This article addresses distinctions underlying concepts of resilience and thriving and issues in conceptualizing thriving. Thriving (physical or psychological) may reflect decreased reactivity to subsequent stressors, faster recovery from subsequent stressors, or a consistently higher level of functioning. Psychological thriving may reflect gains in skill, knowledge, confidence, or a sense of security in personal relationships. Psychological thriving resembles other instances of growth. It probably does not depend on the occurrence of a discrete traumatic event or longer term trauma, though such events may elicit it. An important question is why some people thrive, whereas others are impaired, given the same event. A potential answer rests on the idea that differences in confidence and mastery are self-perpetuating and self-intensifying. This idea suggests a number of variables whose role in thriving is worth closer study, including personality variables such as optimism, contextual variables such as social support, and situational variables such as the coping reactions elicited by the adverse event.

Resilience and thriving: Issues, models, and linkages.

The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.

Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.

Most of the commonly used quality of life (QOL) instruments in oncology do not include spirituality as a core domain. However, previous research suggests that spirituality might be an important aspect of QOL for cancer patients and that it may, in fact, be especially salient in the context of life-threatening illness. This study used a large (n=1610) and ethnically diverse sample to address three questions relevant to including spirituality in QOL measurement: (1) Does spirituality demonstrate a positive association with QOL?; (2) Is this association unique?; and (3) Is there clinical utility in including spirituality in QOL measurement? Spirituality, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was found to be associated with QOL to the same degree as physical well-being, a domain unquestioned in its importance to QOL. The significant association between spirituality and QOL was unique, remaining after controlling for core QOL domains as well as other possible confounding variables. Furthermore, spiritual well-being was found to be related to the ability to enjoy life even in the midst of symptoms, making this domain a potentially important clinical target. It is concluded that these results support the move to the biopsychosocialspiritual model for QOL measurement in oncology.

A case for including spirituality in quality of life measurement in oncology

A QOL instrument was developed to measure the specific concerns of long term cancer survivors. The QOL-CS is based on previous versions of the QOL instrument developed by researchers at the City of Hope National Medical Centre (Grant, Padilla, and Ferrell). This instrument was revised over a one year pilot by Hassey-Dow and Ferrell. The revised instrument included 41 items representing the four domains of quality of life incorporating physical, psychological, social, and spiritual well being. The present study was conducted as a mail survey to the membership (n = 1,200) of the National Coalition for Cancer Survivorship with 686 subjects responding to the survey. This survey included a Demographic tool, QOL-CS and the FACT-G tool developed by Cella. Psychometric analysis, performed on 686 respondents, included measures of reliability and validity. Two measures of reliability included test-retest and internal consistency. The overall QOL-CS tool test-retest reliability was 0.89 with subscales of Physical r = 0.88, Psychological r = 0.88, Social r = 0.81, and Spiritual, r = 0.90. The second measure of reliability was computation of internal consistency using Cronbach's alpha coefficient as a measure of agreement between items and subscales. Analysis revealed an overall r = 0.93. Subscale alphas average ranged from r = 0.71 for spiritual well being, r = 0.77 for physical, r = 0.81 for social, and r = 0.89 for psychological. Several measures of validity were used to determine the extent to which the instrument measured the concept of QOL in cancer survivors. The first method of content validity was based on a panel of QOL researchers and nurses with expertise in oncology. The second measure used stepwise multiple regression to determine factors most predictive of overall QOL in cancer survivors. Seventeen variables were found to be statistically significant accounting for 91% of the variance in overall QOL. The fourth measure of validity used Pearson's correlations to estimate the relationships between the subscales of QOL-CS and the subscales of the established FACT-G tool. There was moderate to strong correlation between associated subscales including QOL-CS physical to FACT physical (r = 0.74), QOL-CS Psych to FACT Emotional (r = 0.65), QOL Social to FACT Social (r = 0.44). The overall QOL-CS correlation with the FACT-G was 0.78. Additional measures of validity included correlations of individual items of the QOL-CS tool, factor analysis, and construct validity discriminating known groups of cancer survivors. Findings demonstrated that the QOL-CS and its subscales adequately measured QOL in this growing population of cancer survivors.

Measurement of the quality of life in cancer survivors

Summary Background Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls. Methods We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls. Findings Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7–16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0–12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96–1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8–23·6) in 48 964 cancer survivors and 13·9% (9·8–18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08–1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86–1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44–1·14; p=0·16) differed significantly between cancer patients and their spouses. Interpretation Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses. Funding None.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(13)70244-4.pdf

Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

Purpose/objectives To describe the quality of life (QOL) of long-term cancer survivors Design Descriptive, mailed survey Setting Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer Sample 687 (57%) of the 1,200 members of NCCS completed the survey The mean age of the sample was 496 years; 81% were female The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%) Methods Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool Main research variables Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being Findings Results include areas of positive effects for cancer survivors and continued demands of survivorship Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 588 for psychological well-being, 659 for spiritual well-being, 662 for social well-being, and 778 for physical well-being Several demographic factors (eg, evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL Conclusions Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness Implications for nursing practice The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL

P Gulasekaram

Papers

Quality of life in long-term cancer survivors.

An evaluation of the quality of life among long-term survivors of breast cancer.