Psychological Resilience and Breast Cancer: An Integrative Review

Psychological Resilience and Breast Cancer: An Integrative Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Psychological Resilience and Breast Cancer: An Integrative Review Maria Fernanda Matos Maluf, Lincon Jo Mori This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4864236/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Breast cancer is the second cancer among women in Brazil, with 66,280 new cases in 2022 and estimated 72,000 new cases by 2025, according to data from the Brazilian National Institute of Cancer. On the other hand, there are a few studies of psychological resilience in Brazilian women with breast cancer. The aim of this study was to investigate the psychological resilience process in breast cancer patients. An integrative review was conducted using databases such as PubMed, the Virtual Health Library (BVS), and ScienceDirect. The search included articles published between 2019 and 2024 in Portuguese, English, and Spanish. The following mesh terms were included: psychological resilience and breast cancer. The selection and analysis of articles followed the PRISMA guidelines. Of the 319 articles firstly selected, 39 were used in review. Of these, 14 included articles indicate that lack of support during breast cancer treatment can lead to adverse psychological consequences, thereby hindering resilience. The patients demonstrate hight level of anxiety, depression, decrease in self-esteem and self-concept, loss, or low fertility during the treatment in young women in childbearing age, which represents a significant concern for this population. For all breast cancer patients, the presence of external support, such as having family, friends, financial resources, and a support to carry out the treatment, prove to be relevant in maintaining mental health, thus enabling positive resilience. psychological resilience breast cancer women Figures Figure 1 Figure 2 Introduction In Brazil, 704,000 cancer cases are projected for the triennium from 2023 to 2025. Among women, breast cancer is one of the most prevalent malignancies, comprising 10.5% of cases, with an estimated incidence of 72,000 new cases by 2025, according to the National Cancer Institute (INCA) 1 . In 2022, the incidence of breast cancer among women was 66,280 new cases per 100,000 women, corresponding to an adjusted incidence rate of 43.74 cases per 100,000 women¹. In Iran, an estimated 6,160 new cases and 1,063 deaths are attributed to the disease each year 2 . In contrast, Sweden reports approximately 8,000 new cases annually 3 . Turkey exhibits a breast cancer incidence rate of 47.7 cases per 100,000 women 4 . Breast cancer prognosis is influenced by the stage at diagnosis and the tumor's characteristics. Early detection enhances the treatment's curative potential. However, in the presence of metastatic disease, treatment main objectives are prolonging survival and improving quality of life (INCA, 2022) 5 . The breast cancer treatment process is lengthy and influenced by multiple factors, including: the presence of a robust familial and social support system, the availability of comprehensive medical care encompassing all aspects of breast cancer treatment (access to a medical team addressing patient needs, medication for treatment continuity, socio-psychological support, etc), personal religious beliefs, reintegration into daily activities 6 , and consistent self-care practices 2 . The existence of the support network mentioned above is beneficial for the resilience process to occur properly. Resilience assists women with breast cancer in preserving quality of life (QOL) during treatment by promoting psychological flexibility and thereby enhancing problem-solving skills 2 . Resilience is defined as the capacity to face and respond positively to adversities and their potential negative outcomes, such as those encountered in breast cancer, which involve multimodal treatments (surgery, chemotherapy, radiotherapy, hormone therapy, etc.). These treatments can result in various psychological impacts on women, including self-image, self-esteem, and self-concept, leading to both psychological and psychiatric distress. Resilience is an individual characteristic encompassing emotional strength, courage, and adaptability. It helps to mitigate the negative impact of the illness and supports the adjustment process, characterized by perseverance, maintaining life's purpose, and self-confidence 4 . Being resilient does not imply that the individual does not experience stress, discomfort, or lack awareness of the adverse situation or the potential need for distancing oneself from it 9 . The Fig. 1 summarizes the negative and positive influences on the psychological resilience of women with breast cancer. Figure 1 illustrates the positive and negative elements that influence psychological resilience processes. Individuals diagnosed with breast cancer have a pre-existing psychological structure, which may be more or less altered by the diagnosis and treatment, along with existing socio-environmental factors. Resilience in breast cancer patients can foster health-related behaviors and lead to an improved Qol. One possible explanation is that resilience can mitigate negative emotions, such as distress and anger, thereby promoting health-related behaviors. These enhanced positive behaviors, in turn, contribute to an improved Qol 2 . Several factors can delay or hinder a patient's recovery from breast cancer treatment, potentially compromising their resilience (Table 1 ): Table 1 Barriers to resilience in breast cancer Source: adapted from Walton et al (2023) 10 Barrier Description Lack of