Post-Traumatic Growth and Resilience in Adolescent and Young Adult Cancer Patients: An Overview

Long-term health-related quality of life among adolescent and young adult breast cancer survivors

PURPOSE

As the prognosis for adolescents and young adults (AYAs) with breast cancer has improved, long-term health-related quality of life (HRQoL) has become increasingly important. This study aimed to analyze the long-term HRQoL of AYA breast cancer survivors compared to an age-matched normative population and to identify factors associated with HRQoL.

METHODS

Secondary analyses were conducted using data from the SURVAYA study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was used to assess HRQoL. The Mann-Whitney U test was used to compare HRQoL scores of AYA breast cancer survivors with those of the normative population (n = 409). Linear regression models were constructed to identify patient and treatment characteristics associated with HRQoL.

RESULTS

A total of 944 female AYA breast cancer survivors were included, with a median age of 36.0 years and a median follow-up of 12.2 years. AYA breast cancer survivors scored significantly lower on five functional scales: physical, role, emotional, cognitive, and social, and higher on five symptom scales: fatigue, pain, dyspnea, insomnia, and financial impact compared to the normative population. Being in a relationship, having a positive body image, and adaptive coping were positively associated with HRQoL, while older age, chemotherapy, unemployment, and maladaptive coping were negatively associated.

CONCLUSION

AYA breast cancer survivors experience significantly compromised long-term HRQoL compared to an age-matched normative population. These results highlight the need for tailored follow-up care and long-term support, as well as the importance of shared decision-making about the benefits and risks of treatments before initiation.

Post-traumatic growth and influencing factors of parents with children with Duchenne muscular dystrophy: a cross-sectional survey study

BACKGROUND

The aim of the study was to identify the post-traumatic growth status and influencing factors of parents with children with Duchenne muscular dystrophy (DMD).

METHODS

We adopted a cross-section survey study. Between February and December 2022, 181 parents responded to the survey including a participants' characteristics section, post-traumatic growth assessment scale, caregiver burden scale, and social support assessment scale. Multiple linear regression analysis was used to investigate influencing factors of post-traumatic growth.

RESULTS

The mean score of post-traumatic growth of parents was 56.66 (SD ± 18.67). Post-traumatic growth was positively correlated with social support (r = 0.452, P < 0.01) and negatively correlated with care burden (r = -0.207, P < 0.01). Multiple linear regression showed that the child's age, course of disease, self-care ability, parent's working condition, residence, education, number of children, and health status were the main influencing factors for the post-traumatic growth of parents (P < 0.001).

CONCLUSION

The post-traumatic growth of parents with children with DMD was at a moderate level. Healthcare professionals should pay attention to the psychological state of parents with children with this rare disease and promote post-traumatic growth through psychological mindfulness interventions, strengthening family and social support, and providing care knowledge and skills.

Suicide and Suicidal Ideation Among Survivors of Childhood Cancer: A Systematic Review and Meta-Analysis

Importance

Reliable estimates of the prevalence and risk of suicide and suicidal ideation (SI) among childhood cancer survivors (CCSs) are crucial in informing efforts to address this issue.

Objective

To systematically evaluate the prevalence and risk of suicide and SI among CCSs.

Data Sources

A literature search was conducted of PubMed, Embase, Cochrane Library, and PsycINFO from January 1, 2000, to November 17, 2024.

Study Selection

All noncontrolled and controlled studies that evaluated the prevalence and risk of suicide and SI and drew comparisons between CCSs and their counterparts. Studies including participants older than 25 years, no reported outcomes, case studies, case reviews, and review articles were excluded.

Data Extraction and Synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed with prospective PROSPERO registration. Prevalence was pooled for single-arm studies. Relative risk ratio (RR) was pooled for double-arm studies. Metaprop was used to meta-analyze the prevalence of suicide and SI under a generalized linear mixed model. For dichotomous outcomes, meta-analyses were performed to compute the RR of the psychological outcome compared with controls.

Main Outcomes and Measures

Prevalence of suicide and SI, the RR of suicide and SI among CCSs compared with controls, and risk factors associated with suicidality outcomes.

Results

From 531 records, 16 studies were included. Studies on suicide included 148 869 participants and studies on SI included 20 140 participants. The prevalence of suicide among CCSs was 0.30% (0.13%-0.69%) and of SI was 9% (95% CI, 7%-11%). There was a significantly increased risk of SI among CCSs compared with controls (RR, 1.67 [95% Cl, 1.39-2.01]), but not of suicide (RR, 1.50 [95% CI, 0.63-3.62]). Subgroup analyses suggested that prevalence of SI is much higher during the active cancer period than years after (proportion, 0.14 [95% CI, 0.10-0.19] vs 0.08 [95% CI, 0.06-0.09]). The systematic review identified preexisting mental illness, poor physical health, older age, male sex, and being single as risk factors associated with suicidality outcomes.

Conclusions and Relevance

In this meta-analysis of suicide and SI among CCSs, the risk of suicide was no different among CCSs compared with controls, but CCSs had a higher risk of SI. Future studies are needed to explore suicidality outcomes among CCSs to guide targeted support policies.

Conceptualisation and Measurement of Resilience of Adults With Cancer: An Umbrella Review

AIMS

To (1) clarify the key components of resilience of adults with cancer; (2) summarise and analyse the resilience measures used in this population; and (3) discuss future evaluation directions.

DESIGN

An umbrella review.

DATA SOURCES

MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane library and Epistemonikos were searched in December 2023.

METHODS

The Joanna Briggs Institute (JBI) guidelines were followed for undertaking this umbrella review. Systematic and narrative reviews that defined resilience of adults with cancer and reported resilience measures, published in English, were included. The methodological quality was assessed using the JBI appraisal tool.

RESULTS

Fourteen eligible reviews were included. Four key resilience components from various resilience conceptualisations were identified. Twenty resilience measures were used among cancer patients, with the 25-item Connor-Davidson Resilience Scale providing a relatively comprehensive assessment of individual resilience. Recommended future research with cancer patients includes assessing these resilience components: (1) available individual resources-key psychological factors that enhance individual resilience; (2) access to social resources-close interpersonal relationships, family cohesion and social support; (3) adaptive coping ability-problem-solving skills, emotional management strategies and experiences in managing adversity; (4) ability to regain mental health and well-being-the capacity to recover a relatively stable psychological state and promote positive psychological functioning.

