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

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Abstract

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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Interested stakeholders may communicate with the corresponding author (Junying Li) to access de-identified datasets.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660

    Article  PubMed  Google Scholar 

  2. Li T, Mello-Thoms C, Brennan PC (2016) Descriptive epidemiology of breast cancer in China: incidence, mortality, survival and prevalence. Breast Cancer Res Treat 159(3):395–406. https://doi.org/10.1007/s10549-016-3947-0

    Article  CAS  PubMed  Google Scholar 

  3. Mo M, Yuan J, Zhou CM (2020) Changing long-term survival of Chinese breast cancer patients-experience from a large single institution hospital based cancer registry with 35 thousand patients. Chin Oncol 30(2):90–97

    Google Scholar 

  4. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174. https://doi.org/10.1016/S1470-2045(11)70002-X

    Article  PubMed  Google Scholar 

  5. Batty GD, Russ TC, Stamatakis E, Kivimäki M (2017) Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 356:j108. https://doi.org/10.1136/bmj.j108

    Article  PubMed  PubMed Central  Google Scholar 

  6. Riba MB, Donovan KA, Andersen B, Braun I, Breitbart WS, Brewer BW, Buchmann LO, Clark MM, Collins M, Corbett C, Fleishman S, Garcia S, Greenberg DB, Handzo RGF, Hoofring L, Huang CH, Lally R, Martin S, McGuffey L, Mitchell W, Morrison LJ, Pailler M, Palesh O, Parnes F, Pazar JP, Ralston L, Salman J, Shannon-Dudley MM, Valentine AD, McMillian NR, Darlow SD (2019) Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 17(10):1229–1249. https://doi.org/10.6004/jnccn.2019.0048

    Article  PubMed  PubMed Central  Google Scholar 

  7. Head BA, Schapmire TJ, Keeney CE, Deck SM, Studts JL, Hermann CP, Scharfenberger JA, Pfeifer MP (2012) Use of the Distress Thermometer to discern clinically relevant quality of life differences in women with breast cancer. Qual Life Res 21(2):215–223. https://doi.org/10.1007/s11136-011-9934-3

    Article  PubMed  Google Scholar 

  8. Ploos van Amstel FK, Tol J, Sessink KH, van der Graaf WTA, Prins JB, Ottevanger PB (2017) A specifc distress cutoff score shortly after breast cancer diagnosis. Cancer Nur 40:E35-e40. https://doi.org/10.1097/ncc.0000000000000380

    Article  Google Scholar 

  9. Xia HZ, Gao L, Yue H, Shi BX (2018) Exploring meaning in the life of Chinese breast cancer survivors. Cancer Nur 41(2):124–130. https://doi.org/10.1097/NCC.0000000000000466

    Article  Google Scholar 

  10. Murphy D, Klosky JL, Reed DR, Termuhlen AM, Shannon SV, Quinn GP (2015) The importance of assessing priorities of reproductive health concerns among adolescent and young adult patients with cancer. Cancer 121(15):2529–2536. https://doi.org/10.1002/cncr.29466

    Article  PubMed  Google Scholar 

  11. Wang RAH, Davis OSP, Wootton RE, Mottershaw A, Haworth CMA (2017) Social support and mental health in late adolescence are correlated for genetic, as well as environmental, reasons. Sci Rep 7(1):13088. https://doi.org/10.1038/s41598-017-13449-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Geue K, Richter D, Schmidt R, Sender A, Siedentopf F, Brähler E, Stöbel-Richter Y (2014) The desire for children and fertility issues among young German cancer survivors. J Adolesc Health 54(5):527–535. https://doi.org/10.1016/j.jadohealth.2013.10.005

    Article  PubMed  Google Scholar 

  13. Pascoe S, Edelman S, Kidman A (2000) Prevalence of psychological distress and use of support services by cancer patients at Sydney hospitals. Aust N Z J Psychiatry 34(5):785–791. https://doi.org/10.1080/j.1440-1614.2000.00817.x

    Article  CAS  PubMed  Google Scholar 

  14. Schäfer SK, Kunzler AM, Kalisch R, Tüscher O, Lieb K (2022) Trajectories of resilience and mental distress to global major disruptions. Trends Cogn Sci 26(12):1171–1189. https://doi.org/10.1016/j.tics.2022.09.017

    Article  PubMed  PubMed Central  Google Scholar 

  15. Boškailo E, Franjić D, Jurić I, Kiseljaković E, Marijanović I, Babić D (2021) Resilience and quality of life of patients with breast cancer. Psychiatr Danub 33(Suppl 4):572–579