awareness ✓ Lack of awareness regarding the symptoms and signs of breast cancer delays seeking assistance. ✓ Existing myths related to the causes of breast cancer continue to contribute to delays in treatment. ✓ Existence of stigma regarding cancer: not telling family and friends about having breast cancer. Biological / medical barriers : insensitivity of doctors, leading to late/incorrect diagnosis. ✓ Insensitivity of family doctors in referring the patient to hospital care. ✓ Late/incorrect diagnosis: receiving confusing information, misdiagnosis Physical barriers : inability to tolerate and control chemotherapy side effects (such as tiredness, fatigue, decreased energy levels), which hinder the performance of daily tasks. Social barriers : shortage of familiar and social support ✓ Lack of familial / social support : lack of support from spouse and children, fostering feelings of insecurity. Some patients express solitude and a desire to have relatives or someone to talk to when they are alone at home. Colleagues pity and non-acceptance after recovery. Psychological barriers ✓ Early stages : causes anxiety, panic, and non-acceptance. ✓ During treatment : incapability to discuss feelings, solitude, depression, and emotional alterations. ✓ Recovery stage : fear of recurrence, concern, uncertainty, and avoidance, not wanting to remember the lived experience. ✓ Inability to discuss feelings : due to fears of exacerbating existing tensions or becoming a burden, women often choose to avoid discussing their struggles with close family members. Sometimes they feel that their family members do not understand what they are going through. ✓ Emotional alterations : some women experience mood changes, feelings of sadness and aloneness, and may find themselves crying when alone. ✓ Fear and neediness : occur in all patients with breast cancer. ✓ Concern and uncertainty : women harbor concerns regarding the adverse effects of chemotherapy, cancer recurrence, and mortality. ✓ Avoidance : women prefer to avoid discussing or thinking what occurred (or is occurring) or recalling anything related to cancer. The presence of religiosity or faith is also significant in the resilience process of breast cancer patients, as studied by Al Eid et al 11 . In the highly religious society of Saudi Arabia, the authors investigated the relationship between religion, resilience, and mental health in 329 breast cancer patients aged 26 to 46 years, randomly selected using a questionnaire that assesses the role of religion. Findings indicated that within the Muslim cultural context, religion was perceived as a mechanism for coping with health, playing an important role in preserving mental health alongside resilience. A study conducted by Boskailo et al 12 assessed 60 women with breast cancer, divided into two groups: those undergoing chemotherapy (n = 30) and those undergoing radiotherapy (n = 30). The participants completed a sociodemographic questionnaire developed by the authors, as well as the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Connor Davidson Resilience Scale (CD-RISC-25) to measure psychological resilience. Women treated with radiotherapy exhibited statistically significant results in the QOL subscales of mental health, social relationships, and environment compared to individuals treated with chemotherapy. No statistically significant differences were observed in the other QOL domains or in the resilience scale between radiotherapy and chemotherapy groups. Additionally, no statistically significant age differences were found between subjects based on treatment type, and no statistically significant correlations were detected between resilience level and QOL domain scores in women with breast cancer 12 . Furthermore, fertility is a concern reported by young breast cancer patients undergoing treatment. Carr et al 13 explored the impact of cancer-related fertility concerns on existential distress and meaning-making in female breast cancer patients of childbearing age (mean age 37.9 years). The authors employed questionnaires to qualitatively assess participants' experiences and support needs. For this study, 98 participants were recruited, mostly white (88.7%), married/cohabiting (78.5%), and with full-time employment (63.3%). During the cancer experience, over 50% of the participants expressed a need for support from an adviser or support group, 60.2% were seeking some form of help or treatment for anxiety, distress, or other emotional difficulties at the time, and 53.6% reported that these difficulties were "mainly related" or "completely related" to having had cancer 13 . Zhu et al. 13 explored the relationship between fertility concerns and resilience in young breast cancer patients. Their study involved 391 women aged between 20 and 49 years who were aware of their breast cancer diagnosis. The majority of the participants (69%) had undergone radical mastectomy. The authors observed that breast cancer patients of childbearing age, either childless or intending to have children, experienced higher fertility-related pressure that can strain their relationships and lead to marital crises. Higher levels of reproductive concern were observed in patients under 35 years old, with fewer children, lower household income, and unemployment 13 . It was also observed that self-disclosure was significantly associated with reproductive concern. Cancer treatment can impair patients' fertility to some extent, leading to negative emotions such as worry, inferiority, and sadness 13 . Cerezo, Álvarez-Olmo, and Rueda (2015) 15 investigated the role of psychological mechanisms, specifically resilience and well-being, in the psycho-oncological adjustment