resilience in the Face of Cancer: On the Importance of Defining and Studying Resilience as a Dynamic Process of Adaptation

Resilience is defined as the maintenance or relatively quick recovery of mental health during and after adversity. Rather than focusing on psychopathology and its causes, resilience research aims to understand what protective mechanisms shield individuals against developing such disorders and translate these insights to improve psychosocial care. This resilience approach seems especially promising for the field of oncology because patients face stressor after stressor from diagnosis to survivorship. Helping patients to learn how they can best use the resources and abilities available to them can empower patients to handle subsequent stressors. In the past few decades, resilience has increasingly been considered as a dynamic process of adaptation. While researchers use this definition, resilience has not yet been studied as a dynamic process in the field of oncology. As a result, the potential of resilience research to gain insight into what helps protect cancer patients from developing psychopathology is limited. We discuss conceptual and methodological proposals to advance resilience research in oncology. Most importantly, we propose applying prospective longitudinal designs to capture the dynamic resilience process. By gaining insight in how cancer patients engage in protective factors, resilience research can come to its full potential and help prevent psychopathology.

Quality of life in women with early-stage and metastatic hormone receptor-positive, HER2-negative breast cancer receiving endocrine therapy

INTRODUCTION

Early discontinuation of endocrine therapy (ET) is higher among patients with early breast cancer (EBC) compared to patients with metastatic hormone receptor-positive (HR+) breast cancer (MBC). In our clinical experience the reasons for this may include a significant burden of ET side effects impacting quality of life (QOL) in patients with EBC.  We hypothesized that QOL is lower in patients with HR + EBC compared to patients with HR + MBC on ET.

METHODS

We conducted a cross-sectional observational study to assess QOL utilizing FACT-ES & EORTC QLQ C30 tools among patients with EBC and MBC receiving ET across 5 Irish hospitals.

RESULTS

A total of 417 patients were enrolled-EBC (79% n = 331) and MBC 21% (n = 86). Using the FACT-ES, we found no difference in overall QOL by stage (139.2 vs 141, P  = .33). Patients with HR + MBC had a lower symptom burden from ET compared to HR + EBC (61.4 vs 54, P < .01). In adjusted multivariate linear regression models, there was no difference in QOL for patients with EBC and MBC receiving ET.

CONCLUSIONS

There was no significant difference in overall QOL for patients with EBC and MBC. However, patients with EBC experienced more endocrine symptoms. In adjusted multivariate linear regression models, the stage did not predict QOL. Our results suggest that endocrine symptoms are significant contributors to impaired QOL for patients with EBC but the role of other determinants of QOL (eg, stage) is less clear. Future work could include the development of stage-specific QOL tools and utilization of electronic patient-reported outcomes (ePROs) to identify and manage emergent toxicities.

Structural Equation Model of Factors Related to Death Anxiety for Chinese Patients with Cancer

This study aimed to develop a model that specifies the predictive effects of factors on death anxiety among Chinese patients with cancer using structural equation modeling. Using convenience sampling, data were collected from 353 cancer patients. Self-administered questionnaires included Social Support Rating Scale, Rosenberg Self-Esteem Scale, Connor Davidson Resilience Scale, Templer's Death Anxiety Scale, and socio-demographic factors. The results showed that social support, self-esteem, and resilience significantly impacted death anxiety. The final model fitted the data acceptably (χ2 = 37.319, df =31, p = 0.201). Social support mediated death anxiety through self-esteem and resilience. Resilience mediated the buffer effect of self-esteem on death anxiety as an intermediary factor. Findings suggest the need for further studies to explore effective interventions to provide social support and improve self-esteem and resilience among patients with cancer to alleviate death anxiety.

The Impact of Newly Diagnosed Early Breast Cancer on Psychological Resilience, Distress Levels, and the Perception of Health

Confronting a breast cancer diagnosis, along with complex and challenging treatment procedures, is an extremely stressful experience. Psychological resilience is the ability to maintain or restore normal functioning while facing adversity. We aimed to explore the impact of an early breast cancer diagnosis on psychological resilience, distress, and perception of health. A cross-sectional study was conducted, including 50 patients newly diagnosed with early breast cancer and 67 healthy women with screening mammograms graded 1 or 2 using a Breast Imaging Reporting and Data System. The levels of distress, perception of health, and psychological resilience were assessed using the depression, anxiety, and stress scale, the SF 36-Item Health Survey 1.0, and the Connor-Davidson RISC-25 scale. Differences between variables were examined using the t-test and chi-square test for interval and categorial variables. The surveys were conducted within four weeks of a breast cancer diagnosis. Patients with breast cancer reported a deterioration of their health relative to the previous year and significantly higher levels of psychological resilience, while there was no significant difference between the groups in levels of stress, anxiety, or depression. The process of diagnosis with early breast cancer may activate psychological dynamic processes which are involved in the effective adaptation to acute stress, leading to higher resilience levels in breast cancer patients compared to healthy controls.