CONCLUSION

The findings provide evidence for refining future resilience measurement in the adult cancer population. Examining the four key components of resilience with this population across cultures is warranted.

IMPACT

Understanding the key components of resilience of cancer patients can help healthcare professionals identify individuals who may need further support and facilitate early intervention or referral to psychosocial support services. The 25-item Connor-Davidson Resilience Scale is recommended over other tools for use in the cancer population.

PATIENT OR PUBLIC CONTRIBUTION

Patient or public involvement is not applicable in this study.

From worries to resilience: a qualitative study of the psychosocial experiences of diverse adolescents and young adults with heart failure and their caregivers

BACKGROUND AND OBJECTIVES

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers' perceptions, with specific focus on personal challenges, worries, coping skills, and resilience.

METHODS

Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers.

RESULTS

Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult's greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey.

CONCLUSIONS

This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers' perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.

Connections After Cancer: Adolescent and Young Adult Survivors' Perspectives on Forming New Friendships After Cancer

OBJECTIVE

The psychological and social challenges of an adolescent and young adult (AYA) cancer diagnosis often transcend physical health, impacting one's social network during a time when peer connections may be most crucial for support. The current study examines adolescent and young adult (AYA) cancer survivors' perspectives on how cancer impacts their thoughts and behaviors toward forming new peer relationships.

METHODS

Thirty-five YA survivors (Mean age = 33 ± 5.67 years) diagnosed with cancer between 18 and 39 years participated in individual semi-structured interviews. Interviews were coded and analyzed to identify major themes.

RESULTS

When pursuing friendships with non-cancer peers, survivors mentioned discomfort in disclosing, connection through mutual hardship, and revised outlooks on friendship. While befriending new non-cancer peers offered opportunities to be surrounded by positive people, seeking out these friendships was complicated by a desire to find people who understood hardship and could respond well to their cancer status. When forming relationships with cancer peers, AYAs emphasized the shared cancer experience, wariness of negative exposures, and consideration of similarity in cancer factors. They sought shared understanding and validation from cancer peers but were also cautious about exposure to reminders of illness and mindful that certain dissimilarities could hinder the establishment of meaningful connections.

CONCLUSIONS

Findings provide insight into the complex ways that cancer shapes AYA survivors' approach to forming friendships post-diagnosis, presenting guidance on tailored support interventions and resources that can aid in fostering healthy peer relationships and enhance well-being among AYA survivors.

Social Reintegration Experiences of Young Adult Cancer Survivors

This study uses the Q methodology to investigate the subjective perceptions of social reintegration among cancer survivors in their 20s and 30s. We organised a Q population through a pilot study and interviews and finalised 40 Q sample items. For P sample representativeness, we used purposive sampling and selected 12 individuals by age and cancer type. After a Q sorting process, we conducted a key factor analysis using Ken-Q Analysis Desktop Edition. We identified four types of P samples based on their perceptions and noted the main characteristics of each type. We characterised Type 1 as "recovery of presence through social reintegration seeking", Type 2 as "confusion in social reintegration due to social prejudices", Type 3 as "psychosocial support in the process of social reintegration", and Type 4 as "blessing in disguise for post-traumatic growth". The results suggest a need for practical and institutional support reflecting cancer survivors' characteristics by type. This study provides basic data that researchers could use to develop coaching and counselling services to support the social reintegration of cancer survivors in their 20s and 30s.

Adaptation and feasibility of the Swedish Promoting Resilience in Stress Management intervention targeting adolescents and young adults newly diagnosed with cancer

OBJECTIVE

To describe the adaptation and feasibility of the Swedish version of the Promoting Resilience in Stress Management (PRISM) intervention among adolescents and young adults (AYAs) newly diagnosed with cancer.

METHODS

PRISM is a 5-session, manualized program designed to strengthen AYAs individual resources for managing stress by promoting resilience skills: stress-management, goal-setting, cognitive reframing and meaning-making. It is delivered 1:1 by an interventionist via video-visits. PRISM was developed in the US and adapted for a Swedish population. A feasibility study was conducted looking at recruitment, retention, acceptability of the intervention (evaluation survey and exit interviews) and pre- and post- exploratory psychosocial outcome measures (resilience, global health, emotional functioning and rehabilitation needs). Participants were recruited from a comprehensive cancer center in Sweden.

RESULTS

Of the 31 eligible individuals (16-30 years), 20 (65%) agreed to participate and 11 (55%) completed PRISM. Eighty-six percent (6/7) of the participants who completed the evaluation survey thought that the order of the modules and the content were "very good or good". The AYAs that participated in the exit interviews expressed that the programme contributed new knowledge and for some confirmed previous knowledge, which was valuable both during and after participation. The role of the interventionist was stressed as important to support participants through the programme. Suggestions for the future included making PRISM more personalized. Exploratory quantitative analyses suggested improved mean scores regarding resilience, global health and emotional functioning from pre- to post-intervention.

CONCLUSIONS

This study suggests that participating in PRISM has the potential to guide AYAs during the initial period after a cancer diagnosis. Further work to make PRISM more personalized might increase AYAs' interest in, and completion of, PRISM.

"Art is just something that makes people heal"-a qualitative investigation of tattoo artists' perspectives on cancer survivorship therapeutic tattoos

PURPOSE

Many cancer treatments can lead to a disrupted body image and identity. One intervention to address these outcomes is therapeutic tattooing. However, despite the wide dissemination of this practice for cancer survivors (CSs), current research on it is lacking. This study aimed to identify tattoo artists' (TAs') perspectives on the types, impacts, barriers, and facilitators of therapeutic tattooing for CSs and the impact of doing this work on themselves.

METHODS

Twenty-two international TAs who tattoo CSs were interviewed and resultant transcripts were analyzed thematically.

RESULTS

The following themes emerged: Emotional Management of Artists, Emotional Transformation of CSs, Stigma and its effects on CSs, Artist Barriers, CS Barriers, Artist Facilitators, and CS Facilitators. The findings also identify a typology of cancer survivorship therapeutic tattoos.

CONCLUSION

This is the first study to identify barriers/facilitators of therapeutic tattooing, a typology of cancer survivorship therapeutic tattoos, TAs' perspectives on therapeutic tattooing, and potential negative outcomes from this practice. The findings indicate that therapeutic tattooing can be both beneficial and harmful for CSs and TAs, that there is a need for better therapeutic tattooing training for TAs and healthcare providers (HPs), increased awareness of therapeutic tattoos, and a reduction in barriers to the practice and greater collaboration between HPs and TAs.