of 109 breast cancer patients aged between 31 and 75 years, with 60.6% of the participants over 50 years old, who completed questionnaires on general health, resilience, and well-being (life satisfaction and affect). The authors found a correlation between resilience and overall health. Women with higher levels of positive affect reported better overall health, while those with lower overall health scores exhibited negative affect 15 . Health-related quality of life (HRQoL) is an individual's perception of their physical, psychological, and social well-being. It serves as a benchmark for evaluating the overall therapeutic effect of cancer treatment and patients' overall functional rehabilitation throughout their lives 3 , 6 , 9 . Mohin et al. 9 conducted a longitudinal study to investigate the relationship between HRQoL and resilience in the first year following a breast cancer diagnosis. The authors also investigated changes in resilience levels in relation to demographic, clinicopathological, and treatment-specific characteristics in 418 Swedish women with primary breast cancer, aged between 31 and 69 years, of whom 81% were postmenopausal. The study population had clinicopathological characteristics similar to those of the Swedish population diagnosed with breast cancer during the same study period, September 2018 9 . The findings showed that postmenopausal women (n = 325) had lower levels of resilience one year after diagnosis than premenopausal women (n = 74). In addition, higher levels of resilience were also observed in women with greater trust in treatment, satisfaction with treatment implementation, and a higher level of satisfaction with encounters between the team and the patient throughout the treatment process 9 . Univariate and multivariate regression analyses provided strong evidence of associations between resilience and all domains of HRQoL. One year after diagnosis, higher levels of resilience were observed to be associated with higher levels of HRQoL. This suggests that resilience is an important factor in maintaining HRQoL among women with breast cancer 9 . Veličković et al. 3 conducted a longitudinal study to investigate changes in HRQoL from diagnosis to one-year post-diagnosis in breast cancer patients and the influence of clinical, psychological, and sociodemographic variables. The study also examined the mediating and moderating effects of resilience on changes in health-related QOL. The study participants were newly diagnosed with breast cancer, aged between 31 and 89 years, and completed measures of health-related QOL, resilience, and sociodemographic variables at diagnosis (n = 980) and one-year post-diagnosis (n = 780). Clinical variables were extracted from the Swedish National Quality Registry for Breast Cancer 3 . Participants completed the resilience, HRQoL, and sociodemographic measures electronically or on paper at diagnosis and again one year after diagnosis 3 . The type of treatment the patients received had a significant impact on their HRQoL. Patients who underwent total mastectomy, chemotherapy, targeted therapy, and bisphosphonate therapy experienced a greater decline in HRQoL. Furthermore, the most stressful period was the diagnosis, characterized by uncertainty and anticipation. The lowest score and the change in HRQoL are most likely indicative of the impact of the diagnostic process on patients' mental health. This underscores the need for individualized rehabilitation plans that address areas of daily functioning impairment, complementing medical treatment for breast cancer itself. The authors emphasize that even with improvements in mental HRQoL, this should not be neglected and should not be interpreted as an indication that psychosocial support is unnecessary 3 . Zhou et al. 6 evaluated predictors of HRQoL, including coping styles, perceived social support, and resilience, in 231 breast cancer patients aged between 25 and 78 years. The study indicated resilience as a significant mediator between confrontation/resignation (mean = 52.60), perceived social support (mean = 66.50), and coping styles such as confrontation (mean = 19.05), avoidance (mean = 16.96), and resignation (mean = 10.82), in health-related quality of life (HRQoL). This suggests that resilience plays a crucial role in amplifying the positive influences of confrontation and perceived social support, or mitigating the negative influences of resignation, on HRQoL 6 . The correlation analysis demonstrated that confrontation was associated with better perceived social support and resilience, and higher levels of perceived social support were linked to greater resilience. Zhou et al. investigated the mediating roles of perceived social support and coping style (CS) in the relationship between resilience and HRQoL in Chinese women newly diagnosed with breast cancer (n = 431). They observed that these women had low QoL, particularly in functional well-being, lower levels of resilience and perceived social support, and higher levels of avoidance and resignation in coping style. The patients' HRQoL was significantly influenced by resilience, perceived social support, and confrontational and resignation coping styles. Soyer Er e Erkan 4 examined the association between psychological resilience, spiritual well-being, and supportive care needs in women with breast cancer. They found that resilience mediates the relationship between spiritual well-being and supportive care needs, contributing to a decrease in the latter. Additionally, the authors observed lower resilience and perceived social support, and a higher avoidant coping style. Tomić et al. 16 conducted a descriptive cross-sectional analytical study to determine