Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: cross-sectional study

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The role of the oxytocin system in the resilience of patients with breast cancer

Breast cancer is a grave traumatic experience that can profoundly compromise patients' psychological resilience, impacting their overall quality of life. The oxytocin system represents one of the essential neurobiological bases of psychological resilience and plays a critical role in regulating resilience in response to social or traumatic events during adulthood. Oxytocin, through its direct interaction with peripheral or central oxytocin receptors, has been found to have a significant impact on regulating social behavior. However, the precise mechanism by which the activation of peripheral oxytocin receptors leads to improved social is still not completely comprehended and requires additional research. Its activation can modulate psychological resilience by influencing estrogen and its receptors, the hypothalamic-pituitary-adrenal axis, thyroid function, 5-hydroxytryptamine metabolism levels, and arginine pressure release in breast cancer patients. Various interventions, including psychotherapy and behavioral measures, have been employed to improve the psychological resilience of breast cancer patients. The potential effectiveness of such interventions may be underpinned by their ability to modulate oxytocin release levels. This review provides an overview of the oxytocin system and resilience in breast cancer patients and identifies possible future research directions and interventions.

Five-year relative survival by stage of breast and colon cancers in northern Italy

The aim of this study is to present the 5-year relative survival by stage of breast and colorectal cancer patients in a northern Italian province. For the period 2013-2015, cases were selected from the Reggio Emilia Cancer Registry. Breast cancer patients were divided into 3 age groups: <45, 45-74 (the target screening population) and 74+. Colorectal cancers patients were classified into <50, 50-69 (the target screening population), and over 69 years. Carcinomas in situ and unknown stage were both excluded from the survival analyses. The five-year relative survival was estimated using the Pohar Perme method. During the period examined, 1,450 breast cancers and 992 colorectal cancer cases were registered. Analyzing in detail the patients with breast cancer for the entire 2013-2015 period, we noted that 50.4% were in stage I, 33.6% in stage II, 10.8% in stage III and 3.8% in stage IV. The stage was unknown in only 1.3% of patients (19 cases). The stage data of patients with colorectal cancer showed 24.5% were in stage I, 26.1% in stage II, 23.4% in stage III, and 24.6% in stage IV, and 1.4% unknown. Breast cancer 5-year survival was 100%, 89.7%, 71.4%, and 29.1% for stages I, II, III and IV, respectively and for colon cancer 96.7%, 83.4%, 70.8% and 16.2%, respectively.The presence of cancer screening, associated with effective treatments, account for the high survival rate of early-stage breast and colon cancers.

Perceived social support and coping style as mediators between resilience and health-related quality of life in women newly diagnosed with breast cancer: a cross-sectional study

Background

Breast cancer may impair health-related quality of life (HRQoL). We examined the mediating roles of perceived social support (PSS) and coping style (CS) in the relationship between resilience and HRQoL in newly diagnosed breast cancer patients.

Methods

Following a cross-sectional design, 431 patients completed a survey at two hospitals in Shaanxi Province, China. Four validated self-report measures assessed HRQoL, psychological resilience, PSS, and CS. A one-sample t-test analyzed differences between resilience, PSS, and CS in breast cancer patients and the corresponding norm. Multivariate linear regression analyzed the independent predictors of HRQoL. The mediating roles of PSS and CS between resilience and HRQoL were investigated using structural equation modeling (SEM).

Results

Participants had significantly lower scores for resilience and PSS, and higher scores for the avoidance and resignation CSs than their corresponding norm. SEM analysis showed resilience had significant direct effects on PSS (Bs: 0.59, 95% CI 0.49, 0.68, P = 0.003), CS (confrontation: 0.53 (0.44, 0.62), P = 0.001; resignation: − 0.66 (− 0.74, − 0.57), P = 0.002), and HRQoL (Bs range from 0.44 to 0.63, P < 0.05). Resilience had significant indirect effects (Bs range from 0.09 to 0.27), and PSS and CS had significant direct effects on HRQoL (P < 0.05).

Conclusions

Newly diagnosed breast cancer patients had lower resilience and PSS, and higher negative CSs, suggesting that PSS and CS mediated the influence of resilience on HRQoL. A multimodal intervention program focusing on PSS and CS might improve the positive influences of resilience on HRQoL in breast cancer patients.

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.

Resilience: an essential element in head and neck cancer survivorship and quality of life

PURPOSE

Individuals with head and neck cancer (HNCa) face myriad biopsychosocial challenges. Even after treatment completion, these challenges may cause continued disablement and diminished quality of life (QoL). Resilience may serve to minimize the disabling impact of HNCa and, in turn, maximize QoL. The purpose of this study was to formally assess resilience in HNCa survivors and explore its relationship with QoL.