Perceived social support improves health-related quality of life in cochlear implant patients

PURPOSE

Perceived social support has been shown to positively correlate with health-related quality of life (HR-QoL) in a variety of conditions. This study investigated whether perceived social support is affecting HR-QoL of patients who receive a cochlear implant (CI) for deafness.

METHODS

Eighty eight adults (56 males, 32 females; mean age: 60 years) with a uni- or bilateral CI for bilateral high-grade hearing loss were administered two questionnaires: a questionnaire for perceived social support (FSU-14) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) for hearing-specific HR-QoL. Administration of the questionnaires occurred at four points in time: before implantation and three, 12 and 24 months after implant activation.

RESULTS

The CI patients had quite high levels of perceived social support (mean percentile rank: 71), which remained stable at all four measurement points. Multivariate Analysis showed a significant interaction between perceived social support and HR-QoL indicating that higher perceived social support lead to higher improvement of HR-QoL after cochlear implantation.

CONCLUSION

The CI patients in this study had higher than average levels of perceived social support, which did not change before and after cochlear implantation. Perceived social support and HR-QoL were related such that patients with high levels of perceived social support experienced greater improvement of their HR-QoL after cochlear implantation than patients with low levels of perceived social support. Based on this finding, perceived social support must be considered as an important factor for HR-QoL after cochlear implantation.

Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study

PURPOSE

There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy.

METHODS

Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants.

RESULTS

Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities.

CONCLUSION

The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.

Resilience and its related factors among women with breast cancer

OBJECTIVES

Breast cancer is the most challenging disease, and the level of resilience in patients determines their ability to cope with the arising stress. There is relatively limited information on the resilience of patients in clinical settings. Our study aims were to evaluate the extent of resilience and identify factors that predict resilience in women with breast cancer.

PATIENTS AND METHODS

A cross-sectional study was conducted with the participation of 218 women with breast cancer who were referred to the Oncology clinic in 2022. The participants completed three scales, namely the Conner-Davidson Resilience, Schneider's Life Expectancy, and the Multidimensional Scale of Perceived Social Support, along with sociodemographic information. Descriptive statistics, bivariate, and multiple linear regression were used to explore the predictors of resilience.

RESULT

The mean (SD) scores for resilience, social support, and hope were 59.22 (17.25), 38.53 (6.19), and 59.37 (16.68), respectively. Based on analysis 50.8% of the variations in resilience could be explained by 6 variables including social support, hope, women's age, employment, and income status as well as the stage of illness (R 2adj = 0.508, P < 0.001). Employment status and disease stage did not show a significant relationship with resilience and social support was the factor with the highest impact on resilience (β = 0.516, P < 0.001).

CONCLUSION

Our study showed social support, hope, age, and income level predict significant resilience in women with breast cancer. The findings emphasize the importance of fostering strong support networks, cultivating a hopeful mindset, embracing life's transitions, and addressing financial considerations in the pursuit of enhanced resilience.

Effects of interventions for enhancing resilience in cancer patients: A systematic review and network meta-analysis

BACKGROUND

Various interventions appear to enhance cancer patients' resilience. However, the best intervention options are still unknown. This systematic review and network meta-analysis aimed to examine the impact of different interventions on resilience and identify the most effective interventions.

METHODS

Nine major English and Chinese databases were systematically retrieved for randomized controlled trials (RCTs) published from inception to 13 November 2023. The outcome was resilience. The analysis was conducted using Software Review Manager 5.4, R 4.2.3, and STATA 14.0.

RESULTS

The network meta-analysis included 32 RCTs and evaluated 12 interventions. Regarding effectiveness, compared to routine care, the relative effect sizes of attention and interpretation therapy, cyclic adjustment training, cognitive intervention, expressive therapy, positive psychological intervention, social support intervention, and work-environment therapy had statistically significant enhancing resilience, with the SMD (95%CI) of 1.42 (0.75, 2.07), 1.97 (0.76, 3.18), 1.26 (0.76, 1.77), 0.93 (0.08, 1.78), 1.02 (0.55, 1.50), 1.01 (0.48, 1.56), 1.65 (0.94, 2.37), respectively. Considering the rank probability, statistical power, and efficacy, the most effective interventions for improving resilience were attention and interpretation therapy, cognitive intervention, and positive psychological intervention. With the limited quantity of RCTs, the effectiveness of cyclic adjustment training and work-environment therapy still needs to be explored.

CONCLUSIONS

Attention and interpretation therapy was the first best choice for boosting resilience out of the 12 interventions. Cognitive intervention and positive psychological intervention were also better choices for improving cancer patients' resilience. Due to the low quality and quantity of included RCTs, the need for multi-center, higher-quality trials with larger samples should be carried out.