the levels of social support and resilience in breast cancer patients. Moreover, they also investigated the effects of predictors on social support levels and whether resilience was a mediator between patients' sociodemographic and clinical characteristics and social support levels. Serbian women with breast cancer (n = 236) were assessed using the PSS. The majority were over 65 years old (65.7%) and had completed primary school education (55.1%). About half (50.8%) were unemployed, and 61% lived in urban areas. Additionally, 71.2% reported having a partner, and 50.8% classified their socioeconomic level as average. The majority of treatments were completed in the last 3 years (64.4%), and half of them reported no stress in the last year. Combined treatment, including local and systemic methods, was administered to 67.8% of the study participants. Almost half of the participants (49.2% vs. 45.8%) experienced mild pain and fatigue. Methods This integrative literature review utilized the Mesh Terms "psychological resilience AND breast cancer" and "resilience AND breast cancer". It included articles published in English from 2019 to 2024 in the PubMed, Virtual Health Library (BVS), and ScienceDirect databases, using the Boolean operator AND to combine the search terms. “An integrative review synthesizes and evaluates current knowledge of a topic to provide new insights therein. An integrative review enables the synthesis of knowledge from across research approaches in a fragmented field” 17 . An integrative review expands and diversifies knowledge on a topic by integrating knowledge from across the areas of practice that study it, and how, and why the topic has been studied in each area. The integrative review borrows techniques from other knowledge-synthesis vehicles: it collects and evaluates studies (systematic review), describes the landscape of research on a topic (narrative review), evaluates study conclusions regarding specific constructs (meta-analysis), and determines implications for how and why a topic should be studied (theory) moving forward. The representation and knowledge synthesis across different types of practice, however, change the way these common processes are executed. (Cronin e George, 2023, p.169). 17 The review included cross-sectional and longitudinal studies with open access in the databases, which dealt exclusively with the topic of psychological resilience in women with breast cancer, published in English and Portuguese in full text. Furthermore, articles were excluded if they did not return the designated search terms, were letters to the editor, lacked abstracts, or were duplicates within databases. The review also excluded articles focused on Covid-19, without open access, validating research instruments, or exploring psychometric properties of questionnaires. Studies on other cancer types, existing literature reviews (integrative, systematic, bibliometric), and any results outside the research topic were also excluded. The research, conducted on January 4, 2024, identified a total of 319 records. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews. Following the database search, a screening based on titles was conducted to identify articles that contained the terms "breast cancer" and "psychological resilience" (resilience) and met the inclusion criteria. As a result, this process yielded 38 articles, of which 9 were duplicates and 15 were not open access, leaving 14 eligible articles for full-text review. All 14 eligible articles were included in the final analysis Results A total of 14 articles were included in this study. These articles were selected from an initial pool of 319 identified through a PRISMA-compliant analysis (Fig. 2 ). The articles included in the study are listed in Table 2. The majority of the included studies (86.41%) were cross-sectional, with only two longitudinal studies (14.28%) 3,8 . All studies (both cross-sectional and longitudinal) 2 – 14 employed a 95% confidence interval (CI). Table 2 Articles selected for use Author Date Country Type of study Abdollahi et al 2 2022 Iran Cross-sectional study Veličković et al 3 2022 Sweden Longitudinal study Soyer Er and Erkan 4 2023 Türkiye Cross-sectional study Zhou et al 6 2022 China Cross-sectional study Reis, Panobiano, Geadim 7 2019 Brazil Cross-sectional study Mohlin et al 8 2021 Switzerland Longitudinal study Walton et al 9 2023 India Cross-sectional study Al Eid et al 10 2020 Saudi Arabia Cross-sectional study Boskailo et al 11 2021 Bosnia Cross-sectional study Carr et al 12 2022 USA Cross-sectional study Zhu et al 13 2023 China Cross-sectional study Cerezo et al 14 2022 Spain Cross-sectional study Zhou, Ning, Wang e Li 15 2022 China Cross-sectional study. Tomić et al 16 2023 Serbia Cross-sectional study. Font: Search data (2024) Analysis of publication dates revealed that 2022 was the year with the highest number of studies (n = 6, 42.85%), followed by 2023 with four publications (28.57%), two publications in 2021 (14.28%), while 2020 and 2019 each contributed with one study (7.14%, respectively). One year following breast cancer diagnosis, resilience exhibits a positive association with HRQoL 8 . Another component of HRQoL is physical health, which decreases one year after the diagnosis, while mental health-related QOL improves 3 . In contrast to findings from other studies, Boskailo et al.'s 11 investigation did not reveal a significant association between resilience levels and QOL in breast cancer patients, even though the self-care mechanism is implied in the relationship between resilience and QOL. At the time of diagnosis, conducting a biopsychosocial assessment can help identify women in need of additional