{"id":34638,"date":"2020-09-25T11:04:23","date_gmt":"2020-09-25T11:04:23","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=34638"},"modified":"2021-01-04T11:47:47","modified_gmt":"2021-01-04T11:47:47","slug":"psychological-distress-and-adversarial-growth-among-cancer-patients","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol13no3\/psychological-distress-and-adversarial-growth-among-cancer-patients\/","title":{"rendered":"Psychological Distress and Adversarial Growth among Cancer Patients"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Cancer according to the World Health Organization (WHO),1<\/sup> is a public health problem that is one of the chief causes of death worldwide. By the end of 2020, the WHO estimates that across the globe, the incidence of cancer will surge to more than 15 million with the number of deaths with the fatal disease snowballing to 12 million.<\/p>\n

Any individual can experience a disruption in their life due to the uncertainty and the anxiety associated with a cancer diagnosis. The person\u2019s sense of security and order in life could be threatened by a cancer diagnosis. Worldwide, people hold fears that are deeply rooted, that having cancer would mean experiencing tremendous pain and suffering and eventually death, even though in recent times, with advancements in science, treatments for most cancers have been developed. According to Holland,2<\/sup> \u201cno disease has sustained as strong of a negative stigma as cancer\u201d. Hence, this negative stigma that people have, can generate fears which can affect how a person responds to a cancer diagnosis.\u00a0 Research evidence suggests that as people battle with the likelihood of an unpredictable disease trajectory, they experience an unending ambiguity about what is to come, no matter what the type of cancer is.3<\/sup><\/p>\n

Numerous research studies suggest that about 30% of patients can experience psychological distress or other mental health conditions that are significant, on being diagnosed with cancer4-7<\/sup>. Research has also found that hopelessness, anxiety, fear, and depression besides the feeling of pain, are associated with the reception of a cancer diagnosis.8<\/sup> The consequences of the illness too could lead to psychological distress among the patients9<\/sup>. According to some more research reports, among cancer patients, the common psychiatric disorders that follow the use of adjuvant therapy include anxiety, fatigue, adjustment disorder, and depression.6, 10-11<\/sup> The psychological distress that is ubiquitous in patients with cancer, is linked to lesser chances of survival of these patients.12-14<\/sup> This psychological distress is likely to occur at any time during the disease trajectory and has the possibility of worsening with time.13, 15 <\/sup>The psychological distress experienced has been found to affect the patient\u2019s quality of life.16-17<\/sup> Evidence also indicates that the patients are likely to have poor social functioning, poor emotional wellbeing, and poor general health.18<\/sup><\/p>\n

As indicated by the numerous research studies cited above, psychological distress among cancer patients is inevitable, the diagnosis of a terminal illness can wreak havoc in anyone\u2019s life. The patient could be stunned, shocked and could be immersed by strong emotions. However, with time, many patients could begin finding meaning during their time of illness. Research has indicated that these benefits could include improved interpersonal relationships, a greater appreciation of life, a change in priorities, and greater sprirituality.19<\/sup> The positive benefits also include a re-evaluation of former goals, an alteration of priorities, personal growth, and the unearthing of skills and new pursuits.20-25<\/sup> This phenomenon has been referred to by psychologists as adversarial growth or posttraumatic growth. Tedeschi et al. define adversarial growth as \u201cpositive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances\u201d.74<\/sup> There is increasing evidence available over the last few decades, which suggests that life-threatening illnesses can not only lead to an increase in psychological distress but it could also lead to positive life changes.26-28<\/sup> Exhibiting hope and optimism during illness are linked to positive health and thus, lower rates of depression, anger, and better adjustment to negative outcomes and eventually, longer survival rates than patients who are pessimists.19<\/sup> Therefore, during the trajectory of the illness, even with high levels of psychological distress, patients could simultaneously experience positive feelings29-31<\/sup> which suggests that both negative and positive feelings may be viewed as a two-dimensional construct and not as two extremes on a continuum.32-36<\/sup><\/p>\n

Based on the knowledge of the authors and a thorough literature review, there is a scarcity of research carried out on the psychological distress and adversarial growth among cancer patients. There is also a paucity of studies on sex differences in psychological distress and adversarial growth among cancer patients. Research studies in the Indian context are a bare minimum. Thus, the primary objective of the present study was to examine the relationship between psychological distress and adversarial growth among cancer patients and to examine significant differences in psychological distress and adversarial growth among cancer patients in relation to sex. A better understanding of the mental health of cancer patients can help create awareness and could help in developing interventions that could develop adversarial growth.<\/p>\n

Materials and Methods<\/strong><\/p>\n

Objectives of the Study<\/strong><\/p>\n

To examine the relationship between psychological distress and adversarial growth among cancer patients.<\/p>\n

To examine significant differences in psychological distress and adversarial growth among cancer patients with regard to sex.<\/p>\n

Hypotheses of the Study<\/strong><\/p>\n

Ha1<\/sub><\/strong><\/p>\n

There exists a significant and negative correlation between psychological distress and adversarial growth among cancer patients.<\/p>\n