PROSPERO ID

CRD42023434223. The study did not receive funding support.

Symptoms of Anxiety and Depression Among Slovenian Breast Cancer Survivors Post-Treatment During the COVID-19 Pandemic: A Cross-Sectional Study

Background

Although anxiety and depression are important determinants of mental health, the literature in this area is sparse as most studies focus on the period during treatment. Mental health problems can affect cancer recovery as well as quality of life and survival. In this cross-sectional study, we investigated the prevalence of anxiety and depression in Slovenian cancer survivors after treatment and assessed the associated correlates during the COVID-19 pandemic.

Methods

From September 2021 to January 2022, we collected data from 430 breast cancer survivors one to five years after receiving post-local treatment and (neo)adjuvant chemotherapy. We used the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression levels. Multivariate linear regression was used to identify factors associated with higher levels of anxiety and depression.

Results

Key findings from this study are increased levels of psychological distress and identification of relevant factors associated with those elevated levels. Approximately one-third of breast cancer survivors exhibited symptoms of elevated anxiety and depression, with one in eight meeting clinical thresholds. Multivariate linear regression revealed that age, lower quality of life, heightened fear of cancer recurrence (FCR), reduced resilience, limited social support, and unmet psychosocial and emotional needs correlated with increased anxiety symptoms. Additionally, lower quality of life, higher FCR, diminished resilience, and limited social support were associated with higher depression symptomatology.

Conclusions

Our study of Slovenian breast cancer survivors one to five years post-treatment observed a significant increase in anxiety and depression symptoms, possibly exacerbated by the COVID-19 pandemic. The demographic and psychosocial factors identified in this study offer valuable insights for future research. The study emphasises the importance of recognising and addressing the psychological needs of breast cancer survivors and the need to follow them throughout their cancer journey.

Factors influencing resilience among breast cancer survivors: Implications for evidence-based practice

BACKGROUND

Breast cancer survivors are increasing in South Korea, and resilience has become very important in their life.

AIMS

This study aimed to examine the relationships among anxiety, depression, family support, problem-focused coping, emotion-focused coping, self-efficacy, and resilience, and the factors influencing the resilience of breast cancer survivors.

METHODS

A cross-sectional descriptive design was employed. Participants were 153 breast cancer survivors after completion of treatment who were 5 years or less after diagnosis in South Korea. Measures were the general characteristics list, Korean version of Connor-Davidson Resilience Scale, Korean version of Hospital Anxiety and Depression Scale, family support scale, Korean version of Ways of Coping Checklist, and Self-Efficacy Scale.

RESULTS

The strongest predictor that influenced resilience was depression (β = -0.32), followed by family support (β = 0.23) and problem-focused coping (β = 0.15). Resilience levels in breast cancer survivors after completion of treatment were relatively low.

LINKING EVIDENCE TO ACTION

Interventions using problem-focused coping, including family members, could increase resilience, thus, moving away from focusing solely on the perspectives of cancer survivors when developing and implementing support interventions. Nurses should pay attention to influencing factors to help improve the resilience of breast cancer survivors during the extended survivorship phase.

Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients' experience of resilience during the COVID-19 treatment in single-room isolation wards.

METHODS

This study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semistructured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor-Davidson resilience scale were administered to patients (N = 153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N = 13) belonging to the high-resilience group.

RESULTS

Resilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into: (1) facing the reality of being isolated in a room; (2) struggling to accept and adapt to isolation; and (3) seeking connections in isolation.

CONCLUSIONS

This research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

Associations between Psychological Resilience and Social Support with Posttraumatic Growth in Breast Cancer Patients: A Cross-Sectional Study

This cross-sectional study examined the associations of psychological resilience, perceived social support, and posttraumatic growth (PTG) in breast cancer (BC) patients (N = 203). The participants' mean age was 43.14 ± 9.06, 80.3% were married, 40.9% had a university degree, 61.6% were unemployed, and 72.4% reported a moderate economic status. No significant correlation was found between PTG and psychological resilience, while a moderate and positive correlation was observed between PTG and perceived social support. A weak and positive correlation was also detected between perceived social support and psychological resilience.    Professionals working in the field of psycho-oncology and social work can make attempts to increase psychological resilience, perceived social support, and PTG in BC patients.

Resilience in Newly Diagnosed Breast Cancer Women: The Predictive Role of Diurnal Cortisol and Social Support

BACKGROUND

Breast cancer is currently the most prevalent malignancy among women. Psychological resilience is an important factor that diminishes the stress-related emotional and psychosocial disturbances triggered when receiving the diagnosis. Furthermore, resilience appears to be associated with cortisol, the hormonal end-product of the hypothalamic-pituitary-adrenal axis; however, further studies are needed due to the mixed results reported. Thus, we aim to examine the predictive role of social support and cortisol in resilience among breast cancer patients.