IMPLICATIONS FOR CANCER SURVIVORS

Findings from this study have major policy implications for healthcare systems, non-profit organizations, and regulatory bodies, which could serve to empower cancer survivors to make more informed decisions about their bodies and support enhanced training and accreditation of this practice.

Understanding the Experience of Cancer Survivorship Among Pediatric and Adolescent Cancer Survivors and Their Parents Through Camera Lenses: A Photovoice Study

OBJECTIVE

Although the relative survival rate of childhood cancer has increased substantially in recent years, the pursuit of successful outcomes is often accompanied by negative impacts on pediatric and adolescent cancer survivors and their parents' physical and psychological well-being. However, little is known about their experiences during the period of cancer survivorship. This study aimed to gain an understanding of the experience of cancer survivorship among pediatric and adolescent cancer survivors and their parents.

METHODS

This study utilized a descriptive qualitative study employing the photovoice design. From September 2022 to March 2023, 17 pediatric and adolescent cancer survivors (9-18 years), who had completed active treatment at least 6 months before recruitment, participated in this study. A total of 217 photographs submitted by survivors and their parents and the interview data, were thematically analyzed to identify themes and subthemes.

RESULTS

The analysis revealed five prominent themes: indelible marks, struggling with late effects, striving to return to normalcy, the strength of support, and living in the moment and hope for the future.

CONCLUSION

The findings shed light on the experiences of pediatric and adolescent cancer survivors and their parents throughout the cancer journey, elucidating the influence on both negative and positive aspects. Additionally, the study highlighted that photovoice facilitated self-reflection, the discovery of values, and the recognition of strengths and can be a therapeutic strategy for pediatric and adolescent cancer survivors and their parents in further research.

Examining the emotional healing process through bibliotherapy in adolescents with cancer: A qualitative descriptive study

PURPOSE

This study aimed to investigate how interactive bibliotherapy impacted the emotional healing process of adolescents with cancer, drawing upon the three-stage emotional healing process theory-identification, catharsis, and insight.

METHOD

A qualitative descriptive study was conducted on data from 14 adolescents, aged 10-19 years, diagnosed with or relapsing from leukemia or osteosarcoma within the past two years. Participants received two interactive bibliotherapy sessions using The Rabbit Listened and You Are Special. Data were collected through semistructured interviews and content analyzed.

RESULTS

Analysis identified six themes in The Rabbit Listened and eight in You Are Special. Adolescents primarily engaged in identification, empathizing with protagonists and recalling personal experiences. They underwent catharsis, releasing negative emotions and fostering positivity. Insights emerged on companionship, listening, and others' criticism.

CONCLUSIONS

Our study validates the use of the three-stage emotional healing process in interdisciplinary bibliotherapy for understanding emotional changes in adolescents with cancer. It sheds light on their concerns and coping strategies. Healthcare practitioners can utilize interactive bibliotherapy based on this framework to initiate therapeutic communication with adolescent cancer patients and improve interventions and care.

Resilience provides mediating effect of resilience between fear of progression and sleep quality in patients with hematological malignancies

BACKGROUND

Hematological tumors are common malignant tumors, with high morbidity and mortality rates. Most patients with hematological malignancies develop sleep disorders that seriously affect their life and health because of acute onset of disease, rapid progression, high recurrence rates, complex treatment methods, and treatment costs.

AIM

To explore the mediating effect of resilience on fear of disease progression and sleep quality in patients with hematological malignancies.

METHODS

A cross-sectional analysis of 100 patients with hematological malignancies, treated in the First Affiliated Hospital of Jinzhou Medical University between August 2022 and August 2023, was conducted. Patients were assessed using a general data survey, a simplified scale for the fear of progression (FoP) of disease, a resilience scale, and the Pittsburgh Sleep Quality Index. Statistical analysis was conducted to determine the relationship between various patient characteristics and FoP, resilience, and sleep quality. Spearman's correlation analysis was used to examine the correlations between mental resilience, FoP, and sleep quality.

RESULTS

The total FoP score mean value in patients with hematological malignancies was 38.09 ± 5.16; the total resilience score mean value was 40.73 ± 7.04; and the Pittsburgh Sleep Quality Index score mean value was 10.72 ± 1.90. FoP, resilience, and sleep quality of the patients were associated with family per capita monthly income and patient education level (P < 0.05). Spearman correlation analysis revealed that FoP was negatively correlated with resilience and sleep quality scores (r = -0.560, -0.537, P < 0.01), respectively, and resilience was significantly associated with sleep quality scores (r = 0.688, P < 0.01). Mediation analysis showed that the mediating effect of resilience between FoP and sleep quality in patients with hematological malignancies was -0.100 and accounted for 50.51% of the total effect. This indicated that FoP directly and indirectly affected sleep quality through the mesomeric effect of resilience.

CONCLUSION

Resilience is an intermediary variable between FoP and sleep quality in patients with hematological malignancies. Medical staff should evaluate and follow-up FoP and resilience to implement measures to improve sleep quality.

The Association of Resilience with Psychosocial Outcomes in Teenagers and Young Adults with Cancer

Purpose: There is limited research on the psychological impact of cancer for teenagers and young adults (TYAs) and the role of protective factors such as resilience. This study investigated associations between resilience and psychosocial outcomes in this group. Methods: Data were collected from TYAs (aged 16-24) who attended the TYA cancer clinic at Guy's Hospital between 2013 and 2021. Participants (N = 63) completed psychosocial questionnaires within 4 weeks of their treatment start date (T1) and again between 9 and 15 months later (T2). We used separate multivariable linear regression models to analyze associations of resilience (Brief Resilience Questionnaire) with outcomes measured at T2, including symptoms of depression (Patient Health Questionnaire [PHQ]-9), anxiety (Generalized Anxiety Disorder [GAD]-7), and subjective quality of life. Models were adjusted for age, gender, ethnicity, and T1 outcome assessments. Results: Higher resilience at T1 was associated with increased anxiety (β = 1.68; bootstrapped confidence interval [95% CI -0.28 to 3.19]), depression (β = 1.24; [-0.85 to 2.90]), and quality of life (5.76; [-0.88 to 15.60]). In contrast, an increase in resilience over time was associated with decreases in the same period in anxiety (β = -3.16; [-5.22 to -1.47]) and depression (β = -2.36, [-4.41 to -0.58]), and an increase in quality of life (β = 9.82, [-0.24 to 21.13]). Conclusion: Increases in resilience during cancer treatment were associated with reduced symptoms of depression and anxiety in TYAs. We discuss factors likely to influence these outcomes, the implications for psychosocial interventions in this population, and identify further research to explore the impact of other factors such as diagnosis and treatment type.