METHODS

A cross-sectional descriptive study was conducted. Forty HNCa survivors completed three validated, self-report questionnaires pertaining to the collection of resilience and QoL data. Descriptive and correlational analyses were performed.

RESULTS

Resilience was identified in HNCa survivors and a positive correlation was found between resilience and QoL.

CONCLUSIONS

Data suggest that resilience may buffer the influence of HNCa on QoL. Thus, screening for reduced levels of resilience may proactively facilitate identification of those who are most vulnerable to the psychosocial impact of HNCa. Interventions that foster resilience may ameliorate the challenges of HNCa and maximize QoL.

Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study

Simple Summary

Psychological resilience is an important psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Despite improved prognosis, breast cancer is associated with emotional distress across the trajectory of the disease. This study aimed to investigate psychological resilience and health-related quality of life in Swedish women with breast cancer at diagnosis and one year later. The resilience score declined in the cohort and was associated with health-related quality of life at both time points. Assessment of psychological resilience in breast cancer care might enable the identification of patients in need of intensified rehabilitation to improve their health-related quality of life.

Abstract

Psychological resilience is considered a major protective psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Higher levels of resilience have been associated with higher levels of health-related quality of life (HRQoL) in breast cancer (BC) patients, but research examining the longitudinal process of resilience is limited. The aim of this population-based longitudinal study was to investigate resilience and HRQoL from diagnosis to one year later in 418 Swedish women with primary BC. Resilience was measured with the Connor–Davidson Resilience Scale 25, and HRQoL was measured with the Short Form Health Survey. The participants responded to questions regarding demographic and study-specific variables. Clinicopathological variables were collected from the Swedish National Quality Register for Breast Cancer. The mean score for resilience was 70.6 (standard deviation, SD = 13.0) at diagnosis and 68.9 (SD = 14.0) one year later, p < 0.001. The level of trust in the treatment and financial situation demonstrated the greatest association with the change in resilience levels. No oncological treatment modality was associated with a change in resilience levels. HRQoL decreased over time in the cohort. Resilience was positively associated with HRQoL at one year post diagnosis, which demonstrates that resilience is an important factor in maintaining HRQoL.

Psychological Aspects to Consider in Breast Cancer Diagnosis and Treatment

PURPOSE OF REVIEW

Breast cancer (BC) is the most common cancer diagnosed in women in the West World. Coping with cancer is cause of extreme stress for patients and their family. The purpose of this review is to evaluate possible approaches to follow to control those situations that can impact on quality of life (QoL) and compliance to treatments.

RECENT FINDINGS

Anxiety, distress, depression, and posttraumatic stress disorder are the most frequent psychological disorders in BC patients. Cognitive disorders and sexual dysfunction can also be important in affecting QoL both in younger and older patients. Younger and older patients show different characteristics of these disorders and different strategies of managing them. Several psychotherapeutic and supportive approaches have proven effective in managing psychological disorders in BC patients. Every BC patient should be supported with these techniques during her entire oncological history, in order to increase QoL and compliance to treatments.

Factors related to the resilience and mental health of adult cancer patients: a systematic review

PURPOSE

It has been reported that maintaining the mental health of cancer patients is a critically important issue, and that resilience is related to mental health. This study conducted a systematic literature review in order to fully understand the relationships between resilience and anxiety, depression, and quality of life (QOL) in adult cancer patients, as well as identify factors associated with resilience.

METHODS

The PubMed, CINAHL, Psychology Database, and ICHUSHI Web databases were searched for articles related to resilience in cancer patients published between 2014 and 2019 using the keywords "cancer" and "resilience," connected with "and." The extracted articles that met inclusion criteria were organized using a matrix. To understand the resilience status of adult cancer patients, meta-analyses were performed using resilience scores measured with the most commonly used resilience scale, Connor-Davidson Resilience Scale 25.

RESULTS

Thirty-nine articles were included in the analysis. A higher resilience score is associated with lower anxiety and depression scores and higher QOL scores. Factors related to resilience include personal factors such as age and gender, disease-related factors such as the presence or absence and severity of physical symptoms, and internal factors such as self-efficacy and hopefulness.

CONCLUSIONS

It was found that it is important for cancer patients to improve resilience to maintain mental health and QOL. The findings suggest that providing interventions for factors that will reduce resilience will provide support for patients with cancer.