METHODS

A total of 132 women with primary breast cancer completed the Medical Outcomes Study-Social Support Survey (MOS-SSS) and the Resilience Scale (RS-14) and provided four salivary samples for the estimation of participants' total daily cortisol production, for which the formula of the area under the curve with respect to the ground (AUCg) was applied. Moderation analyses were performed to study the influence of social support and AUCg on psychological resilience levels.

RESULTS

The regression analyses showed a direct significant effect for the emotional support subscale of MOS-SSS on resilience and the interaction between emotional support and AUCg was also found to be statistically significant. Specifically, the conditional effect of emotional support on resilience was found to be significant at middle (M = 3.08; p < .05) and low levels (M = .59; p < .001) of AUCg.

CONCLUSIONS

Our results suggest that newly diagnosed breast cancer women with middle and low diurnal cortisol profiles may benefit more from emotional support based-interventions while women with high diurnal cortisol may need more individualized therapies.

Effectiveness of resilience interventions among cancer patients - A systematic review, meta-analysis, and meta-regression of randomised controlled trials

PURPOSE

This systematic review, meta-analysis and meta-regression aimed to (1) evaluate the effects of resilience interventions on cancer patients' resilience and posttraumatic growth and (2) identify essential contents and features of resilience interventions.

METHODS

A systematic review, meta-analysis, and meta-regression analyses were conducted. Published and unpublished randomised controlled trials evaluating the effects of resilience interventions among cancer patients were retrieved from nine databases, trial registries, and grey literature. The mean and standard deviation scores were used to compute the effect sizes.

RESULTS

23 randomised controlled trials comprising 3287 cancer patients were included. The random effects model found that resilience interventions had beneficial impacts on patients' resilience, posttraumatic growth, quality of life, anxiety, and depressive symptoms with moderate to large effects. The subgroup analyses concluded that theoretically guided interventions that adopted synchronous communication delivered physically had greater effect sizes. Interventions comprising skills that promote patients' cognitive flexibility, self-efficacy, self-esteem, self-regulation, and coping had greater effect in comparison with interventions lacking these components. The meta-regression analyses revealed that sample size has a significant effect on posttraumatic growth scores. More well-designed trials are needed to confirm the effects of resilience interventions.

CONCLUSIONS

There is merit in utilizing resilience interventions to improve cancer patients' resilience and psychological well-being. Resilience interventions should be incorporated into the routine care for cancer patients and survivors.

Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review

Background

Breast cancer is the most prominent cancer type to affect women. Surgical treatment of invasive breast cancers involves mastectomy. Due to mastectomy, women are subjected to social, emotional, and cultural problems which need to be addressed.

Objective

The objective of the study is to understand how women cope with body image-related issues, trauma, anxiety, and depression post-mastectomy.

Design

A systematic literature review was conducted for understanding the coping in post-mastectomy patients. The methods for identifying the studies were based on Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines.

Databases

Medline/PubMed, PsycInfo, and Cochrane databases were used for searching relevant articles. A final of 19 studies were analyzed for the work.

Methods

Search strings such as "coping strategies and post mastectomy," "body image coping and post mastectomy" and "anxiety coping and post mastectomy" were used for identification of references from databases. Eligibility criteria were used for finalizing the references.

Results

Analysis of the 19 studies has clearly shown that women who undergo mastectomy suffer from anxiety, stress, and trauma. This study has observed that women have problems with their body image post-mastectomy along with bouts of depression. Self-coping has been observed in relatively few studies. Psychological interventions before surgery have been observed to be a better coping strategy. In most of the studies, women opted for breast reconstruction to overcome the trauma associated with mastectomy.

Conclusion

Mastectomy has a severe impact on women's appearance and psychology. Breast reconstruction and acceptance have played an important role in coping among these women. However, breast reconstruction is not accepted by many women due to a multitude of factors. Thus, it is essential to have proper intervention programs in place to ensure women can cope with this situation and can lead healthy lives.

Registration

Systematic literature review (SLR) is submitted to PROSPERO. The application confirmation number is 449135.Registration awaited from the database.

Effects of Social Support, Family Resilience, and Individual Resilience on Fear of Cancer Recurrence Among Persons With Breast Cancer: A Cross-Sectional Study

BACKGROUND

There is limited research exploring the psychological and social predictors of fear of cancer recurrence (FCR).

OBJECTIVE

This study tested the effects of social support, family resilience, and individual resilience on FCR among persons with breast cancer.

METHODS

A convenience sampling method was used to select 214 participants from March to August 2021 in 1 tertiary hospital in Jinan, China. Data were collected using self-administered questionnaires. Path analysis was adopted to explore the effects of social support, family resilience, and individual resilience on FCR.

