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

Åsa Mohlin, Pär-Ola Bendahl, Cecilia Hegardt, Corinna Richter, Ingalill Rahm Hallberg, Lisa Rydén, Åsa Mohlin, Pär-Ola Bendahl, Cecilia Hegardt, Corinna Richter, Ingalill Rahm Hallberg, Lisa Rydén

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.

Keywords: Connor–Davidson Resilience Scale 25 (CD-RISC25); Short Form Health Survey (SF-36); breast cancer; health-related quality of life; psychological resilience.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study cohort. Abbreviations: CD-RISC25, Connor-Davidson Resilience Scale 25; SF-36, Short Form Health Survey; NKBC, Swedish National Quality Register for Breast Cancer.
Figure 2
Figure 2
Histogram of the change in psychological resilience score (CD-RISC25) (score at 1 year post diagnosis minus score at diagnosis) (n = 418). Abbreviations: CD-RISC25, Connor-Davidson Resilience Scale 25; SD, standard deviation.

References

    1. Ghoncheh M., Pournamdar Z., Salehiniya H. Incidence and Mortality and Epidemiology of Breast Cancer in the World. Asian Pac. J. Cancer Prev. 2016;17:43–46. doi: 10.7314/APJCP.2016.17.S3.43.
    1. Olsson Moller U., Olsson I.M., Sjovall K., Beck I., Ryden L., Malmstrom M. Barriers and facilitators for individualized rehabilitation during breast cancer treatment—A focus group study exploring health care professionals’ experiences. BMC Health Serv. Res. 2020;20:252. doi: 10.1186/s12913-020-05107-7.
    1. Alarcón R., Cerezo M.V., Hevilla S., Blanca M.J. Psychometric properties of the Connor-Davidson Resilience Scale in women with breast cancer. Int. J. Clin. Health Psychol. 2020;20:81–89. doi: 10.1016/j.ijchp.2019.11.001.
    1. Huang Y., Huang Y., Bao M., Zheng S., Du T., Wu K. Psychological resilience of women after breast cancer surgery: A cross-sectional study of associated influencing factors. Psychol. Health Med. 2019;24:866–878. doi: 10.1080/13548506.2019.1574353.
    1. Fasano J., Shao T., Huang H.-H., Kessler A.J., Kolodka O.P., Shapiro C.L. Optimism and coping: Do they influence health outcomes in women with breast cancer? A systemic review and meta-analysis. Breast Cancer Res. Treat. 2020;183:495–501. doi: 10.1007/s10549-020-05800-5.
    1. Ristevska-Dimitrovska G., Stefanovski P., Smichkoska S., Raleva M., Dejanova B. Depression and Resilience in Breast Cancer Patients. Open Access Maced. J. Med. Sci. 2015;3:661–665. doi: 10.3889/oamjms.2015.119.
    1. Velickovic K., Hallberg I.R., Axelsson U., Borrebaeck C.A.K., Rydén L., Johnsson P., Månsson J. Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a non-clinical population in Sweden. Health Qual. Life Outcomes. 2020;18:1–10. doi: 10.1186/s12955-020-01383-3.
    1. Ristevska-Dimitrovska G., Filov I., Rajchanovska D., Stefanovski P., Dejanova B. Resilience and Quality of Life in Breast Cancer Patients. Open Access Maced. J. Med. Sci. 2015;3:727–731. doi: 10.3889/oamjms.2015.128.
    1. Zhang H., Zhao Q., Cao P., Ren G. Resilience and Quality of Life: Exploring the Mediator Role of Social Support in Patients with Breast Cancer. Med. Sci. Monit. 2017;23:5969–5979. doi: 10.12659/MSM.907730.
    1. Izci F., Sarsanov D., Erdogan Z.I., Ilgun A.S., Celebi E., Alco G., Kocaman N., Ordu C., Ozturk A., Duymaz T., et al. Impact of Personality Traits, Anxiety, Depression and Hopelessness Levels on Quality of Life in the Patients with Breast Cancer. Eur. J. Breast Health. 2018;14:105–111. doi: 10.5152/ejbh.2018.3724.
    1. Avis N.E., Levine B., Goyal N., Crawford S.L., Hess R., Colvin A., Bromberger J.T., Greendale G.A. Health-related quality of life among breast cancer survivors and noncancer controls over 10 years: Pink SWAN. Cancer. 2020;126:2296–2304. doi: 10.1002/cncr.32757.
    1. Wu Z., Liu Y., Li X., Li X. Resilience and Associated Factors among Mainland Chinese Women Newly Diagnosed with Breast Cancer. PLoS ONE. 2016;11:e0167976. doi: 10.1371/journal.pone.0167976.
    1. Markovitz S.E., Schrooten W., Arntz A., Peters M.L. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients. Psycho-Oncology. 2015;24:1639–1645. doi: 10.1002/pon.3834.
    1. Harms C.A., Cohen L., Pooley J.A., Chambers S.K., Galvão D.A., Newton R.U. Quality of life and psychological distress in cancer survivors: The role of psycho-social resources for resilience. Psycho-Oncology. 2019;28:271–277. doi: 10.1002/pon.4934.
    1. Alizadeh S., Khanahmadi S., Vedadhir A., Barjasteh S. The Relationship between Resilience with Self- Compassion, Social Support and Sense of Belonging in Women with Breast Cancer. Asian Pac. J. Cancer Prev. 2018;19:2469–2474.