Fostering resilience in adolescence and young adulthood: Considerations for evidence-based, patient-centered oncology care

Adolescence and young adulthood are times of growth and change. For adolescents and young adults (AYAs) who are diagnosed with cancer, the demands of illness may compound normal developmental challenges and adversely affect physical, emotional, and social health. Nevertheless, AYAs have a tremendous capacity for psychosocial adaptation and resilience. Informed by the Transactional Model of Stress and Coping, observational studies in AYA oncology suggest consistent individual, social, and existential resources that may promote resilience. To date, few interventions have been designed to examine whether resilience can be taught and whether doing so affects patient-centered outcomes. Findings point to the potential value of multicomponent programs that include various skills-building strategies, such as stress management, mindfulness, gratitude, and positive reappraisal coping, among others. New research directions include the need to evaluate delivery strategies to enhance participant adherence and retention (e.g., eHealth modalities, optimization studies) and to examine program effectiveness in community-based oncology practices (e.g., less resource-rich settings in which most AYAs receive care). Ultimately, this scholarship may inform, refine, and strengthen intervention science in resilience more broadly.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

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

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

Connectedness to the young adult cancer community and post-traumatic growth: A young adults with cancer in their prime study

OBJECTIVE

For young adults (YAs) with cancer, connecting with peer cancer survivors can provide a unique sense of community and may enhance post-traumatic growth (PTG). This study examined the relationship between connectedness to the YA cancer community and PTG among YAs, independent of overall social support.

METHODS

Data were obtained from the young adults with cancer in their prime study, a cross-Canada survey of YA cancer survivors. Participants were stratified by level of social support into two groups (low/high). Multivariable logistic regression was used to examine the association between PTG and connectedness to the YA community adjusting for respondent characteristics, and the interaction between support and connectedness.

RESULTS

Of 444 respondents, mean age was 34.2 (SD = 6.0), time-since-diagnosis was 4.8 years (SD = 5.4), and 87% were female. Over two-thirds of respondents (71%) reported feeling connected to the YA community. Level of connectedness to the YA community did not differ by social support group, and interaction between social support and connectedness to the YA community was not significant. In the adjusted regression, connectedness to the YA community (aOR = 2.29, 95% CI: 1.10-4.91), high social support (aOR = 2.98, 95% CI: 1.36-6.74), greater time-since-diagnosis (aOR = 1.09, 95% CI: 1.04-1.15) and female sex (aOR = 2.21, 95% CI: 1.23-4.04) were associated with greater odds of moderate-to-high PTG.

CONCLUSIONS

Feeling connected to a community of YA cancer peers was associated with moderate-to-high PTG among YAs, independent of overall perceived social support. Future efforts should increase access to YA cancer communities and foster a sense of connectedness among YAs with cancer.

Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth

BACKGROUND

Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect.

OBJECTIVE

This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship.

METHODS

A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life.

RESULTS

Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker.

CONCLUSIONS

Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.

'It's Nothing Like Cancer': Young Adults with Cancer Reflect on Memorable Entertainment Narratives

A cancer diagnosis in young adulthood disrupts the achievement of developmental milestones, and young adults struggle to make sense of their cancer experience due to a lack of opportunities to both openly talk about cancer and engage in reflective activities. However, entertainment narratives - or stories - may be an alternative to prompt these activities, as narratives can elicit self-expansion that may help fulfill intrinsic needs. One way to think about these narratives is as memorable messages. These messages stick with a person for a long period of time, have an anticipatory socialization effect, and may prompt the sense-making process through narrative communication. Little is known, though, about the use of entertainment narratives among young adults with cancer. We interviewed 25 young adults with cancer about entertainment narratives that were memorable during their cancer experience and how those narratives affected them. From these in-depth, semi-structured interviews, we found that entertainment narratives were generally helpful if they provided distraction from cancer, were relatable, and/or prompted participants to explore their emotions. We found that entertainment narratives were generally harmful if they worsened participants' emotional state, either by exacerbating fears of death and/or depicting cancer unrealistically. Our findings suggest that entertainment narratives are memorable messages, and that helpful messages increased feelings of competence and validation, which could promote psychological adaptation to the disease. Harmful messages increased fear and invalidated participants' difficult experiences, which could lead to greater illness centrality and internalized stigma. Implications for future research are discussed.

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.

Supporting Personal Growth in Childhood, Adolescent and Young-Adult Cancer Survivors Through Challenges in Nature - A Qualitative Study of WAYA Wilderness Programme Participation

Background

Childhood, adolescent and young-adult (AYA) cancer survivors often experience health problems due to late or long-term effects of their cancer or the treatment thereof. The general population gains health benefits from immersion in nature, and nature-based programmes seem to be an intervention that can promote health among childhood and AYA cancer survivors.

Objective

To explore the impact of the WAYA wilderness programme on the health of childhood and AYA cancer survivors.

Methods

The study had a qualitative approach, with data from individual interviews (n = 18) 3 months after completion of the WAYA programme. In addition, case report data was collected during follow-up talks (1, 2 and 12 months after the programme) (n = 19). The WAYA programme consisted of an 8-day expedition, followed 3 months later by a 4-day base camp. The programme included activities such as hiking, backpacking, kayaking, rock climbing, bushcraft and mindfulness. Data was analysed according to a qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) were followed.

Results

An overarching theme was identified: "Personal growth from challenges in nature supported by deep connections with others". In 4 additional themes, participants' experiences describe how deep personal connections arose, as they developed a feeling of being able and competent in nature. Nature provided a space that supported relaxation and respite from everyday challenges and stimuli, which also led to an experience of being more connected to nature.