RESULTS

Findings showed that 94.6% of the participants reached a clinical level of FCR. Social support (β = -.75, p < .01) and individual resilience (β = -.32, p < .01) negatively and directly impacted FCR. Family resilience indirectly impacted FCR through individual resilience (β = -.22, 95% confidence interval (CI): -.34 to -.08). Social support indirectly impacted FCR through family resilience and individual resilience (β = -.15, 95% CI: -.23 to -.06).

CONCLUSIONS

Persons with breast cancer experienced a high level of FCR. Individual resilience was a mediator between family resilience and FCR. Resilience (individual resilience and family resilience) partially mediated the effects of social support on FCR. The findings indicate that measures focused on improving individual resilience, family resilience, and social support should be considered by nurses, which are helpful for easing FCR.

Examining the Role of Resilience, Posttraumatic Growth, and Quality of Life in Women with Breast Cancer: A Serial Multiple Mediator Model Approach

OBJECTIVES

It is unclear how resilience and posttraumatic growth help women with breast cancer face cancer-related symptom distress. This study included both resilience and posttraumatic growth as mediators in a serial multiple mediator model to examine changes in the relationship between symptom distress and quality of life among women with breast cancer.

DATA SOURCES

We conducted the descriptive, cross-sectional study in Taiwan. Data were collected using a survey that assessed symptom distress, resilience, posttraumatic growth, and quality of life. A serial multiple mediator model examined one direct and three specific indirect effects of symptom distress on quality of life through resilience and posttraumatic growth. All 91 participants reported the presence of symptom distress and moderate levels of resilience. Quality of life was significantly associated with symptom distress (b = -1.04), resilience (b = 0.18), and posttraumatic growth (b = 0.09). The indirect effect of symptom distress on quality of life through resilience alone was statistically significant (b = -0.23, 95% CI -0.44 to -0.07) and statistically greater than the specific indirect effect through resilience and posttraumatic growth combined (b = -0.21, 95% CI -0.40 to -0.05).

CONCLUSION

Resilience plays a unique role in reducing the impact of symptom distress on the quality of life among women with breast cancer.

IMPLICATIONS FOR NURSING PRACTICE

Given the importance of resilience to quality of life, oncology nurses can assess the resilience of women with breast cancer and help identify available internal, external, and existential resources to strengthen their resilience.

Personalized Risk Analysis to Improve the Psychological Resilience of Women Undergoing Treatment for Breast Cancer: Development of a Machine Learning-Driven Clinical Decision Support Tool

BACKGROUND

Health professionals are often faced with the need to identify women at risk of manifesting poor psychological resilience following the diagnosis and treatment of breast cancer. Machine learning algorithms are increasingly used to support clinical decision support (CDS) tools in helping health professionals identify women who are at risk of adverse well-being outcomes and plan customized psychological interventions for women at risk. Clinical flexibility, cross-validated performance accuracy, and model explainability permitting person-specific identification of risk factors are highly desirable features of such tools.

OBJECTIVE

This study aimed to develop and cross-validate machine learning models designed to identify breast cancer survivors at risk of poor overall mental health and global quality of life and identify potential targets of personalized psychological interventions according to an extensive set of clinical recommendations.

METHODS

A set of 12 alternative models was developed to improve the clinical flexibility of the CDS tool. All models were validated using longitudinal data from a prospective, multicenter clinical pilot at 5 major oncology centers in 4 countries (Italy, Finland, Israel, and Portugal; the Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back [BOUNCE] project). A total of 706 patients with highly treatable breast cancer were enrolled shortly after diagnosis and before the onset of oncological treatments and were followed up for 18 months. An extensive set of demographic, lifestyle, clinical, psychological, and biological variables measured within 3 months after enrollment served as predictors. Rigorous feature selection isolated key psychological resilience outcomes that could be incorporated into future clinical practice.

RESULTS

Balanced random forest classifiers were successful at predicting well-being outcomes, with accuracies ranging between 78% and 82% (for 12-month end points after diagnosis) and between 74% and 83% (for 18-month end points after diagnosis). Explainability and interpretability analyses built on the best-performing models were used to identify potentially modifiable psychological and lifestyle characteristics that, if addressed systematically in the context of personalized psychological interventions, would be most likely to promote resilience for a given patient.

CONCLUSIONS

Our results highlight the clinical utility of the BOUNCE modeling approach by focusing on resilience predictors that can be readily available to practicing clinicians at major oncology centers. The BOUNCE CDS tool paves the way for personalized risk assessment methods to identify patients at high risk of adverse well-being outcomes and direct valuable resources toward those most in need of specialized psychological interventions.