support. This assessment can facilitate the development of a multidimensional treatment plan that assists patients in overcoming daily challenges 3 and enhancing the positive influences of resilience on their HRQoL 6 . Psychoeducational interventions should be prioritized to reduce reproductive concerns 13 . Women who have had cancer need resilience to face the challenges posed by society, alongside the support of their families 7 , and the need to incorporate spirituality in their lives, as it positively can positively enhance their resilience 10 . Regarding the fertility of breast cancer patients of childbearing age, Carr et al. 12 emphasize the need for the development of psychological interventions to support and assist these women in addressing their existential distress, which arises from the potential impact of cancer treatment on their fertility. Psychological resilience plays a crucial role in reducing the support needs of breast cancer patients, positively impacting their well-being and spirituality 4 . Therefore, it is essential for healthcare professionals to assess the resilience needs of breast cancer survivors and provide high-quality oncological care through individualized evaluation of each patient 9 . Discussion This study aimed to investigate the process of psychological resilience in women with breast cancer through an integrative literature review, using the Prisma guideline for selection and evaluation of the articles included. Therefore, analysis of 14 articles revealed that a strong social support network, including healthcare providers, friends, and family is positively associated with psychological resilience. Additionally, the absence of pre-existing mental health conditions, such as anxiety and depression, and good HRQoL emerged as contributing factors The findings indicate the importance of the multidisciplinary team in acknowledging patients' need to process the experience and providing support when resilience mechanisms are not functioning effectively. Younger women in their reproductive years may face a more challenging resilience process due to social pressure to have children. Conversely, older women may exhibit better psychological resilience as a result of having already established their families 12 , 13 . In addition to the previously discussed findings, the main contribution of a literature review is to consolidate knowledge and understanding on a particular topic, starting with its definition. In this case, resilience is defined as the ability to face and respond positively to adversities and their potential negative outcomes 8 . This concept applies to breast cancer 9 , which involves surgery, chemotherapy, radiotherapy, and hormone therapy. Each of these interventions can exert a significant impact on women's psyche, affecting not only their self-image but also their self-esteem, self-concept, sexuality, and both psychological and psychiatric well-being. The limitations of this study include the small and inconsistent volume of articles published on the topic of psychological resilience and breast cancer within the period of 2019 to 2024, despite the initially large number of articles selected (n = 319). Moreover, another limitation is the scarcity of longitudinal studies, with only two identified compared to twelve cross-sectional studies. In Brazil, as in other countries, cross-sectional studies are more common (12 in this review versus two longitudinal studies) due to the ease of carrying them out and the lower cost involved, for example. Therefore, further longitudinal studies are needed, such as the one currently being conducted by this author, which aims to evaluate the resilience process in women with breast cancer in Brazil over the course of a year, with quarterly reassessments. This approach will enable a comprehensive understanding of the resilience trajectory of these patients from the time of diagnosis. Declarations Contribution MF conducted the literature review and wrote the article. LM reviewed the article and contributed to the development of the discussion section. Declaration of interests We declare no competing interests. Author Contribution MF conducted the literature review and wrote the article. LM reviewed the article and contributed to the development of the discussion section. Acknowledgement To Fabricio Saad in reviewed the article and contributed to the development of the discussion section. References National Cancer Institute (INCA). 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Eur J Breast Health 19(4):297–303. 10.4274/ejbh.galenos.2023.2023-6-5 National Cancer Institute (INCA). Tratamento: tratamento do câncer de mama. 26 set (2022) Retrieved from: https://www.gov.br/inca/pt-br/assuntos/gestor-e-profissional-de-saude/controle-do-cancer-de-mama/acoes/tratamento Zhou K, Ning F, Wang X, Wang W, Han D, Li X (2022) Perceived social support and coping style as mediators between resilience and health-related quality of life in women newly diagnosed with breast cancer: a cross-sectional study. BMC Womens Health 22(1):198. 10.1186/s12905-022-01783-1 Reis APL, Panobianco MS, Gradim CVC (2019) Enfrentamento de mulheres que vivenciaram o câncer de mama. Rev Enfer Centro-Oeste Mineiro 9:e2758. http://dx.doi.org/10.19175/recom.v9i0.2758 Mohlin Å, Bendahl PO, Hegardt C, Richter C, Hallberg IR, Rydén L (2021) Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study. Cancers (Basel) 13(9):2233. 10.3390/cancers13092233 Walton M, Lee P Lived Experience of Adult Female Cancer Survivors to Discover Common Protective Resilience Factors to Cope with Cancer Experience and to Identify Potential Barriers to Resilience. Indian J Palliat Care 2023 Apr-Jun ;29(2):186–194. 