Ha2<\/sub><\/strong><\/p>\n

Significant differences exist in psychological distress among cancer patients as a function of sex.<\/p>\n

Ha3<\/sub><\/strong><\/p>\n

Significant differences exist in adversarial growth among cancer patients as a function of sex.<\/p>\n

Sample<\/strong><\/p>\n

A prospective cohort of patients with cancer (n\u2009=\u2009230) was recruited from public hospitals in Goa. A convenient sampling method was employed and based on the availability of the sample group, male and female participants between the age range of 30-55 years were included in the current research. The patients diagnosed previously with any psychiatric condition were excluded from the study.<\/p>\n

Tools Used for Data Collection<\/strong><\/p>\n

Personal Data Sheet <\/strong><\/p>\n

Included socio-demographic information about the sample.<\/p>\n

Brief Symptom Inventory<\/strong><\/p>\n

The brief symptom inventory by Derogatis et al. (1975) measures psychological distress experienced by an individual. The inventory comprises of 53 items which are ranked on a five-point scale that ranges from 0 (not at all) to 4 (extremely). The items on the inventory cover nine symptom dimensions which include: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The scale also consists of three global indices that measure the current or past level of symptomatology (global severity index), the intensity of symptoms (positive symptom distress index), and the number of reported symptoms (positive symptom total).\u00a0 For the purpose of this study, only the global severity index was considered.<\/p>\n

Silver Lining Questionnaire<\/strong><\/p>\n

The silver lining questionnaire by Sodergren\u00a0and Hyland (2000) measures adversarial growth based on three factors: changes in life philosophy, changes within the self, and enhanced relationships. The questionnaire consists of 38 items which are rated on a five-point scale ranging from strongly agree to strongly disagree. For the purpose of this study, the total score on the scale was considered.<\/p>\n

Procedure<\/strong><\/p>\n

The respondents were contacted personally, the purpose of the visit was made known to them, and their consent was sought for participation. Written informed consent to participate and view their medical records, was obtained from the patients who agreed to participate in the study. No identifying information was included in the questionnaires, in order to ensure anonymity. The medical records of the participants were viewed in order to confirm the validity of the diagnosis, date of diagnosis, treatment method, and the stage of the disease. The data for the study was collected from 130 cancer patients (62 Males, 68 Females) admitted in public hospitals in Goa. The tools used for data collection included the brief symptom inventory by Derogatis et al. (1975) which was used to measure the level of psychological distress in the cancer patients; and the silver lining questionnaire by Sodergren and Hyland (2000) which was used to measure adversarial growth in the sample group. Upon completion of the questionnaires, the participants were debriefed about the study and thanked for their participation. The questionnaires were then scored and subjected to statistical analysis.<\/p>\n

Tools used for Statistical Analysis<\/strong><\/p>\n

On completion of the data collection, the collected data was scrutinized, scored, and coded. Descriptive statistics, Karl Pearson\u2019s Product Moment Correlation, and t-test were used to analyze the data.<\/p>\n

Results and Discussion<\/strong><\/p>\n

Relationship between Psychological Distress and Adversarial Growth among Cancer Patients<\/strong><\/p>\n

The relationship between psychological distress and adversarial growth among cancer patients was examined using Karl Pearson\u2019s product-moment correlation. As indicated in table 1, the correlation coefficient was found to be -0.62 showing a moderate negative correlation which is highly significant (P<0.01). This indicates that the higher the psychological distress, the lower will be the adversarial growth and vice versa.<\/p>\n

Table 1: Correlation between psychological distress and adversarial growth among cancer<\/strong> patients<\/strong><\/p>\n\n\n\n\n\n
Measure<\/strong><\/td>\nMean<\/strong><\/td>\nStandard Deviation<\/strong><\/td>\nCorrelation Coefficient<\/strong><\/td>\n<\/tr>\n
Psychological Distress<\/td>\n106.80<\/td>\n55.12<\/td>\n-0.62**<\/td>\n<\/tr>\n
Adversarial Growth<\/td>\n125.20<\/td>\n40.05<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

**Significant at 0.01 level<\/p>\n

Receiving a cancer diagnosis can cause a complete disruption in the life of almost any person creating a threat to their sense of security and order in life. Besides experiencing pain associated with the illness, the patients could experience hopelessness, fear, anxiety, and depression.\u00a0 As per the findings of Singer et al.4<\/sup>, Mitchell et al.,6<\/sup> and Vehling et al.,7<\/sup> about 30% of patients can suffer from psychological distress when diagnosed with cancer. This is probably because there is a lot of negative stigmas attached to cancer \u2013 that cancer represents pain, suffering, and eventually death. People hold on to these deeply rooted fears even though with advancements in the medical field, most cancers are now treatable. No matter what the type of cancer is, people keep experiencing uncertainty about what is to come and deal with the likelihood of an unpredictable course. The psychological distress that these patients experience could eventually make the person feel hopeless and thus the person may not be able to see anything positive. To worsen things, higher levels of psychological distress could hinder a patients’ prognosis thus making him\/her susceptible to more pain and thus elevating the levels of distress.<\/p>\n