    PubMed  Google Scholar 

  16. Strain JJ (2018) The psychobiology of stress, depression, adjustment disorders and resilience. World J Biol Psychiatry 19(sup1):S14–S20. https://doi.org/10.1080/15622975.2018.1459049

    Article  PubMed  Google Scholar 

  17. Henry CS, Morris AS, Harrist AW (2015) Family resilience: moving into the third wave. Fam Relat 64(1):22–43. https://doi.org/10.1111/fare.12106

    Article  Google Scholar 

  18. Park M, Choi EK, Lyu CJ, Han JW, Hahn SM (2022) Family resilience factors affecting family adaptation of children with cancer: a cross-sectional study. Eur J Oncol Nurs 56:102078. https://doi.org/10.1016/j.ejon.2021.102078

    Article  PubMed  Google Scholar 

  19. Eales L, Ferguson GM, Gillespie S, Smoyer S, Carlson SM (2021) Family resilience and psychological distress in the COVID-19 pandemic: a mixed methods study. Dev Psychol 57(10):1563–1581. https://doi.org/10.1037/dev0001221

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kuang Y, Wang M, Yu NX, Jia S, Guan T, Zhang X, Zhang Y, Lu J, Wang A (2023) Family resilience of patients requiring long-term care: A meta-synthesis of qualitative studies. J Clin Nurs 32(13–14):4159–4175. https://doi.org/10.1111/jocn.16500

    Article  PubMed  Google Scholar 

  21. Li Y, Wang K, Yin Y, Li Y, Li S (2018) Relationships between family resilience, breast cancer survivors’ individual resilience, and caregiver burden: a cross-sectional study. Int J Nurs Stud 88:79–84. https://doi.org/10.1016/j.ijnurstu.2018.08.011

    Article  PubMed  Google Scholar 

  22. Li YL, Zhao Y, Zhang J, Lou FL, Cao FL (2016) Psychometric properties of the shortened Chinese version of the Family Resilience Assessment Scale. J Child Fam Stud 2:2710–2717. https://doi.org/10.1007/s10826-016-0432-7

    Article  Google Scholar 

  23. Wang L, Shi Z, Zhang Y, Zhang Z (2010) Psychometric properties of the 10-item Connor-Davidson Resilience Scale in Chinese earthquake victims. Psychiatry Clin Neurosci 64:499–504. https://doi.org/10.1111/j.1440-1819.2010.02130.x

    Article  PubMed  Google Scholar 

  24. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396. https://doi.org/10.2307/2136404

    Article  CAS  PubMed  Google Scholar 

  25. Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82(10):1904–1908. https://doi.org/10.1002/(sici)1097-0142(19980515)82:10%3c1904::aid-cncr13%3e3.0.co;2-x

    Article  CAS  PubMed  Google Scholar 

  26. Shen Y, Zhang J, Bu QY, Bai YL, Liu CX (2018) A longitudinal study of psychological distress and its related factors in patients with breast cancer. Chin Nurs Manage 18(5):617–621

    Google Scholar 

  27. Armuand GM, Wettergren L, Rodriguez-Wallberg KA, Lampic C (2014) Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Support Care Cancer 22(10):2805–2812. https://doi.org/10.1007/s00520-014-2279-z

    Article  PubMed  PubMed Central  Google Scholar 

  28. Abdollahi A, Panahipour H, Hosseinian S, Allen KA (2019) The effects of perceived stress on hope in women with breast cancer and the role of psychological hardiness. Psychooncology 28(7):1477–1482. https://doi.org/10.1002/pon.5102

    Article  PubMed  Google Scholar 

  29. Aminisani N, Nikbakht H, AsghariJafarabadi M, Shamshirgaran SM (2017) Depression, anxiety, and health related quality of life among colorectal cancer survivors. J Gastrointest Oncol 8(1):81–88. https://doi.org/10.21037/jgo.2017.01.12

    Article  PubMed  PubMed Central  Google Scholar 

  30. Chen CM, Du BF, Ho CL, Ou WJ, Chang YC, Chen WC (2018) Perceived stress, parent-adolescent/young adult communication, and family resilience among adolescents/young adults who have a parent with cancer in Taiwan: a longitudinal study. Cancer Nur 41(2):100–108. https://doi.org/10.1097/NCC.0000000000000488