    1. Tu P.C., Yeh D.C., Hsieh H.C. Positive psychological changes after breast cancer diagnosis and treatment: The role of trait resilience and coping styles. J. Psychosoc. Oncol. 2020;38:156–170. doi: 10.1080/07347332.2019.1649337.
    1. Fradelos E.C., Latsou D., Mitsi D., Tsaras K., Lekka D., Lavdaniti M., Tzavella F., Papathanasiou I.V. Assessment of the relation between religiosity, mental health, and psychological resilience in breast cancer patients. Współczesna Onkol. 2018;22:172–177. doi: 10.5114/wo.2018.78947.
    1. Fradelos E.C., Papathanasiou I.V., Veneti A., Daglas A., Christodoulou E., Zyga S., Kourakos M. Psychological Distress and Resilience in Women Diagnosed with Breast Cancer in Greece. Asian Pac. J. Cancer Prev. 2017;18:2545–2550.
    1. Padilla-Ruiz M., Ruiz-Román C., Pérez-Ruiz E., Rueda A., Redondo M., Rivas-Ruiz F. Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: Cross-sectional study. Support. Care Cancer. 2019;27:1279–1286. doi: 10.1007/s00520-018-4612-4.
    1. Connor K.M., Davidson J.R.T. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC) Depress. Anxiety. 2003;18:76–82. doi: 10.1002/da.10113.
    1. The Connor-Davidson Resilience Scale. [(accessed on 5 February 2021)]; Available online:
    1. Windle G., Bennett K.M., Noyes J. A methodological review of resilience measurement scales. Health Qual. Life Outcomes. 2011;9:8. doi: 10.1186/1477-7525-9-8.
    1. Sullivan M., Karlsson J., Ware J.J.E. The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc. Sci. Med. 1995;41:1349–1358. doi: 10.1016/0277-9536(95)00125-Q.
    1. Sullivan M., Karlsson J., Taft C., Ware J.E. SF-36 hälsoenkät: Svensk Manual och Tolkningsguide = (Swedish Manual and Interpretation Guide) Sahlgrenska Sjukhuset, Sektionen för Vårdforskning; Göteborg, Sweden: 2002.
    1. Axelsson U., Rydén L., Johnsson P., Edén P., Månsson J., Hallberg I.R., Borrebaeck C.A.K. A multicenter study investigating the molecular fingerprint of psychological resilience in breast cancer patients: Study protocol of the SCAN-B resilience study. BMC Cancer. 2018;18:1–7. doi: 10.1186/s12885-018-4669-y.
    1. Saal L.H., Vallon-Christersson J., Hakkinen J., Hegardt C., Grabau D., Winter C., Brueffer C., Tang M.-H.E., Reuterswärd C., Schulz R., et al. The Sweden Cancerome Analysis Network-Breast (SCAN-B) Initiative: A large-scale multicenter infrastructure towards implementation of breast cancer genomic analyses in the clinical routine. Genome Med. 2015;7:20. doi: 10.1186/s13073-015-0131-9.
    1. Rydén L., Loman N., Larsson C., Hegardt C., Vallon-Christersson J., Malmberg M., Lindman H., Ehinger A., Saal L.H., Borg Å. Minimizing inequality in access to precision medicine in breast cancer by real-time population-based molecular analysis in the SCAN-B initiative. Br. J. Surg. 2018;105:e158–e168. doi: 10.1002/bjs.10741.
    1. Swedish National Quality Register for Breast Cancer (NKBC) [(accessed on 5 February 2021)]; Available online:
    1. Mohlin Åsa, Axelsson U., Bendahl P.-O., Borrebaeck C., Hegardt C., Johnsson P., Hallberg I.R., Rydén L. Psychological Resilience and Health-Related Quality of Life in Swedish Women with Newly Diagnosed Breast Cancer. Cancer Manag. Res. 2020;12:12041–12051. doi: 10.2147/CMAR.S268774.
    1. The Public Health Agency of Sweden. [(accessed on 5 February 2021)]; Available online:
    1. Statistics Sweden. Surveys about Living Conditions (ULF/SILC) [(accessed on 5 February 2021)]; Available online:
    1. Steyerberg E. Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating. Springer; New York, NY, USA: 2009.
    1. Loprinzi C.E., Prasad K., Schroeder D.R., Sood A. Stress Management and Resilience Training (SMART) Program to Decrease Stress and Enhance Resilience among Breast Cancer Survivors: A Pilot Randomized Clinical Trial. Clin. Breast Cancer. 2011;11:364–368. doi: 10.1016/j.clbc.2011.06.008.
    1. Tan W.S., Beatty L., Kemp E., Koczwara B. What contributes to resilience in cancer patients? A principal component analysis of the Connor–Davidson Resilience Scale. Asia-Pac. J. Clin. Oncol. 2019;15:e115–e119.
    1. Dooley L.N., Slavich G.M., Moreno P.I., Bower J.E. Strength through adversity: Moderate lifetime stress exposure is associated with psychological resilience in breast cancer survivors. Stress Health. 2017;33:549–557. doi: 10.1002/smi.2739.
    1. Fernández de Larrea-Baz N., Pérez-Gómez B., Guerrero-Zotano Á., Casas A.M., Bermejo B., Baena-Cañada J.M., Antolin S., Sánchez-Rovira P., Vázquez M.R., Garcia-Sáenz J.Á., et al. Primary breast cancer and health related quality of life in Spanish women: The EpiGEICAM case-control study. Sci. Rep. 2020;10:7741. doi: 10.1038/s41598-020-63637-w.

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