Reflecting a psychological paradigm shift, a number of studies at the American Society of Clinical Oncology 2012 annual meeting focus on individuals’ inherent coping skills, sources of strength, and resilience.
One such study, from Australia, takes the important step of studying resiliency prospectively, drawing important conclusions about which cancer patients are most likely to negotiate the journey just fine, without professional psychological intervention.
Dr. Barbara Kaye Bennett of Prince of Wales Hospital in Sydney led the study of 218 women enrolled just following surgery for early-stage breast cancer. At baseline, she and her associates administered validated measures of mood, somatic symptoms, temperament, illness attitudes, and social support, following up at 1, 3, 6, 9, and 12 months with scales tracking mood and somatic changes.
More than a third of women (34%) never registered clinically relevant signs of psychological or somatic distress during a year of adjuvant treatment and adjustment. Another 15% were temporarily traumatized by the experience, but "recovered promptly and remained well," she reported in a poster displayed at ASCO June 2.
Importantly, the 49% of resilient women did not differ from those with higher psychosocial need in terms of age, marital status, tumor size, treatment modality, or treatment toxicity (nadir hemoglobin and neutrophil count). Mortality was identical, with eight patients in each group dying within 5 years post treatment.
Several factors did distinguish the two groups, including measures of neuroticism, primarily assessed in the study by the Eysenck Personality Questionnaire. Higher scores on the neuroticism scale of the EPQ were strongly, and negatively, correlated with resilience (with a correlation of –.351, P less than.001).
One of the so-called "Big Five" personality traits (openness, conscientiousness, extroversion, agreeableness, and neuroticism), neuroticism basically describes an emotionally reactive, anxious, sensitive, easily rattled temperament, widely believed to be genetic and essentially fixed throughout life.
People who score high on this measure are worriers, somatically focused and more prone than others are to pessimism, anxiety, and depressive symptoms. Resilient patients in the study, then, would be the opposite ... generally calm, optimistic, and not overly sensitive to somatic symptoms.
Other significant findings in the study lent support to the characterization of resilient patients as easy-going, unflappable people. Think of them as "Teflon" rather than "Velcro" responders to major life crises such a diagnosis of cancer and its day-to-day challenges of treatment pain, life disruption, and existential uncertainty.
In the study, they registered lower scores than nonresilient patients on the Illness Behavior Questionnaire scales of anxious concern, disease conviction (hypochondriasis, pain intensity and interference, psychological distress), psychological vs. somatic perception, affective inhibition, and mood disturbance.
Resilient patients perceived higher levels of social support than did their less-resilient peers, but social support was not actually predictive of a resilient psychological outcome. They were also more likely to have received more than 12 years of education and to work more than 20 hours a week – signs, perhaps, of an outward-focused outlook on life.
"Identifying low risk [of psychological distress] may have some important implications," said Dr. Bennett, a postdoctoral fellow in psychology, in an interview from ASCO’s meeting in Chicago. An overabundance of psychological resources for those who do not need them might "undermine [an] individual’s own resources," she noted.
Secondly, it wouldn’t make sense to "squander scarce health resources on those who may not be in need of them and who would not benefit further," if they received counseling or other forms of professional psychosocial care.
If half of patients are so resilient that they tend to do just fine on their own, it’s certainly an observation that deserves more study.
Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.
Note: Dr. Bennett and her coauthors had no relevant disclosures.