Decision Tree Analyses for Prediction of QoL over a One-Year Period in Breast Cancer Patients: An Added Value of Patient-Reported Outcomes

Despite the current shift in medicine towards patient-centered care, clinicians rarely utilize patient-reported outcomes (PROs) in everyday practice. We examined the predictors of quality- of-life (QoL) trajectories in breast cancer (BC) patients during the first year after primary treatment. A total of 185 BC patients referred for postoperative radiotherapy (RT) filled in the EORTC QLQ-C30 Questionnaire assessing global QoL, functioning and cancer-related symptoms before starting RT; directly after RT; and 3, 6 and 12 months after RT. We used decision tree analyses to examine which baseline factors best allowed for predicting the one-year trajectory of the global QoL after BC treatment. We tested two models: 'basic', including medical and sociodemographic characteristics, and 'enriched', additionally including PROs. We recognized three distinct trajectories of global QoL: 'high', 'U-shape' and 'low'. Of the two compared models, the 'enriched' model allowed for a more accurate prediction of a given QoL trajectory, with all indicators of model validation being better. In this model, baseline global QoL and functioning measures were the key discriminators of QoL trajectory. Taking PROs into account increases the accuracy of the prediction model. Collecting this information in the clinical interview is recommended, especially for patients with lower QoL.

Latency of breast cancer stigma during survivorship and its influencing factors: A qualitative study

Introduction

Breast cancer diagnosis and treatment have been shown in studies to have a negative impact on patients’ physical, psychological, and social well-being, as well as overall quality of life. Psychologically, it’s linked to sadness, anxiety, and demoralisation. Stigma contributes to the hidden burden of breast cancer as a chronic illness. Research on the elements that breast cancer survivors encounter as influences on stigma associated to the disease is lacking. Based on the lived experiences of breast cancer survivors, this study sought to investigate the factors that lead to the manifestations of both self- and public breast cancer stigma.

Methods

Individual semi-structured interviews with 24 patients diagnosed with breast cancer were performed, followed by five focus groups with 25 patients diagnosed with breast cancer. Interviews were verbatim transcribed and analysed using thematic framework analysis.

Results

Two major themes have emerged from the data: a) Breast cancer stigma among breast cancer survivors, highlighting the various manifestations of stigma and the variables that influence them; including disease-related factors, patients’ views of cancer, public perceptions of breast cancer, family and interpersonal dynamics, and b) Stigma resilience and empowerment, emphasising the necessity of sociocultural transformation and coping strategies to preserve resilience.

Conclusions

To improve the well-being of breast cancer survivors, practitioners and health policymakers should be aware of the breast cancer stigma that underpins patients’ emotional and behavioural outlooks and its potential consequences on patients’ quality of life. They need to develop interventions to address the different stages of cancer stigma taking into consideration sociocultural influences, norms, and beliefs.

Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image

PURPOSE

This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship.

METHODS

We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure.

RESULTS

SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62).

CONCLUSIONS

Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.

Associations among resilience, hope, social support, stress, and anxiety severity in Chinese women with abnormal cervical cancer screening results

This study was to explore the resilience level and its potential correlates and further to evaluate the influence of these resilience-centred variables on anxiety severity among Chinese women with abnormal cervical cancer screening results. One hundred and seventy-five subjects completed self-administered questionnaires to collect relevant variables. The level of resilience of our sample is moderate (70.57 ± 12.14). The data identified hope (β = 0.218), social support (β = 0.247) and perceived stress (β = -0.320) as independent associates for resilience. Finally, among variables, only perceived stress is found to have a direct and positive influence on anxiety severity. Interventions on these variables can be effective for resilience promotion in this population. In addition, anxiety should be preferentially intervened in through the alleviation of perceived stress.

Cognitive function is well preserved in a cohort of breast cancer survivors: Roles of cognitive reserve, resilience, and general health

Many patients return to cognitively demanding work after breast cancer treatments. This makes treatment-related cognitive decline an important research topic. Psychological resilience, cognitive reserve and better perceived general health may work as protective factors against cognitive decline. The aim of this study was to analyse whether these factors are associated with cognitive function among such women.

Data from 384 breast cancer survivors who underwent neuropsychological examination at follow-up 4–9 years after surgery were used. The neurocognitive domain variable Learning and Memory was computed from Wechsler Memory Scale-III subtests Learning and Delayed Recall. Another variable, Attention, Processing speed and Executive function, was computed from semantic and verbal fluency tests, Trail Making Test A and B, and Wechsler Adult Intelligence Test-IV subtest Coding. Psychological resilience was measured with Resilience Scale-14, and perceived general health with RAND-36 subitem General Health.

Results

showed that levels of cognitive performance and general health were statistically higher than population average. Resilience and general health in separate models were associated with Attention, Processing speed and Executive function (β = 0.14, p = 0.01; β = 0.13, p = 0.03, respectively). When added simultaneously in the same model, resilience was significant (β = 0.13, p = 0.04), but general health was not. These associations were nonsignificant after controlling for confounding factors. Learning and Memory was not associated with resilience or general health.

Future research should focus on longitudinal studies identifying patients at a high risk of developing cognitive decline after breast cancer treatments and on preventive and therapeutic approaches.

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401 women were neuropsychologically examined 4–9 years after breast cancer surgery.