Breast Cancer and Resilience: The Controversial Role of Perceived Emotional Intelligence

Cancer is a chronic disease that causes the most deaths in the world, being a public health problem nowadays. Even though breast cancer affects the daily lives of patients, many women become resilient after the disease, decreasing the impact of the diagnosis. Based on a positive psychology approach, the concept of co-vitality arises understood as a set of socio-emotional competencies that enhance psychological adaptation. In this sense, emotional intelligence is one of the main protective factors associated with resilience. However, it is not always as beneficial as it seems, and can lead to collateral effects on psychological adjustment. Given this controversy, this study aims to find the specific processes through which the dimensions of Perceived Emotional Intelligence (PEI) (Emotional Attention, Emotional Clarity, and Mood Repair) can act as a risk or protective factor in the development of resilience. The total sample was 167 women (Age: M = 43.26; SD = 12.43), 46.7% were breast cancer survivors, and 53.3% were healthy controls. The selection of women with breast cancer carries out randomly, recruited through the Oncology Units. The sample completed measures of resilience and PEI, through Resilience Scale (Wagnild and Young, 1993) and TMMS-24 (Salovey et al., 1995). The results showed that breast cancer survivors showed higher age and greater levels of resilience and mood repair than healthy women. The mediation analysis revealed that breast cancer survival and PEI predicted 28% of the variance of resilience. The direct effects showed that emotional clarity and mood repair increased resilience levels. Although breast cancer did not predict resilience directly, it does through mood repair by an indirect process. Besides, the analysis showed that emotional attention played a role in vulnerability, decreasing mood repair, and resilience. These research support theories that point to a possible dark side of PEI, thus, a great level of emotional attention makes dark the positive effect of mood repair and personal growth if a clear perception of emotions does not complement it. These results provide empirical support concerning the need to work complementary each dimension of PEI to avoid unwanted effects on intrapersonal adjustment.

Resilience in women with breast cancer: A systematic review

PURPOSE

Resilience refers to a dynamic process that promotes a successful adaptation to cancer-related adversity. The aim of this systematic review was to identify the biopsychosocial factors involved in the resilience of women with breast cancer and to integrate evidence on the interventions that can contribute to significantly enhancing it.

METHOD

Three databases were searched. In all, 923 articles were identified and, of these, 39 peer-reviewed articles were included.

RESULTS

Resilience was associated with multiple clinical, sociodemographic, social, psychological and physiological variables, with psychological factors being the most important contributors to the development of resilience. Some protective factors were identified, such as social support, several dimensions of quality of life (QOL) and adaptive coping strategies. Psychological distress was the variable most frequently linked to reductions in resilience, finding a bidirectional relationship between them. Resilience-promoting interventions were found to be effective in improving participants' psychological well-being.

CONCLUSION

Resilience is a relevant factor related with several sociodemographic, clinical, psychosocial and physiological variables in women with breast cancer. However, limitations such as the wide variability of instruments used together with the heterogeneity and small size of the samples restrict the generalizability of our conclusions.

Psychological resilience associates with pain experience in women treated for breast cancer

Background and aims Psychological resilience refers to successful adaptation or a positive outcome in the context of significant life adversity, such as chronic pain. On the other hand, anxiety closely associates with pain. The aim of this study was to explore how anxiety and psychological resilience together associate with persistent and experimental pain. Methods In a cross-sectional design, we studied 160 patients who had previously been treated for breast cancer and who now reported at least moderate pain (NRS ≥ 4) in any area of the body. Psychological resilience was measured on the Resilience Scale-14, anxiety on the Hospital Anxiety and Depression Scale, and intensity and interference of persistent pain by means of the Brief Pain Inventory. The cold pressor test was conducted to assess sensitivity to experimental cold pain. Results The results showed that resilience associated with pain interference in persistent pain, and that anxiety moderated this effect. Higher psychological resilience was associated with lower pain interference and this association was stronger in patients with low anxiety than among patients with high anxiety. These effects were visible with regard to persistent pain but not in experimental cold pain. Conclusions These results indicate that chronic pain and experimental pain as well as pain severity and pain interference are psychologically different phenomena. Psychological resilience protects against pain interference but effectively only in patients with low anxiety. It is necessary also to consider protective factors in addition to vulnerability factors in cases of persistent pain. Implications Resilience has been considered a potential target for intervention in chronic pain. However, high levels of anxiety might diminish the protective effect of psychological resilience in clinical settings. Therefore, it is important to treat anxiety in addition to resilience enhancing interventions. Patients with low psychological distress might be more suitable for resilience enhancing interventions than patients with high anxiety.