10.25259/IJPC_214_2022 Al Eid NA, Alqahtani MM, Marwa K, Arnout BA, Alswailem HS, Al Toaimi AA, Religiosity (2020) Psychological Resilience, and Mental Health Among Breast Cancer Patients in Kingdom of Saudi Arabia. Breast Cancer (Auckl) 14:1178223420903054. 10.1177/1178223420903054 Boškailo E, Franjić D, Jurić I, Kiseljaković E, Marijanović I, Babić D (2021 Spring-Summer) Resilience and Quality of Life of Patients with Breast Cancer. Psychiatr Danub 33(Suppl 4):572–579 Carr AL, Roberts S, Bonnell LN, Kolva E (2022) Existential distress and meaning making among female breast cancer patients with cancer-related fertility concerns. Palliat Support Care 196–204. https://doi.org/10.1017/S1478951522001675 Zhu H, Tao L, Hu X, Jiang X (2023) Effects of self-disclosure and resilience on reproductive concern in patients of childbearing age with breast cancer: a cross-sectional survey study. BMJ Open 13(2):e068126. 10.1136/bmjopen-2022-068126 Cerezo MV, Álvarez-Olmo A, Rueda P (2022) General Health and Resilience of Breast Cancer Patients: The Mediator Role of Affective Well-Being. Int J Environ Res Public Health 19(9):5398. 10.3390/ijerph19095398 Cronin MAe, George E (2023) O porquê e como da revisão integrativa. Métodos de Pesquisa Organizacional 26(1):168–192. Doi.org/10.1177/1094428120935507 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4864236","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":337861668,"identity":"6cf195ab-ff93-47d1-b30f-da766c897ff1","order_by":0,"name":"Maria Fernanda Matos Maluf","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYFAC5gaGCgY5CJuHwQZIMjYewK+FsYHhDIMxTEsaWIQkLYfBNF4tuu0H2yQOMBjImc9ufvbgTc15u7Xth4G21NhE49JidiYRrMVY5s4xc8M5x24nbzuTCNRyLC23AZeWA4lt0h8Y/iTOkEgwk+Zhu50MFGk4wNhwGLeW8w/BttTPkEj/Js3z71wyUISAlhsQhyVISOSYSfO2HbADihDS8rDZ4oCBgeEMiZwyybl9yQlAkYYDCfj8cj754I0DFQbyEhLp2yTefLOzNzuf/vDBhxobnFogwADBTASrTMCrHA3Yk6J4FIyCUTAKRgYAAFZKZCfoYLi0AAAAAElFTkSuQmCC","orcid":"","institution":"Fluminese Federal University","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"Fernanda Matos","lastName":"Maluf","suffix":""},{"id":337861669,"identity":"0d618915-df93-4f18-a26b-47480df94067","order_by":1,"name":"Lincon Jo Mori","email":"","orcid":"","institution":"Syrian Lebanese Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lincon","middleName":"Jo","lastName":"Mori","suffix":""}],"badges":[],"createdAt":"2024-08-05 20:44:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4864236/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4864236/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62321797,"identity":"0ac04249-1969-4a8b-b60f-139ea5766f4b","added_by":"auto","created_at":"2024-08-13 01:55:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":798065,"visible":true,"origin":"","legend":"\u003cp\u003eElements that promote positive or negative resilience\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4864236/v1/6dbc3cf070040f39cfb15b96.png"},{"id":62321815,"identity":"9a419873-9e9f-4a24-b61b-b8512aede77e","added_by":"auto","created_at":"2024-08-13 01:55:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45998,"visible":true,"origin":"","legend":"\u003cp\u003eStudy selection\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4864236/v1/e675e5b1cd1f050055c65329.png"},{"id":62321845,"identity":"684e92ec-2018-4623-b267-5a0ad41c70f6","added_by":"auto","created_at":"2024-08-13 01:55:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1290572,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4864236/v1/bdaa01a3-4d27-4499-b612-7a6fc80183bf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePsychological Resilience and Breast Cancer: An Integrative Review\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Brazil, 704,000 cancer cases are projected for the triennium from 2023 to 2025. Among women, breast cancer is one of the most prevalent malignancies, comprising 10.5% of cases, with an estimated incidence of 72,000 new cases by 2025, according to the National Cancer Institute (INCA)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In 2022, the incidence of breast cancer among women was 66,280 new cases per 100,000 women, corresponding to an adjusted incidence rate of 43.74 cases per 100,000 women\u0026sup1;.\u003c/p\u003e\n\u003cp\u003eIn Iran, an estimated 6,160 new cases and 1,063 deaths are attributed to the disease each year\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. In contrast, Sweden reports approximately 8,000 new cases annually\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Turkey exhibits a breast cancer incidence rate of 47.7 cases per 100,000 women\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBreast cancer prognosis is influenced by the stage at diagnosis and the tumor's characteristics. Early detection enhances the treatment's curative potential. However, in the presence of metastatic disease, treatment main objectives are prolonging survival and improving quality of life (INCA, 2022)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe breast cancer treatment process is lengthy and influenced by multiple factors, including: the presence of a robust familial and social support system, the availability of comprehensive medical care encompassing all aspects of breast cancer treatment (access to a medical team addressing patient needs, medication for treatment continuity, socio-psychological support, etc), personal religious beliefs, reintegration into daily activities\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, and consistent self-care practices\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe existence of the support network mentioned above is beneficial for the resilience process to occur properly. Resilience assists women with breast cancer in preserving quality of life (QOL) during treatment by promoting psychological flexibility and thereby enhancing problem-solving skills\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eResilience is defined as the capacity to face and respond positively to adversities and their potential negative outcomes, such as those encountered in breast cancer, which involve multimodal treatments (surgery, chemotherapy, radiotherapy, hormone therapy, etc.). These treatments can result in various psychological impacts on women, including self-image, self-esteem, and self-concept, leading to both psychological and psychiatric distress.