Psychological distress could be probably very high when the person just receives the diagnosis. However, with time, and with appropriate social support, the person may begin to see the illness more positively. Their interpersonal relationships may improve and they may begin to have a greater appreciation for life. They may also unearth new skills and pursuits. All these positive changes could decrease the level of psychological distress.<\/p>\n

The above finding is supported by research conducted by Stiegelis et al.37<\/sup> who in their study discovered that the higher the psychological distress, the lower was the positivistic outlook. This finding is also supported by a study by Ackroyd et al.38<\/sup> who found that psychological distress is reduced if the positivistic outlook is enhanced in cancer patients. This would automatically reduce the psychological distress experienced by the patient and thereby also help in the treatment.<\/p>\n

Differences in Psychological Distress among Cancer Patients with Regard to Sex<\/strong><\/p>\n

An observation of table 2 which indicates the mean, standard deviation scores and t-value for psychological distress as a function of sex, reveals that the mean scores for male and female cancer patients were 93.13 and 122.43 respectively with corresponding standard deviations of 58.70 and 48.50. The t-value was computed to be 1.48 which was found to be highly significant (P <0.01), thus indicating that significant differences exist in psychological distress among cancer patients with regard to sex. Comparing the mean scores, it is observed that female cancer patients have higher psychological distress as compared to male cancer patients.<\/p>\n

Table 2: Mean, standard deviation, and t-value for psychological distress among cancer<\/strong> patients as a function of sex.<\/strong><\/p>\n\n\n\n\n\n
\u00a0<\/strong><\/td>\n\u00a0Sex<\/strong><\/td>\nMean<\/strong><\/td>\nStandard Deviation<\/strong><\/td>\nt-value<\/strong><\/td>\n<\/tr>\n
Psychological Distress<\/td>\nMale<\/td>\n93.13<\/td>\n58.70<\/td>\n1.48**<\/td>\n<\/tr>\n
Female<\/td>\n122.43<\/td>\n48.50<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

**Significant at 0.01 level<\/p>\n

A possible reason for this finding could be that receiving a cancer diagnosis could cause a psychological blow that can lead to cognitive and emotional crises and obstinate distress among the patients.39-41<\/sup> With regard to women, the blow may be worse for several reasons. First of all, cancer can be more troublesome for the roles that women play than the ones that men play. Women are usually portrayed by traditional ideas of feminity as caring, nurturing, and compassionate.42<\/sup> Rather than prioritizing their own needs and accomplishments, women are socialized to prioritize the needs of their families and to nurture and care for others. Research evidence also indicates that women are more responsive to others\u2019 needs (emotional and physical) and indulge in care work more often than men.43-44<\/sup> Therefore, even when women suffer from chronic illnesses, they are more likely than their male counterparts to be confronted with the continuing demands of the household and thus, to neglect their own health because of their family responsibilities.45<\/sup> While on the other hand, when males suffer from chronic illnesses, they are usually cared for and nurtured by their wives and other family members.46-47<\/sup> When women juggle multiple roles and simultaneously deal with their illness and the physical symptoms of the illness, their resources are likely to get exhausted thus leading to problems in adjustment and distress.48<\/sup> In order to recover from the illness, a woman would require to put themselves first and prioritize their needs, but, the breaking gender norms of putting the needs of others first could create stress and could lead to an identity crisis among these women. Moreover, a women\u2019s distress could increase with the guilt of putting a burden on others because of their illness.49<\/sup> Since women accept more family obligations and providing of care and cast a more extensive net of worries than men do,47<\/sup> this passionate expense of caring may build women’s’ defencelessness to stressors thereby making them more prone to psychological distress as compared to men.44<\/sup><\/p>\n

As per the National Cancer Institute,50<\/sup> \u201cdespite the fact that men face a more prominent lifetime risk of cancer, women are more likely to be diagnosed with cancer earlier in life\u201d. Receiving a cancer diagnosis at a more youthful age, particularly before the age of 45, is related to more significant levels of misery contrasted with more established ages.51-52<\/sup> A conclusion of malignant growth might be a significant stun for more youthful individuals, while more seasoned individuals are probably going to envision the beginning of constant disease with cutting edge age.53<\/sup> More youthful female patients go up against the chance of imperilled regenerative capacity and early menopause, which may affect their self-concept.54<\/sup> Women who are younger when diagnosed with cancer may feel disconnected from their friends and may encounter neglected childcare needs and monetary glitches due to their sickness.53, 55<\/sup><\/p>\n

Further, as concluded by Yoshiuchi et al.,56<\/sup> \u201cchanges in appearance cause serious distress for cancer patients, which is manifested as five D\u2019s: Death; Dependence on family or medical staff; Disfigurement; Disruption of life, purpose or desire; and Disability\u201d. With regard to women, cosmetic issues can undoubtedly influence their mental state and personal satisfaction. Past investigations demonstrated that women with breast cancer experience the ill effects of mental misery because of unfriendly impacts and long-lasting physical deformation.57<\/sup> Irreversible changes as well as transitory changes in appearance, for example, chemotherapy-instigated alopecia, additionally affect the mental health of these patients.58-59<\/sup> Additionally, these changes in appearance may identify with sexuality issues.60<\/sup><\/p>\n