Conclusion

The WAYA programme was experienced as being of support to childhood and AYA cancer survivors. The programme provided them with skills and tools to be safe in nature. When connected to nature, the participants developed trust and self-confidence, personal growth, relaxation and recovery from stress. Their engagement in outdoor activities continued after completion of the programme, when they returned to everyday life at home.

Words matter: The use of generic "you" in expressive writing in an oncology setting

The use of generic "you" (GY) in writing samples fosters psychological distancing and functions as a linguistic mechanism to facilitate emotion regulation. This method of creating psychological distance from the traumatic experience of cancer may be used by patients processing emotions. We used behavioral coding to analyze expressive writing samples collected from 138 cancer patients to examine the association between the use of "you" and cancer-related symptoms and psychological outcomes. Occurrences of GY were low, but our qualitative results showed how the use of GY could create a universal experience of cancer. The use of GY was not associated with cancer-related symptoms and depressive symptoms, but longitudinal analyses revealed that those using GY had fewer intrusive thoughts and avoidance behaviors across the follow-up period of 1, 4, and 10 months after the intervention. The development of psychological self-distancing prompts to use in writing interventions or as a clinical tool for cancer patients should be explored.

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.

Resilient Hearts: Measuring Resiliency in Young People With Congenital Heart Disease

Background Congenital heart disease (CHD) is a life-long disease with long-term consequences on physical and mental health. Patients with CHD face multifaceted physical and psychosocial challenges. Resilience is an important factor that can be protective and positively impact mental health. We studied resiliency and its associated factors in teenagers and young adults with and without CHD using a social media-delivered survey. Resilience was measured using the 25-item Connor-Davidson Resilience Scale, a validated metric with a historical mean of 80.4/100 in the general adult population. Methods and Results Individuals with and without CHD, aged 10 to 25 years, were prospectively recruited on social media to complete an online survey. The survey was completed from January to February 2022. Respondents provided information on their demographics and CHD details (where applicable) and completed the Connor-Davidson Resilience Scale. As a group, participants with CHD had higher resilience scores compared with same-aged healthy individuals (65.3±16.1 versus 55.4±13.8; P<0.001). For both cohorts, sex, race, and age were not associated with differences in resilience score. For individuals with CHD, lower resilience was associated with more hospital admissions, lack of exercise, presence of a mental health diagnosis, and no participation in support groups or disease-specific camps. Conclusions Young people with CHD had higher resilience than individuals without CHD in our sample. We identified several factors, both modifiable and nonmodifiable, that are associated with higher resilience. Awareness of resiliency and its contributors in the population with CHD may assist medical teams in improving patient physical and psychological well-being.

Posttraumatic growth and illness perception in survivors of adolescent and young adult cancer

BACKGROUND

Adolescents and young adults (AYAs) are diagnosed with cancer during a challenging period of life. We aimed to (1) describe positive changes (posttraumatic growth; PTG) and illness perception, and (2) determine associations between PTG and illness perception, sociodemographic, and cancer-related characteristics in Swiss AYA cancer survivors.

METHODS

We conducted a population-based survey among AYA cancer survivors diagnosed 1990-2005 at age 16-25 years, who had survived ≥ 5 years. We used the Posttraumatic Growth Inventory (PTGI) and the Brief Illness Perception Questionnaire (BIPQ). Data were analyzed using descriptive statistics and linear regressions.

RESULTS

Among 389 contacted survivors, 160 responded (61.3% male; mean age = 34 years, SD = 5.8). The mean PTG sum score was 54.63 (SD = 20.24; range: 8-101). Survivors reported high PTG especially in the domains Appreciation of life (mean = 3.23; 95% confidence interval, 3.05-3.40), Personal strength (2.94; 2.77-3.12), and Relating to others (2.57; 2.40-2.74). Neither sociodemographic nor cancer-related characteristics were associated with PTG. Survivors who perceived follow-up care as helpful (p < 0.001) and those with high concerns about the consequences of the illness (p < 0.001) reported higher PTG.

CONCLUSIONS

Finding ways to promote PTG and to identify and address maladaptive illness perceptions may help survivors transform their experience into something meaningful for their future life.

Exploring the potential impact of group identity on post-traumatic growth in the aftermath of Corona outbreak: function of social-emotional competence as a mediator

Background

This research endeavors to examine the potential effects of human and societal interactions on individuals' post-traumatic growth in the aftermath of the Corona outbreak. To achieve the aforementioned objective, the current research investigates the correlations between post-traumatic growth and group identity, while also examining the potential mediating function of social-emotional competence.

Methods

A cross-sectional design included a representative sample of 2,637 high school students located in the capital territory of Pakistan using convenience sampling method. To explore the associations, correlation and mediation analyzes utilizing the group identification scale, the social-emotional competence scale, and the post-traumatic growth scale was performed with SPSS PROCESS 4 macro and AMOS.

Results

The findings demonstrated that group identification emerged as a substantial predictor substantially associated with post-traumatic growth. Moreover, the relationship linking group identification and post-traumatic growth was found to be partially moderated by social-emotional competence.

Conclusion

The phenomenon of group identification can exert influence on post-traumatic growth through both direct and mediating pathways, with the latter being essentially mediated by social-emotional competence. The aforementioned outcomes possess significant academic and practical implications concerning the promotion of post-traumatic growth and the improvement of psychological well-being after the Corona outbreak.

Mediators of Social Acceptance Among Emerging Adult Survivors of Childhood Cancer

Purpose: Examine associations of social developmental factors (e.g., peer/parent social attachment, romantic relationships) and perceptions of social acceptance among emerging adult survivors of childhood cancer. Methods: A cross-sectional, within-group design was used. Questionnaires included the Multidimensional Body-Self Relations Questionnaire, Inventory of Parent and Peer Attachment, Adolescent Social Self-Efficacy Scale, Personal Evaluation Inventory, Self-Perception Profile for Adolescents, and demographics. Correlations were utilized to determine associations between general demographic, cancer-specific, and the psychosocial outcome variables. Peer and romantic relationship self-efficacy were assessed as potential mediators of social acceptance in three mediation models. Relationships between perceived physical attractiveness, peer attachment, parental attachment, and social acceptance were assessed. Results: Data were collected from N = 52 adult participants (Mage = 21.38 years, standard deviation = 3.11 years) diagnosed with cancer as a child. The first mediation model demonstrated a significant direct effect of perceived physical attraction on perceived social acceptance and retained significance after adjusting for indirect effects of the mediators. The second model demonstrated a significant direct effect of peer attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer relationship self-efficacy. The third model demonstrated a significant direct effect of parent attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer self-efficacy. Conclusion: Relationships between social developmental factors (e.g., parental and peer attachment) and perceived social acceptance are likely mediated by peer relationship self-efficacy in emerging adult survivors of childhood cancer.

Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care

The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors' perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors' physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship.

Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: A systematic review and meta-analysis

BACKGROUND

Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences.

METHODS

We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses.

RESULTS

Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I2  = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I2  = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I2  = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers.

CONCLUSIONS

Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.

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.

The Association Between Group Identity and Post-Traumatic Growth in the Post COVID-19 Era: The Mediating Effect of Social-Emotional Competence

Purpose

To investigate the impact of human-society relationships on individual post-traumatic growth (PTG) in the post COVID-19 era, this study examined the association between group identity (GI) and PTG, and explored the mediating role of social-emotional competence (SEC).

Patients and Methods

In this cross-sectional study, we surveyed 1203 high school students in an eastern region of China using the GI Scale, the SEC Scale, and the PTG Scale. We conducted correlation and mediation analyses using SPSS 23.0 and PROCESS software.

Results

The results indicated that GI was a significant positive predictor of PTG (β=0.219, p<0.001), and that the pathway between GI and PTG was partially mediated by SEC (Effect=0.074, 95% CI= [0.045,0.104]).

Conclusion

GI can have both direct and indirect effects on PTG, with the latter mediated by SEC. These findings hold important theoretical and practical implications for promoting PTG and enhancing mental health in the post COVID-19 era.

Post-traumatic growth and cancer-related communication among adolescents having mothers with breast cancer

PURPOSE

This study aimed to clarify the characteristics of post-traumatic growth (PTG) among adolescents having mothers diagnosed with breast cancer and the relationship between PTG and cancer-related communication with breast cancer survivors.

METHODS

A cross-sectional study was conducted using anonymous self-report questionnaires with breast cancer survivors and adolescent children. PTG in adolescents was measured using the Japanese version of the revised PTG Inventory for Children (PTGI-C-R-J). Furthermore, hierarchical multiple regression analysis was implemented. To evaluate the impact of cancer-related communication on each subscale, the total score of cancer-related communication was switched with other subscales individually within the constructed model.

RESULTS

A total of 97 breast cancer survivors and their adolescent children were included. The mean scores of the total PTGI-C-R-J and subscale scores for "personal strength," "new possibilities," "relating to others," "appreciation of life," and "spiritual change" were 9.0, 1.7, 1.8, 2.3, 2.4, and 0.9, respectively. The connection between PTG and cancer-related communication was partially clarified. The PTGI-C-R-J score was higher when adolescents shared more information regarding breast cancer with their mothers and lower when adolescents expressed more negative feelings toward their mothers. Communication regarding relationships with mothers was not correlated with PTG.

CONCLUSIONS

Of all PTG domains, "relating to others" and "appreciation of life" were comparatively higher in adolescents. Health professionals should support breast cancer survivors to ensure that they convey appropriate information regarding their treatment plans and side effects to their adolescent children. Health professionals should help adolescent children express their negative feelings calmly and clearly.

Higher family and individual resilience and lower perceived stress alleviate psychological distress in female breast cancer survivors with fertility intention: a cross-sectional study

PURPOSE

The aim of this study was to explore how family resilience and individual resilience reduce perceived stress and psychological distress in young female breast cancer survivors with fertility intention.

METHODS

From June 2020 to June 2021, female breast cancer survivors were selected from the cancer centers of 10 tertiary Level A general hospitals in five cities of Sichuan Province. The survivors completed the Chinese versions of the Family Resilience Assessment Scale, Connor-Davidson Resilience Scale, Perceived Stress Scale, and a self-report distress thermometer. A multiple mediation effects test and structural equation modeling were used to explore the relationships among family resilience, individual resilience, perceived stress, and psychological distress.

RESULTS

The direct effect of family resilience on perceived stress was β = -0.320 (95% confidence interval -0.365, -0.271, P < 0.01). The direct effect of family resilience on psychological distress was β = -0.263 (95% confidence interval -0.363, -0.153, P < 0.001). The direct effect of family resilience on individual resilience was β = 0.593 (95% confidence interval 0.542-0.640, P < 0.001). The indirect effect of family resilience on psychological distress was β = -0.322 (95% confidence interval -0.373, -0.274, P < 0.001). Both perceived stress and individual resilience mediated the relationship between family resilience and psychological distress. Furthermore, a partial mediating effect of perceived stress and individual resilience on family resilience and psychological distress was observed.

CONCLUSION

Young female breast cancer survivors in China experience moderate levels of psychological distress.

'My Transplanted Self': Adolescent recipients' experience of post-traumatic growth following thoracic transplantation

BACKGROUND

Despite heart and lung transplantation being life-saving therapies for children and adolescents, little research has focused on recipients' lived experience post-transplant. This study captures the subjective experiences of adolescent thoracic transplant recipients, providing insight into the impact of life changes following transplantation in this population.

METHODS

A grounded theory approach guided an iterative process of data collection and data analysis. Adolescent heart and lung transplant recipients were recruited from a large Canadian pediatric teaching hospital to participate in one-on-one semi-structured interviews. Analysis using line-by-line coding and constant comparison methods facilitated reflection and agreement on categories and emergent themes.

RESULTS

A total of 27 heart and 5 lung transplant recipients (66% female) participated at a median age of 15.9 years and a median time post-transplant of 2.7 years. Participant narratives illuminated three themes describing (1) personal growth - an awareness of personal strengths and coping abilities, (2) relationship growth - a greater appreciation for family and friends, and (3) introspective growth - a developing life philosophy. Findings suggest that adolescents experience an emergent 'transplanted self', positioning thoracic transplantation as a potential catalyst for positive growth and personal change.

CONCLUSIONS

The study findings describe pediatric thoracic transplantation as potentially transformative in nature and sheds light on the application of post-traumatic growth theory. Practitioners and researchers are encouraged to acknowledge the possibility of growth, transformation, and positive change that may be possible within the adolescent thoracic transplant experience and leverage such strengths in clinical care.

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.