\u003c/p\u003e\n\u003cp\u003eResilience is an individual characteristic encompassing emotional strength, courage, and adaptability. It helps to mitigate the negative impact of the illness and supports the adjustment process, characterized by perseverance, maintaining life's purpose, and self-confidence\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBeing resilient does not imply that the individual does not experience stress, discomfort, or lack awareness of the adverse situation or the potential need for distancing oneself from it\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the negative and positive influences on the psychological resilience of women with breast cancer.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the positive and negative elements that influence psychological resilience processes. Individuals diagnosed with breast cancer have a pre-existing psychological structure, which may be more or less altered by the diagnosis and treatment, along with existing socio-environmental factors.\u003c/p\u003e\n\u003cp\u003eResilience in breast cancer patients can foster health-related behaviors and lead to an improved Qol. One possible explanation is that resilience can mitigate negative emotions, such as distress and anger, thereby promoting health-related behaviors. These enhanced positive behaviors, in turn, contribute to an improved Qol\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSeveral factors can delay or hinder a patient's recovery from breast cancer treatment, potentially compromising their resilience (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003eBarriers to resilience in breast cancer\u003c/span\u003e Source: adapted from Walton et al (2023)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBarrier\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDescription\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eLack of awareness\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Lack of awareness regarding the symptoms and signs of breast cancer delays seeking assistance.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Existing myths related to the causes of breast cancer continue to contribute to delays in treatment.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Existence of stigma regarding cancer: not telling family and friends about having breast cancer.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eBiological / medical barriers\u003c/span\u003e: insensitivity of doctors, leading to late/incorrect diagnosis.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Insensitivity of family doctors in referring the patient to hospital care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Late/incorrect diagnosis: receiving confusing information, misdiagnosis\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePhysical barriers\u003c/span\u003e: inability to tolerate and control chemotherapy side effects (such as tiredness, fatigue, decreased energy levels), which hinder the performance of daily tasks.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSocial barriers\u003c/span\u003e: shortage of familiar and social support\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eLack of familial / social support\u003c/span\u003e: lack of support from spouse and children, fostering feelings of insecurity. Some patients express solitude and a desire to have relatives or someone to talk to when they are alone at home. Colleagues pity and non-acceptance after recovery.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"8\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePsychological barriers\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eEarly stages\u003c/span\u003e: causes anxiety, panic, and non-acceptance.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eDuring treatment\u003c/span\u003e: incapability to discuss feelings, solitude, depression, and emotional alterations.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eRecovery stage\u003c/span\u003e: fear of recurrence, concern, uncertainty, and avoidance, not wanting to remember the lived experience.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eInability to discuss feelings\u003c/span\u003e: due to fears of exacerbating existing tensions or becoming a burden, women often choose to avoid discussing their struggles with close family members. Sometimes they feel that their family members do not understand what they are going through.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eEmotional alterations\u003c/span\u003e: some women experience mood changes, feelings of sadness and aloneness, and may find themselves crying when alone.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eFear and neediness\u003c/span\u003e: occur in all patients with breast cancer.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eConcern and uncertainty\u003c/span\u003e: women harbor concerns regarding the adverse effects of chemotherapy, cancer recurrence, and mortality.