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Their cognitive performance was on average well preserved.

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Psychological Resilience associated with better cognitive performance in one domain.

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The association between General Health and cognition was less prominent.

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High education level might protect against cognitive decline after breast cancer.

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

BACKGROUND

Postmastectomy pain syndrome (PMPS) is a common postoperative condition after breast cancer surgery.

PURPOSE

The aim of this study was to investigate the incidence rate and risk factors of PMPS, and to propose prevention and treatment methods.

METHODS

The study included 1790 postoperative breast cancer patients from three hospitals from 2017 to 2021, of which 302 (13.0%) patients with PMPS were included in the study.

RESULTS

Age, breast surgery type, axillary surgery type and radiotherapy are the risk factors of PMPS. Age, radiotherapy and chemotherapy affect the pain degree of PMPS during movement.

CONCLUSIONS

For breast cancer patients with high risk factors, pain should be actively prevented during perioperative period. Oral pharmacological agents, multidisciplinary combination therapy, local anesthetics and regional anesthesia are the most common treatment of PMPS.

Development, usability and quality evaluation of the resilient mobile application for women with breast cancer

Introduction

Mental health problems as a consequence of cancer lower the quality of life of cancer patients. Despite increasing studies of breast cancer‐focused mobile health applications (m‐Health apps), there is less research on breast cancer patients' quality of life or well‐being. The purpose of this study is to develop and evaluate the usability and quality of an educational m‐Health app aimed at improving the resilience of breast cancer in women.

Methods

This study was conducted in four phases. It included extracting the requirements of the app through the nominal group technique. Based on these results, an m‐Health app was developed and evaluated in terms of usability and quality by two scales, System Usability Scale and Mobile App Rating Scale questionnaires, respectively. Finally, the role of patients' age and educational backgrounds in the use of the app was assessed. The relationship between learnability and usability of the app was measured by the T‐Test.

Results

The app was developed with three user interfaces. Its usability developed from the patient's point of view scored a remarkable score of 83.20 with a 95% confidence interval. This value was too indicative of high satisfaction with the usefulness and the possibility of recommending it to other cancer survivors. The results of the quality evaluation from an expert's point of view showed that this app had good functionality. Evaluation of the role of demographic information in the use of the app showed that it can be used for all age groups with different levels of education. The app did not differ significantly between learnability and usability.

Conclusion

The development of m‐Health apps, based on usability principles that are suitable for all age groups with different levels of education, is welcomed by cancer patients.

Post-Traumatic Growth in Women with Breast Cancer: Intensity and Predictors

Experiencing a traumatic situation such as breast cancer can, beside negative consequences, have a positive impact, described as post-traumatic growth (PTG). A factor that facilitates psychological recovery when coping with stressful events is psychological resilience. The aim of the present study was to assess whether PTG occurs in a group of women with breast cancer and whether resilience is a personal trait contributing to its occurrence. The study group comprised 100 women with breast cancer, aged 31-80 years, almost half of whom were aged 61-70 years (n = 46, 46%). The Post-Traumatic Growth Inventory, the Impact of Event Scale, and the Resilience Assessment Questionnaire (KOP) were used for the study. All women manifested PTG, with a mean intensity of 76.61 ± 13.45 points. The greatest changes were observed in the subjects' appreciation of life, and the smallest in their relations with others, self-perception, and spiritual changes. The KOP scale measured a mean resilience of 103.80 ± 16.57. The results obtained confirm the co-occurrence of psychological resilience and PTG, especially personal resilience and social competences. Additionally, women subjected to additional traumatic events other than cancer manifested a higher level of PTG.

General Health and Resilience of Breast Cancer Patients: The Mediator Role of Affective Well-Being

A considerable percentage of breast cancer patients present adequate psychological adjustment and do not become distressed after a breast cancer diagnosis, or, if they do, they manage to recover quickly, which is reflected in their general health. This study aims to determine the role of some psychological mechanisms that affect psycho-oncological adjustment, specifically, resilience and well-being, in a sample of 109 breast cancer patients. For this purpose, participants completed questionnaires on general health, resilience, and well-being (life satisfaction and affect). Correlation analyses and a multiple mediation model were carried out. The results revealed that Pearson correlations between all variables showed strong associations between general health scores and positive and negative affect scores, and moderate associations with life satisfaction and resilience scores. Furthermore; in the mediation model, the total percentage of variance explained by the overall model was 55% (R² = 0.55), where resilience was associated with positive and negative affect, and that influenced general health. These results show that affective well-being is especially relevant in breast cancer patients in terms of its mediating role in resilience, making it clear that an appropriate intervention focused on managing patients' affective status can have a favorable impact on their overall health.