Properties of the Shift and Persist Questionnaire in adolescent and young adult cancer patients and survivors: Validity, consistency, and interpretability

PURPOSE

The Shift and Persist model provides an informative framework to understand how adolescent and young adult (AYA) cancer patients and survivors (ages 15-39) may withstand stress and thrive despite adversity. The goal of the present study was to examine the psychometric properties of the Shift and Persist Questionnaire (SPQ) in this population and provide guidelines for interpretation.

METHODS

AYA cancer patients and survivors were recruited via an online research panel. Participants reported demographics and health history and completed the SPQ and Patient-Reported Outcome Measurement Information System 29-item profile (PROMIS®-29). We evaluated the structural validity, internal consistency, and construct validity of the SPQ. Minimally important differences (MIDs) were estimated to inform SPQ score interpretation.

RESULTS

572 eligible individuals completed the survey. On average, participants were aged 24 (SD = 7) at evaluation. Of the participants, 43.5% were female, 77.1% were white, and 17.5% were Hispanic (across races). The two-factor structure of the SPQ demonstrated very good structural validity (CFI > 0.95, SRMR < 0.08), and construct validity with PROMIS-29® domains (convergent Rs = 0.17 to 0.43, divergent Rs = - 0.11 to - 0.51). Internal consistency was adequate (ω = 0.76-0.83). Recommended MIDs were 1 point for the Shift subscale, 1-2 point(s) for the Persist subscale, and 2-3 points for the total SPQ score.

CONCLUSION

The SPQ is a psychometrically sound measure of skills that contribute to resilience in AYA cancer patients and survivors. MID recommendations enhance the interpretability of the SPQ in this population. Future studies examining shifting and persisting in this population may benefit from administering the SPQ.

'Learning and growing': Young people's experiences of being peer trainers within a 'Beads of life' group in an oncology setting

AIMS

To explore the experiences of young people who take on a peer mentoring role within a psycho-oncology service narrative therapy informed 'Beads of Life' group.

METHOD

Eight semi-structured interviews were conducted with these 'Peer Trainers' and analysed using Interpretive Phenomenological Analysis.

RESULTS

Three superordinate themes emerged: identity and self, identity and others, and identity and relationship to cancer. Peer trainers perceived themselves as helpful and mentoring provided an opportunity to develop and grow as a person, while feeling good through helping others. Peer trainers tested out alternative roles, and experienced the benefits of challenging isolation, through connection to others and processing of the emotional burden of cancer. Peer trainers felt grateful for the opportunity, while wanting to make way for the next generation.

CONCLUSIONS

Findings suggest an impact on identity, with young people noticing changes in the self, their relationships with others, and their relationship to cancer. Overall, young people reported positive experiences and a 'levelling up' of identity, suggesting future potential for peer mentoring and community narrative practices within paediatric settings.

Posttraumatic growth after childhood cancer: Psychometric evaluation of a five-item short form and associations with mental health

OBJECTIVE

Research has described positive psychological outcomes after severe illness, including posttraumatic growth. The aim of the present research was to evaluate a short scale assessing posttraumatic growth within a sample of cancer survivors to provide an efficient instrument for research and care settings.

METHODS

Using data of a registry-based sample of N = 633 childhood cancer survivors (CCS) more than 25 years after diagnosis, we conducted an investigation of a five-item short form of the established Posttraumatic Growth Inventory (PTGI), the PPR-5 (PPR stands for "Posttraumatische Persönliche Reifung", the German expression for posttraumatic growth). We performed a confirmatory factor analysis, tested the PPR-5's internal consistency, and investigated associations with cancer-related, sociodemographic, and mental health variables (assessed using psychometrically tested screening instruments) using group comparisons and correlation analyses within a cross-sectional design.

RESULTS

Findings supported a unidimensional structure of the PPR-5. It also showed good reliability (ω = 0.81). CCS especially endorsed Relating to others and Personal strength. The PPR-5's sum score was negatively associated with current depression, anxiety, and sleep disorder symptoms, intake of antidepressants, and lifetime diagnoses of depression and anxiety disorders. It showed positive associations with resilient coping, higher age at diagnosis, partnership, and parenthood.

CONCLUSION

The PPR-5 allows for a brief assessment of posttraumatic growth. As it indicates aspects that support positive psychological adaptation to life as a (cancer) survivor, it could inform research and practice (e.g., as a screening measure, or in psychotherapy/counseling settings).

The relationship of potential biomarkers with psychological resilience and post-traumatic growth in female patients with breast cancer

While investigating psychosocial factors on resilience and post-traumatic growth draws attention, research on biological correlates is limited. We investigated the relationship between post-traumatic growth, resilience, post-traumatic stress, and potential biomarkers in female patients with breast cancer (n = 71) from the general surgery or oncology clinics. They completed the Post-Traumatic Growth Inventory (PTGI), Connor Davidson Psychological Resilience Scale (CD-RISC), Brief Resilience Scale (BRS), PTSD Checklist for DSM-V, and Hospital Anxiety and Depression Scale. Blood samples were collected for NPY, ALLO, DHEA-S, testosterone, cortisol, and hsCRP levels. The relationship between biochemical parameters and the scales was investigated in the whole patient group and in the subgroup of patients who perceived breast cancer as traumatic. When all the patients were evaluated, hsCRP and depression scores were significantly and positively correlated; and hsCRP, BRS score, and PTGI change in self-perception subscale score were significantly and negatively correlated. There was a significant positive correlation between the ALLO level and the psychological resilience (CD-RISC) score in the patient group who perceived breast cancer as traumatic. It was observed that psychological resilience and PTG were positively correlated, and that multiple biomarkers were associated with psychological resilience in female breast cancer patients. Especially findings regarding ALLO levels and psychological resilience could be a new target for future research.