    Article  Google Scholar 

  31. Korte E, Schilling R, Balcerek M, Byrne J, Dirksen U, Herrmann G, Kepak T, Klco-Brosius S, Kruseova J, Kunstreich M, Langer T, Panasiuk A, Stefanowicz J, Strauß G, Wiegele K, Borgmann-Staudt A (2020) Fertility-related wishes and concerns of adolescent cancer patients and their parents. J Adolesc Young Adult Oncol 9(1):55–62. https://doi.org/10.1089/jayao.2019.0064

    Article  PubMed  Google Scholar 

  32. Xu J, Wang X, Chen M, Shi Y, Hu Y (2021) Family interaction among young Chinese breast cancer survivors. BMC Fam Pract 22(1):122. https://doi.org/10.1186/s12875-021-01476-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ludolph P, Kunzler AM, Stoffers-Winterling J, Helmreich I, Lieb K (2019) Interventions to promote resilience in cancer patients. Dtsch Arztebl Int 51–52(51–52):865–872. https://doi.org/10.3238/arztebl.2019.0865

    Article  PubMed  Google Scholar 

  34. Greup SR, Kaal SEJ, Jansen R, Manten-Horst E, Thong MSY, van der Graaf WTA, Prins JB, Husson O (2018) Post-traumatic growth and resilience in adolescent and young adult cancer patients: an overview. J Adolesc Young Adult Oncol 7(1):1–14. https://doi.org/10.1089/jayao.2017.0040

    Article  PubMed  Google Scholar 

  35. Liu Y, Li Y, Chen L, Li Y, Qi W, Yu L (2018) Relationships between family resilience and posttraumatic growth in breast cancer survivors and caregiver burden. Psychooncology 27(4):1284–1290. https://doi.org/10.1002/pon.4668

    Article  PubMed  Google Scholar 

  36. Li Y, Qiao Y, Luan X, Li S, Wang K (2019) Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Eur J Cancer Care (Engl) 28(2):e12984. https://doi.org/10.1111/ecc.12984

    Article  PubMed  Google Scholar 

  37. Yan Z, Zhang Q, Chang L, Liu Y, Li Y (2021) Dyadic effects of family resilience on post-traumatic stress symptoms among breast cancer patients and their primary family caregivers: a cross-sectional study. Eur J Oncol Nurs 53:101998. https://doi.org/10.1016/j.ejon.2021.101998

    Article  PubMed  Google Scholar 

  38. Xu W, Zhou Y, Fu Z, Rodriguez M (2017) Relationships between dispositional mindfulness, self-acceptance, perceived stress, and psychological symptoms in advanced gastrointestinal cancer patients. Psychooncology 26(12):2157–2161. https://doi.org/10.1002/pon.4437

    Article  PubMed  Google Scholar 

  39. Darabos K, Renna ME, Wang AW, Zimmermann CF, Hoyt MA (2021) Emotional approach coping among young adults with cancer: relationships with psychological distress, posttraumatic growth, and resilience. Psychooncology 30(5):728–735. https://doi.org/10.1002/pon.5621

    Article  PubMed  Google Scholar 

  40. Borgi M, Collacchi B, Ortona E, Cirulli F (2020) Stress and coping in women with breast cancer: unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 119:406–421. https://doi.org/10.1016/j.neubiorev.2020.10.011

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the participants of this study for their time and dedication.

Author information

Author notes

  1. Lin Tao and Ting Zhong contributed equally to this work.

Authors and Affiliations

  1. Cancer Day-Care Unit, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China

    Lin Tao, Ting Zhong & Lan Fu

  2. Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Breast Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China

    Xiaoxia Hu

  3. Thoracic Oncology Ward, Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China

    Junying Li

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  1. Lin Tao
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  4. Lan Fu
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Contributions

Lin Tao, Ting Zhong, and Junying Li contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lin Tao, Ting Zhong, Xiaoxia Hu, and Lan Fu under the supervision of Junying Li. The first draft of the manuscript was written by Lin Tao and Ting Zhong. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Junying Li.

Ethics declarations

Ethics approval

The Clinical Trial and Biomedical Ethics Committee of West China Hospital, Sichuan University (No. 2020[564]) approved the data collection procedures that involved the study participants to ensure that they are conducted in accordance with the ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Not applicable.

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The authors declare no competing interests.

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Tao, L., Zhong, T., Hu, X. et al. Higher family and individual resilience and lower perceived stress alleviate psychological distress in female breast cancer survivors with fertility intention: a cross-sectional study. Support Care Cancer 31, 408 (2023). https://doi.org/10.1007/s00520-023-07853-w

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