This finding is bolstered by Hagedoorn et al.61<\/sup> and Sterba et al.62<\/sup> whose reviews uncovered that female cancer patients as well as female partners of male cancer patients had mental trouble and low personal satisfaction. Research by Bultz and Carlson63<\/sup> and Stommel et al.64<\/sup> likewise reveal that among patients with cancer, women report more significant levels of psychological distress as compared to men.<\/p>\n

Differences in Adversarial Growth among Cancer Patients as a Function of Sex<\/strong><\/p>\n

The mean, standard deviation scores, and t-value for adversarial growth as a function of sex can be seen in table 3. As depicted in the table, the mean scores for male and female cancer patients were found to be 126.07 (SD 38.88) and 124.44 (45.88) respectively. The t-value was computed to be 0.11 (P< 0.05). Hence, comparing the mean scores, it is observed that males have a higher adversarial growth as compared to females.<\/p>\n

Table 3: Mean, standard deviation, and t-value for adversarial growth among cancer patients<\/strong> as a function of sex.<\/strong><\/p>\n\n\n\n\n\n
\u00a0<\/strong><\/td>\n\u00a0Sex<\/strong><\/td>\nMean<\/strong><\/td>\nStandard Deviation<\/strong><\/td>\nt-value<\/strong><\/td>\n<\/tr>\n
Adversarial Growth<\/td>\nMale<\/td>\n126.07<\/td>\n33.88<\/td>\n <\/p>\n

0.11<\/td>\n<\/tr>\n

Female<\/td>\n124.44<\/td>\n45.88<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Significant at 0.05 level<\/p>\n

Cancer is normally seen as a perilous and conceivably horrendous ailment, recognitions exacerbated by its surprising beginning and wild nature.65<\/sup> Besides, cancer patients need to cope with the changes caused due to the ailment to which they need to adjust during their treatment direction.66<\/sup><\/p>\n

Regardless of generous trouble that is related to the diagnosis of cancer and its treatment, numerous patients show unprecedented versatility.67-68<\/sup>\u00a0Studies have indicated that weakening malignant growth and its treatment can be a possibility for self-awareness, just as for upgraded mental and enthusiastic prosperity that might be related to better adapting to the demands related to the illness.69-71<\/sup>\u00a0In any case, not every person responds to afflictions similarly, with some stronger than others.72<\/sup><\/p>\n

As found in the current study, males have better adversarial growth than women. A potential explanation behind the above finding could be that women usually shuffle a larger number of jobs than men, and when women should at the same time manage their ceaseless ailment, their assets may get depleted, prompting change issues and pain.48<\/sup> Breaking gender norms could lead women to engage in negative ruminative contemplations that they are unequipped for doing what society or their family expects of them. In addition, the pain that women experience might be exacerbated by the guilt of troubling others with their disease.49<\/sup> Research indicates that women have more ruminative thoughts as compared to men and these negative ruminative thoughts have been associated with higher levels of depression in women.73<\/sup> Therefore, brooding on negative thoughts regarding their ailment and their incapability to function like they used to before the illness, may affect the adversarial growth of women. On the other hand, when males experience any chronic illness, they tend to rely on their independence.<\/p>\n

The current study aimed at investigating the relationship between psychological distress and adversarial growth among patients with cancer and examining significant differences in psychological distress and adversarial growth among cancer patients with regard to sex. Our study found a significant and negative correlation between psychological distress and adversarial growth among cancer patients, thus indicating that higher levels of psychological distress would lead to lower adversarial growth and vice versa. Significant differences were found in psychological distress among cancer patients with regard to sex with female cancer patients scoring higher on psychological distress than males. Significant differences were also found in adversarial growth among cancer patients with regard to sex with males obtaining a higher score on adversarial growth than females. A better understanding of the psychological distress experienced by cancer patients can help in raising awareness and could also help in developing interventions that could develop adversarial growth. Further, understanding the components that separate cancer patients and cancer survivors who experience adversarial growth from those who do not, might have critical clinical ramifications and could help guide interventions to help cancer patients and cancer survivors with their recuperation from cancer.<\/p>\n

The results of the current study highlight primary data on the incidence of psychological distress and adversarial growth among patients with cancer in the state of Goa. Finding a way to diminish the psychological distress not just improves the quality of life among patients with cancer but also helps them to adhere to the treatment. Routine screening should be attempted and psychosocial support services ought to be accessible for these patients. Future research could incorporate the level of psychological distress before and after treatment and differences in psychological distress among patients with different types of cancer. Further research could likewise be attempted to examine the viability of psychosocial support and endeavors to improve techniques to reduce psychological distress and increase adversarial growth among these patients.<\/p>\n

Acknowledgment<\/strong><\/p>\n

We are thankful to the doctors at the hospitals that we visited for granting us permission for conducting our research on their patients. We are exceptionally grateful to all the participants who shared their precious time and contributed to our study.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.<\/p>\n