The Relationship between Anxiety, Resilience, and Posttraumatic Growth of the Medical Students in COVID-19 Pandemic in Iran

Background: Medical students serve as frontline individuals to COVD-19 patients, and their mental health affects the quality and safety of the provided services. Objectives: The present study aimed to identify the relationship between anxiety, resilience, and posttraumatic growth of medical interns during COVID-19 pandemic. Methods: This descriptive-correlational study was conducted in Kerman and Isfahan, Iran, from June to September 2020. The socio-demographic questionnaire, Beck Anxiety Inventory (BAI), Connor-Davidson Resilience Scale (CD-RIS), and Posttraumatic Growth Inventory (PTGI) were completed by 235 medical students. Pearson correlation test and descriptive statistics were used to analyze the data. Results: The mean and standard deviation scores of anxiety, resilience, and posttraumatic growth were 10.49, 1.08, and 50.60, as well as 13.39, 65.70, and 15.90, respectively. The results showed no significant relationship between anxiety and resilience (r = 0.16 and P = 0.057). A positive and significant correlation was observed between resilience and posttraumatic growth (r = 0.42 and P = 0.000). Furthermore, a significant negative correlation was found between anxiety and posttraumatic growth scores (r = -0.20 and P = 0.002). Conclusions: In sum, the more resilient and less anxious a person was, the greater his/her posttraumatic growth became. Therefore, it was recommended that appropriate psychological interventions be designed and implemented to improve the mental health of medical interns.

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

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

The mediating role of appraisal on health-related quality of life in adolescent and young adult cancer survivors

BACKGROUND

Adolescent and young adult (AYA) cancer survivors (first diagnosed with cancer at age 15-39) are distinct within the cancer community due to their unique challenges and diverse psycho-behavioral characteristics. This study aimed to analyze psycho-behavioral pathways and further explore the mediating role of cognitive appraisals on AYA cancer survivors' quality of life (QoL).

METHODS

Three hundred and eighty-nine AYA cancer survivors were eligible for analyses and recruited to self-administer questionnaires on QoL (the Chinese version of EORTC Quality of Life Questionnaire-C30 v3.0), resilience, coping, and appraisal on site. This study performed structural equation modeling (SEM) to examine pathways on QoL based on the Rapkin & Schwartz QoL Appraisal Model.

RESULTS

The average age of participants (47.6% female) was 32.7 ± 4.1 years. The SEM results closely fit the measured data (RMSEA = 0.053, GFI = 0.955, CFI = 0.964, SRMR = 0.052). The final model showed direct negative effects of later clinical-stage, more comorbidities, and more Acceptance-Resignation coping on QoL; indirect positive effects of better resilience on QoL through less Acceptance-Resignation coping (β = 0.286, P = 0.002). Appraisal mediated the effects of treatment and resilience on QoL (β = -0.024, P = 0.038). Further, Calm, Peaceful, and Active appraisal patterns were associated with improved Cognitive Functioning (β = 0.119, P = 0.009).

CONCLUSION

Appraisal, coping, and resilience could significantly mediate the effects of cancer and its treatment on the QoL of AYA cancer survivors. Future interventions targeting cognitive appraisals and psycho-behaviors will be helpful. Figuring out what matters to such a unique population and how they appraise a cancer diagnosis through treatment trajectories could help nurses adjust support.

Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center

PURPOSE

There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma.

METHODS

Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression.

RESULTS

Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p < 0.001), female (p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033).

CONCLUSION

20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice.

LEVEL OF EVIDENCE

III-prospective long-term follow-up study.

Psychological, functional and social outcomes in adolescent and young adult cancer survivors over time: A systematic review of longitudinal studies

Objective

Most adolescents and young adults (AYA) can expect to survive a cancer diagnosis and treatment, but all will be left with the potential of long‐term negative effects that can impact their ability to reach their full potential in life. Understanding aspects of psychological, functional, and social health and well‐being outcomes, is pivotal for optimising long‐term well‐being.

Methods

We completed a systematic review of longitudinal studies reporting outcomes after anti‐cancer treatment for Adolescents and Young Adults diagnosed between the age of 12–29 years according to established systematic review processes. The protocol was registered with PROSPERO (ID: CRD 42020203116).

Results

Thirteen reports from 10 studies met eligibility criteria representing 17,645 individuals (50.3% female, mean age at diagnosis 22 years, and 26 years at last, follow up). Eleven reports were from eight quantitative studies that relied on self‐report surveys and two were qualitative studies. Psychological outcomes were reported to improve over time, as were functional health outcomes, although reported health behaviours were inconsistent between studies. Neurocognitive deficits were reported to affect the ability to return to work and impacts on fertility and sexuality were sustained over time.

Conclusions

While some outcomes for AYA are reported to improve over time, particularly for physical functioning, and anxiety and depression, the long‐term impact of cancer on many important domains remains largely unknown. Specifically, the evidence to understand what changes occur over time, and when, remains underdeveloped.

Adolescents and young adults have a long time to live as survivors of cancer, and the negative effects of disease and treatment can compromise long‐term well‐being

Longitudinal research is important for understanding changes in outcomes over time

While a wide range of outcomes have been studied, the evidence to understand what changes occur and when remains underdeveloped

The Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals

Objective

Routine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services.

Method

In total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST.

Results

Participants’ responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups.

Conclusion

This study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients.

Next Step for Global Adolescent and Young Adult Oncology: A Core Patient-Centered Outcome Set

The relatively small number of cancers in the adolescent and young adult (AYA) age group, those aged 15-39 years, does not appropriately reflect the personal and societal costs of cancer in this population, as reflected in the potential years of life lost or saved, the decreased productivity and health-related quality of life due to the impact of the disease during formative years, and long-term complications or disabilities. Improvements in care and outcomes for AYAs with cancer require collaboration among different stakeholders at different levels (patients, caregivers, health-care professionals, researchers, industry, and policymakers). Development of a Core Outcome Set (COS), an agreed minimum set of outcomes that should be measured globally in research and routine clinical practice-specifically for AYAs with cancer-with outcomes that are well defined based on the perspective of those who are affected and assessed with validated measures, is urgently required. A globally implemented COS for AYAs with cancer will facilitate better pooling of research data and the implementation of high-quality health-care registries, which by benchmarking not only nationally but also internationally, may ultimately improve the value of the care given to these underserved young cancer patients. We reflect on the need to develop a COS for AYAs with cancer, the arenas of application, and the challenges of implementing an age-specific COS in research and clinical practice.

Psychosocial Distress Due to Interference of Normal Developmental Milestones in AYAs with Cancer

Cancer in the adolescent and young adult phase poses additional challenges to this period of development that is crucial to the transition to independence. This report provides a brief review of normal developmental milestones in this age range while highlighting the disruptive effects of cancer. We focus on the psychological burden of cancer in patients aged 15–39 years and explore the application of the total pain model to highlight the psychological/emotional, social, and spiritual aspects of non-physical pain. We also briefly review posttraumatic growth and resilience. Lastly, we provide a review of areas for possible development and future research.