Allostatic Load as an Insight into the Psychological Burden after Primary Treatment in Women with Breast Cancer: Influence of Physical Side Effects and Pain Perception

Breast cancer (BC) diagnosis and treatment have become a cumulative long-standing chronic disease impairment, causing stress and turning into an allostatic load (AL) framework. This study aimed to investigate the relationship between physical issues and mental health in patients with BC after medical treatment. We conducted an observational study of 61 female patients with BC, and clinical and psychological markers have been detected. We conducted descriptive statistics, ANOVA analyses, correlations, and mediation analyses to verify the effect of the comorbidity index on psychological dimensions. The findings showed high levels of distress and moderate pain, and 32.8% of the patients showed moderate physical impairment. Significant effects of “age” and “physical issues” were found. The adult group reported a higher incidence of physical issues, and the group of patients reporting moderate physical impairment seemed more depressed than patients with mild physical issues. Finally, the comorbidity condition mediated the presence of signs of depression. Patients with BC seemed to experience negative emotions related to comorbidities associated with compromised activities of daily living. Our findings highlighted allostatic overload as a predictive framework to better understand the mental health of women with BC diagnoses to tailor effective psychological treatments for enhanced recovery.

Psychological Distress, Coping Strategies, and Quality of Life in Breast Cancer Patients Under Neoadjuvant Therapy: Protocol of a Systematic Review

Introduction

Women with breast cancer eligible for neoadjuvant therapy (NAT) present a disorder of biopsychosocial variables and alteration of their quality of life. They cope with this changing by adopting psychological adjustment strategies, either passive or active. This systematic review aims to investigate the psychological distress, coping strategies, and quality of life in breast cancer patients under neoadjuvant therapy.

Methods

Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Wiley Online library represent the databases that were searched to identify relevant published articles until September 27, 2021. Full-text published articles, written in English and assessing the main outcomes (namely: psychological distress, coping strategies, and quality of life) in women with breast cancer under NAT will be included. Also, we will integrate papers dealing with the related bio psychosocial variables to the main variables. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. We will bring together the results of all of the included studies to draw conclusions based on the body of evidence. The narrative approach will be adopted to analyze the results and conclusions extracted and we would perform quantitative groupings if we have similar data.

Ethics and dissemination

Ethical approval is not required as the proposed systematic review will not use primary data. The results of this review will be disseminated through publication in a peer-reviewed journal and conference presentation(s). PROSPERO registration number: CRD42021230300.

Resilience and related factors in colorectal cancer patients: A systematic review

PURPOSE

To explore resilience and its related factors in adult colorectal cancer patients.

METHODS

Three databases (CINAHL, Scopus and PubMed) were searched for literature published from January 2009 to February 2021 using the terms colorectal and resilience or resilient or resiliency. The review was registered with PROSPERO and followed the PRISMA statement guidelines.

RESULTS

The studies (n = 11) showed that most colorectal cancer patients exhibit moderate levels of resilience. Resilience was identified as a mediator in the positive or negative aspects of illness, while three studies investigated resilience as an outcome variable. Resilience was associated with social support, mental and physical burden, post-traumatic growth, hope, and quality of life. The studies showed that resilience might not be an immutable situation; social support seemed to provide patients the tools necessary for managing their illness, as well as helped them confront future events. The interventions designed to help with self-care issues and coping strategies eased a patient's mental and physical burden, and improved resilience.

CONCLUSIONS

Resilience among colorectal cancer patients was connected to both negative and positive aspects of the illness. Psychosocial and illness-related practical support might be key for strengthening resilience in these patients. However, longitudinal and intervention studies are required to confirm these indications. Research should study resilience as an outcome variable and provide information related to resilience at different phases of cancer, and what type of support is offered by professionals.

The Satisfaction with Life Scale in breast cancer patients: Psychometric properties

Background/Objective

This study aims to analyze the psychometric properties of the Satisfaction with Life Scale (SWLS), examining the reliability of scale scores and providing validity evidence for its use with breast cancer patients. We provide validity evidence based on internal structure and on relationships with positive psychological variables and other variables indicative of psychological adjustment.

Method

Participants were 222 Spanish women with a diagnosis of breast cancer. They completed the SWLS and a battery of questionnaires measuring positive and negative affect, self-esteem, resilience, emotional intelligence, flourishing, optimism, depression, anxiety, and stress.

Results

Confirmatory factor analysis supported a single-factor structure for the SWLS, S-B χ²(5) = 7.36, p = .19, CFI = .99, NNFI = .99, RMSEA = .046. The reliability of test scores estimated with McDonald's omega yielded a value of .80. Validity evidence was provided by a positive correlation between SWLS scores and positive affect, self-esteem, resilience, emotional intelligence (specifically, clarity and repair), flourishing, and optimism (range: .24, .69), and by a negative correlation with negative affect, pessimism, depression, anxiety, and stress (range: -.25, -.59).

Conclusions

The Spanish version of the SWLS showed satisfactory psychometric properties and it is an appropriate measure for use in the breast cancer context.