Funding Source<\/strong><\/p>\n

There is no funding source<\/p>\n

Statement of Informed Consent<\/strong><\/p>\n

We the authors of this paper, hereby declare that informed consent from all the participants had been obtained before the collection of the research data. However, all identifying details of the participants have been omitted from the paper.<\/p>\n

Ethical Approval<\/strong><\/p>\n

All procedures performed in the study were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Cancer [Internet]. Who.int. 2020 [cited 22 February 2020]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cancer
    \nCrossRef<\/li>\n
  2. Holland J. History of Psycho-Oncology: Overcoming Attitudinal and Conceptual Barriers. Psychosomatic Medicine. 2002;64(2):206-221.
    \nCrossRef<\/a><\/li>\n
  3. Dankert A., Duran G., Engst-Hastreiter U., Keller M., Waadt S., Henrich G., et al.. Fear of progression in patients with cancer, diabetes mellitus, and chronic arthritis. Rehabilitation, 2003; 42: 155\u2013163.
    \nCrossRef<\/li>\n
  4. Singer S., Das-Munshi J. and Br\u00e4hler E.\u00a0Prevalence of mental health conditions in cancer patients in acute care\u2014a meta-analysis.\u00a0 Oncol., 2010; 21: 925\u2013930. 10.1093\/annonc\/mdp515
    \n    CrossRef<\/a><\/li>\n
  5. Singer S., Ehrensperger C., Briest S., Brown A., Dietz A., Einenkel J., et al.\u00a0Comorbid mental health conditions in cancer patients at working age\u2014prevalence, risk profiles, and care uptake.\u00a0Psychooncology, 2013; 22: 2291\u20132297. 10.1002\/pon.3282
    \n    CrossRef<\/a><\/li>\n
  6. Mitchell A. J., Chan M., Bhatti H., Halton M., Grassi L., and Johansen C. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: a meta-analysis of 94 interview-based studies.\u00a0Lancet Oncol<\/em>. 2011; 12:160\u2013174. doi:10.1016\/S1470-2045(11)70150-4
    \n    CrossRef<\/a><\/li>\n
  7. Vehling S., Koch U., Ladehoff N., Sch\u00f6n G., Wegscheider K., Heckl U., et al.\u00a0Pr\u00e4valenz affektiver und angstst\u00f6rungen bei krebs: systematischer literature review und metaanalyse.\u00a0 Psychosom. Med. Psychol.\u00a02012; 62: 249\u2013258. 10.1055\/s-0032-1309032
    \n    CrossRef<\/a><\/li>\n
  8. Breen S.J, Baravelli C.M, Schofield P.E, Jefford M., Yates P.M, and Aranda S.K.\u00a0Is symptom burden a predictor of anxiety and depression in patients with cancer about to commence chemotherapy?Med J Aust<\/em>. 2009; 190:99\u2013104.
    \n    CrossRef<\/a><\/li>\n
  9. Fann J.R, Thomas-Rich A.M, Katon W.J, et al.\u00a0Major depression after breast cancer: a review of epidemiology and treatment.\u00a0Gen Hosp Psychiatry<\/em>. 2008; 30: 112\u2013126. doi:10.1016\/j.genhosppsych.2007.10.008
    \n    CrossRef<\/a><\/li>\n
  10. Iwamitsu Y.\u00a0Anxiety, emotional suppression, and psychological distress before and after breast cancer diagnosis.\u00a0Psychosomatics<\/em>. 2005; 46: 19\u201324. doi:10.1176\/appi.psy.46.1.19
    \n    CrossRef<\/a><\/li>\n
  11. Janaki M.G, Kadam A.R, Mukesh S., Nirmala S., Arul Ponni R.BS, and Rajeev A.G.\u00a0Magnitude of fatigue in cancer patients receiving radiotherapy and its short term effect on quality of life.\u00a0J Cancer Res Ther<\/em>. 2010; 6:1. doi:10.4103\/0973-1482.63566
    \n    CrossRef<\/a><\/li>\n
  12. Hamer M., Chida Y., and Molloy G.J.\u00a0Psychological distress and cancer mortality.\u00a0J Psychosom Res<\/em>. 2009; 66(3): 255\u2013258. doi:10.1016\/j.jpsychores.2008.11.002.
    \n    CrossRef<\/a><\/li>\n
  13. Chida Y., Hamer M., Wardle J., and Steptoe A.\u00a0Do stress-related psychosocial factors contribute to cancer incidence and survival? A systematic quantitative review of 40 years of inquiry.\u00a0Nat Clin Pract Oncol<\/em>. 2008; 5:466\u2013475. doi:10.1038\/
    \n    CrossRef<\/a><\/li>\n
  14. Lavelle C., Ismail M.F, Doherty K., Bowler A., Mohammad M.M, and Cassidy E.M.\u00a0Association between psychological distress and cancer type in patients referred to a psycho-oncology service.\u00a0Ir Med J<\/em>. 2017; 110(6): 579.
    \n    CrossRef<\/a><\/li>\n
  15. Murray S.A, Kendall M., Grant E., Boyd K., Barclay S., and Sheikh A.\u00a0Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure.\u00a0J Pain Symptom Manage<\/em>. 2007; 34(4): 393\u2013402. doi:10.1016\/ j.jpainsymman. 2006.12.009
    \n    CrossRef<\/a><\/li>\n
  16. Guo Z., Tang H., Li H., et al.\u00a0The benefits of psychosocial interventions for cancer patients undergoing radiotherapy.\u00a0Health Qual Life Outcomes<\/em>. 2013; 11:121. doi:10.1186\/1477-7525-11-83
    \n    CrossRef<\/a><\/li>\n
  17. Fallowfield L., Ratcliffe D., Jenkins V. and Saul J.\u00a0Psychiatric morbidity and its recognition by doctors in patients with cancer.\u00a0Br J Cancer<\/em>. 2001; 84:1011\u20131015. doi:10.1054\/bjoc.2001.1724
    \n    CrossRef<\/a><\/li>\n
  18. Ahmed A.E, Almuzaini A.S, Alsadhan M.A, et al.\u00a0Health-related predictors of quality of life in cancer patients in Saudi Arabia.\u00a0J Canc Educ<\/em>. 2018; 33:1011. doi:10.1007\/s13187-017-1198-3
    \n    CrossRef<\/a><\/li>\n
  19. Zanni G. R. Optimism and health. Consult Pharm. 2008; 23:112-6, 119, 121,124,126.
    \n    CrossRef<\/a><\/li>\n
  20. Manne S, Ostroff J, Winkel G, Goldstein L, Fox K, Grana G.\u00a0Posttraumatic growth after breast cancer: patient, partner, and couple perspectives.\u00a0Psychosom Med. 2004;\u00a066(3):442\u201354. 10.1097\/01.psy.0000127689.38525.7d
    \n    CrossRef<\/a><\/li>\n
  21. Thornton AA, Perez MA.\u00a0Posttraumatic growth in prostate cancer survivors and their partners.\u00a0Psychooncology. 2006; 15(4):285\u201396.<\/li>\n
  22. Weiss T.\u00a0Correlates of posttraumatic growth in husbands of breast cancer survivors.\u00a0Psychooncology. 2004; 13(4):260\u20138.
    \n    CrossRef<\/a><\/li>\n
  23. Andrykowski M. A, Curran S. L, Studts J. L, Cunningham L., Carpenter J. S, McGrath P. C, Sloan D. A, and Kenady D. E. Psychosocial adjustment and quality of life in women with breast cancer and benign breast problems: a controlled comparison. Journal of Clinical Epidemiology. 1996; 49: 827-834.
    \n    CrossRef<\/a><\/li>\n
  24. Fromm K., Andrykowski M. A and Hunt J. Positive and negative psychosocial sequelae of bone marrow transplantation: implications for quality of life assessment. Journal of Behavioral Medicine. 1996; 19: 221-240.
    \n    CrossRef<\/a><\/li>\n
  25. O’Connor A. P, Wicker C.A and Germino B. B. Understanding the cancer patient’s search for meaning. Cancer Nursing. 1990; 13: 167-175.
    \n    CrossRef<\/a><\/li>\n
  26. Sodergren S. and Hyland M. What are the positive consequences of illness? Psychology and Health. 2000; 15: 85-97.
    \n    CrossRef<\/a><\/li>\n
  27. Thibodeau J. and MacRae J.. Breast cancer survival: a phenomenological inquiry. Advances in Nursing Science. 1997; 19: 65-74.
    \n    CrossRef<\/a><\/li>\n
  28. Andrykowski M. A, Brady M. J and Hunt J. W. Positive psychosocial adjustment in potential bone marrow transplant recipients: cancer as a psychosocial transition. Psycho-Oncology. 1993; 2: 261-276.
    \n    CrossRef<\/a><\/li>\n
  29. Ferrans C. E. Quality of life through the eyes of survivors of breast cancer. Oncology Nursing Forum. 1994; 21: 1645-1651.
    \n    CrossRef<\/a><\/li>\n
  30. Ferrell B. R, Grant M. M, Funk B. M, Otis G. S and Garcia N. J. Quality of life in breast cancer survivors: implications for developing support services. Oncology Nursing Forum. 1998; 25: 887-895.
    \n    CrossRef<\/a><\/li>\n
  31. Folkman S. Positive psychological states and coping with severe stress. Social Science and Medicine. 1997; 45: 1207-1221.
    \n    CrossRef<\/a><\/li>\n
  32. Folkman S. and Moskowitz J. T. Positive affect and the other side of coping. American Psychologist. 2000; 55: 647-654.
    \n    CrossRef<\/a><\/li>\n
  33. Helgeson V. S and Cohen S. Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychology. 1996; 15: 135-148.
    \n    CrossRef<\/a><\/li>\n
  34. McGrath J. E and Beehr T. A. Time and the stress process: some temporal issues in the conceptualization and measurement of stress. Stress Medicine. 1990; 6: 93-104.
    \n    CrossRef<\/a><\/li>\n
  35. Schroevers M. J, Sanderman R., van Sonderen E. and Ranchor A. V. The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: Depressed and Positive Affect in cancer patients and healthy reference subjects. Quality of Life Research. 2000; 9: 1015-1029.
    \n    CrossRef<\/a><\/li>\n
  36. Stiegelis H. E., Hagedoorn M., Sanderman R., Zee K. I. v. d., Buunk B. P. and Bergh, A. C. M. Cognitive adaptation: a comparison of cancer patients and healthy references. British Journal of Health Psychology. 2003; 8: 303-318.
    \n    CrossRef<\/a><\/li>\n
  37. Ackroyd R., Shorthouse A. J. and Stephenson T. J.\u00a0Gastric carcinoma in siblings with Friedreich\u2019s ataxia.\u00a0 J. Surg. Oncol. 2011;22, 301\u2013303
    \n    CrossRef<\/a><\/li>\n
  38. Akechi T,\u00a0Okuyama T,\u00a0Imoto S,\u00a0Yamawaki S and Uchitomi Y. Biomedical and psychosocial determinants of psychiatric morbidity among postoperative ambulatory breast cancer patients. Breast Cancer Res Treat.\u00a02001; 65(3):195-202.
    \n    CrossRef<\/a><\/li>\n
  39. Baum A. and Posluszny D. M. Traumatic stress as a target for intervention with cancer patients. In A. Baum & B. L. Andersen (Eds.),\u00a0Psychosocial interventions for cancer. <\/em>2001; 143\u2013173.
    \n    CrossRef<\/a><\/li>\n
  40. Manne S. L, Glassman M. and DuHamel K. Intrusion, avoidance and psychological distress among individuals with cancer. Psychosomatic Medicine. 2000; 63:\u00a0658\u2013667.
    \n    CrossRef<\/a><\/li>\n
  41. Bottorff J.L, Oliffe J.L, Halpin M., Phillips M., McLean G. and Mroz L. Women and prostate cancer support groups: the gender connect? Soc Sci Med. 2008; 66(5):1217-27.
    \n    CrossRef<\/a><\/li>\n
  42. England P. Emerging Theories of Carework.\u00a0Annual Review of Sociology.\u00a02005; 31:381\u2013399.<\/li>\n
  43. Kessler R and McLeod J. D. Sex Differences in Vulnerability to Undesirable Life Events.\u00a0American Sociological Review.\u00a01984; 49:620\u2013631.<\/li>\n
  44. Boogaard MA. Rehabilitation of the female patient after myocardial infarction. Nurs Clin North Am. 1984; 19(3):433-40.<\/li>\n
  45. King KM. Gender and short-term recovery from cardiac surgery. Nurs Res. 2000 Jan-Feb; 49(1):29-36.
    \n    CrossRef<\/a><\/li>\n
  46. Stanton AL, Revenson TA, Tennen H. Health psychology: psychological adjustment to chronic disease.Annu Rev Psychol. 2007; 58:565-92.
    \n    CrossRef<\/a><\/li>\n
  47. Northouse LL, Mood D, Templin T, Mellon S, George T. Couples’ patterns of adjustment to colon cancer.Soc Sci Med. 2000; 50(2):271-84.
    \n    CrossRef<\/a><\/li>\n
  48. Sulik Gayle A. On the Receiving End: Women, Caring, and Breast Cancer.\u00a0Qualitative Sociology.\u00a02007; 30:297\u2013314.
    \n    CrossRef<\/a><\/li>\n
  49. National Cancer Institute.\u00a0SEER Cancer Statistics Review 1975 \u2013 2005.Bethesda, MD: 2008.
    \n    CrossRef<\/a><\/li>\n
  50. Kroenke CH, Rosner B, Chen WY, Kawachi I, Colditz GA and Holmes MD. Functional impact of breast cancer by age at diagnosis. J Clin Oncol. 2004; 22(10):1849-56.<\/li>\n
  51. Schnittker J. Chronic illness and depressive symptoms in late life.Soc Sci Med. 2005; 60(1):13-23.
    \n    CrossRef<\/a><\/li>\n
  52. Mosher C.E and Danoff-Burg S. A review of age differences in psychological adjustment to breast cancer.J Psychosoc Oncol. 2005; 23(2-3):101-14.
    \n    CrossRef<\/a><\/li>\n
  53. Avis N.E,\u00a0Crawford S. and Manuel J. Psychosocial problems among younger women with breast cancer. 2004; 13(5):295-308.
    \n    CrossRef<\/a><\/li>\n
  54. Mor V, Malin M, and Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr. 1994; 16:191-7.<\/li>\n
  55. Yoshiuchi K, Kikuchi H. IX Zouketsuki kei shuyou. In: Uchitomi Y, Ogawa A, editors.\u00a0Seishin Shuyou Gaku.Tokyo: Igaku Shoin; 2011. p. 283.<\/li>\n
  56. Pan XF, Fei MD, Zhang KY, Fan ZL, Fu FH and Fan JH. Psychopathological profile of women with breast cancer based on the symptom checklist-90-R. Asian Pac J Cancer Prev. 2014; 14(11):6579-84.
    \n    CrossRef<\/a><\/li>\n
  57. Ishida K, Ishida J and Kiyoko K. Psychosocial reaction patterns to alopecia in female patients with gynecological cancer undergoing chemotherapy.Asian Pac J Cancer Prev. 2015; 16(3):1225-33.
    \n    CrossRef<\/a><\/li>\n
  58. Choi EK, Kim IR, Chang O, Kang D, Nam SJ, Lee JE, Lee SK, Im YH, Park YH, Yang JH and Cho J. Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. 2014; 23(10):1103-10.
    \n    CrossRef<\/a><\/li>\n
  59. Monga U, Tan G, Ostermann HJ and Monga TN. Sexuality in head and neck cancer patients. Arch Phys Med Rehabil. 1997; 78(3):298-304.
    \n    CrossRef<\/a><\/li>\n
  60. Hagedoorn M, Buunk BP, Kuijer RG, Wobbes T and Sanderman R. Couples dealing with cancer: role and gender differences regarding psychological distress and quality of life. 2000; 9(3):232-42.
    \n    CrossRef<\/a><\/li>\n
  61. Sterba KR, Swartz RJ, Basen-Engquist K, Black PC, and Pettaway CA. Long-term quality of life after radical prostatectomy in wives of men in the postoperative adjuvant androgen deprivation trial. Support Care Cancer. 2011; 19(8):1117-24.
    \n    CrossRef<\/a><\/li>\n
  62. Bultz BD and Carlson LE. Emotional distress: the sixth vital sign–future directions in cancer care. 2006; 15(2):93-5.
    \n    CrossRef<\/a><\/li>\n
  63. Stommel M, Kurtz ME, Kurtz JC, Given CW and Given BA. A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate. Health Psychol. 2004; 23(6):564-73.
    \n    CrossRef<\/a><\/li>\n
  64. Tedeschi RG and Calhoun LG.\u00a0Trauma and transformation: growing in the aftermath of suffering. (1995). Available from:\u00a0http:\/\/sk.sagepub.com\/books\/trauma-and-transformation.
    \n    CrossRef<\/a><\/li>\n
  65. Molina Y, Yi JC, Martinez-Gutierrez J, Reding KW, Yi-Frazier JP and Rosenberg AR. Resilience among patients across the cancer continuum: diverse perspectives. Clin J Oncol Nurs. 2014; 18(1):93-101.
    \n    CrossRef<\/a><\/li>\n
  66. Carver CS.\u00a0Resilience and thriving: issues, models, and linkages.\u00a0J Soc Issues. 1998;\u00a054(2):245\u201366. 10.1111\/j.1540-4560.1998.tb01217.x
    \n    CrossRef<\/a><\/li>\n
  67. Gouzman J, Cohen M, Ben-Zur H, Shacham-Shmueli E, Aderka D, Siegelmann-Danieli N and Beny A. Resilience and psychosocial adjustment in digestive system cancer.J Clin Psychol Med Settings. 2015; 22(1):1-13.
    \n    CrossRef<\/a><\/li>\n
  68. Ruini C, Vescovelli F and Albieri E.\u00a0Post-traumatic growth in breast cancer survivors: new insights into its relationships with well-being and distress.\u00a0J Clin Psychol Med Settings. 2013;\u00a020(3):383\u201391. 10.1007\/s10880-012-9340-1
    \n    CrossRef<\/a><\/li>\n
  69. Danhauer SC, Russell GB, Tedeschi RG, Jesse MT, Vishnevsky T, Daley K, et al.\u00a0A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia.\u00a0J Clin Psychol Med Settings. 2013;\u00a020(1):13\u201324. 10.1007\/s10880-012-9304-5
    \n    CrossRef<\/a><\/li>\n
  70. Lelorain S, Bonnaud-Antignac A and Florin A.\u00a0Long term posttraumatic growth after breast cancer: prevalence, predictors and relationships with psychological health.\u00a0J Clin Psychol Med Settings. 2010;\u00a017(1):14\u201322. 10.1007\/s10880-009-9183-6
    \n    CrossRef<\/a><\/li>\n
  71. Chan CL, Chan TH and Ng SM.\u00a0The Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation (SMART): a body-mind-spirit approach to trauma management.\u00a0Soc Work Health Care. 2006;\u00a043(2\u20133):9\u201336. 10.1300\/J010v43n02_03
    \n    CrossRef<\/a><\/li>\n
  72. Nolen\u2010Hoeksema S.,\u00a0Larson J. and\u00a0Grayson C.\u00a0Explaining the gender differences in depressive symptoms.\u00a0Journal of Personality and Social Psychology. 1999;77:\u00a01061\u2013\u00a01072.
    \n    CrossRef<\/a><\/li>\n
  73. Nolen\u2010Hoeksema S.,\u00a0Morrow J. and\u00a0Frederickson B. L.\u00a0Response styles and the duration of episodes of depressed mood.\u00a0Journal of Abnormal Psychology. 1993; 102:\u00a020\u2013\u00a028.
    \n    CrossRef<\/a><\/li>\n
  74. Tedeschi, R. G., Shakespeare-Finch, J., Taku, K., & Calhoun, L. G. (2018).\u00a0Posttraumatic growth: Theory, research, and applications<\/em>. Routledge.
    \n    CrossRef<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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