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ \u003cspan class=\"Underline\"\u003eAvoidance\u003c/span\u003e: women prefer to avoid discussing or thinking what occurred (or is occurring) or recalling anything related to cancer.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cp\u003eThe presence of religiosity or faith is also significant in the resilience process of breast cancer patients, as studied by Al Eid et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In the highly religious society of Saudi Arabia, the authors investigated the relationship between religion, resilience, and mental health in 329 breast cancer patients aged 26 to 46 years, randomly selected using a questionnaire that assesses the role of religion. Findings indicated that within the Muslim cultural context, religion was perceived as a mechanism for coping with health, playing an important role in preserving mental health alongside resilience.\u003c/p\u003e\n\u003cp\u003eA study conducted by Boskailo et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e assessed 60 women with breast cancer, divided into two groups: those undergoing chemotherapy (n\u0026thinsp;=\u0026thinsp;30) and those undergoing radiotherapy (n\u0026thinsp;=\u0026thinsp;30). The participants completed a sociodemographic questionnaire developed by the authors, as well as the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Connor Davidson Resilience Scale (CD-RISC-25) to measure psychological resilience.\u003c/p\u003e\n\u003cp\u003eWomen treated with radiotherapy exhibited statistically significant results in the QOL subscales of mental health, social relationships, and environment compared to individuals treated with chemotherapy. No statistically significant differences were observed in the other QOL domains or in the resilience scale between radiotherapy and chemotherapy groups. Additionally, no statistically significant age differences were found between subjects based on treatment type, and no statistically significant correlations were detected between resilience level and QOL domain scores in women with breast cancer\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFurthermore, fertility is a concern reported by young breast cancer patients undergoing treatment. Carr et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e explored the impact of cancer-related fertility concerns on existential distress and meaning-making in female breast cancer patients of childbearing age (mean age 37.9 years). The authors employed questionnaires to qualitatively assess participants' experiences and support needs.\u003c/p\u003e\n\u003cp\u003eFor this study, 98 participants were recruited, mostly white (88.7%), married/cohabiting (78.5%), and with full-time employment (63.3%). During the cancer experience, over 50% of the participants expressed a need for support from an adviser or support group, 60.2% were seeking some form of help or treatment for anxiety, distress, or other emotional difficulties at the time, and 53.6% reported that these difficulties were \"mainly related\" or \"completely related\" to having had cancer\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eZhu et al. \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e explored the relationship between fertility concerns and resilience in young breast cancer patients. Their study involved 391 women aged between 20 and 49 years who were aware of their breast cancer diagnosis. The majority of the participants (69%) had undergone radical mastectomy.\u003c/p\u003e\n\u003cp\u003eThe authors observed that breast cancer patients of childbearing age, either childless or intending to have children, experienced higher fertility-related pressure that can strain their relationships and lead to marital crises. Higher levels of reproductive concern were observed in patients under 35 years old, with fewer children, lower household income, and unemployment\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIt was also observed that self-disclosure was significantly associated with reproductive concern. Cancer treatment can impair patients' fertility to some extent, leading to negative emotions such as worry, inferiority, and sadness\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCerezo, \u0026Aacute;lvarez-Olmo, and Rueda (2015)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e investigated the role of psychological mechanisms, specifically resilience and well-being, in the psycho-oncological adjustment of 109 breast cancer patients aged between 31 and 75 years, with 60.6% of the participants over 50 years old, who completed questionnaires on general health, resilience, and well-being (life satisfaction and affect).\u003c/p\u003e\n\u003cp\u003eThe authors found a correlation between resilience and overall health. Women with higher levels of positive affect reported better overall health, while those with lower overall health scores exhibited negative affect\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eHealth-related quality of life (HRQoL) is an individual's perception of their physical, psychological, and social well-being. It serves as a benchmark for evaluating the overall therapeutic effect of cancer treatment and patients' overall functional rehabilitation throughout their lives\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMohin et al.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e conducted a longitudinal study to investigate the relationship between HRQoL and resilience in the first year following a breast cancer diagnosis. The authors also investigated changes in resilience levels in relation to demographic, clinicopathological, and treatment-specific characteristics in 418 Swedish women with primary breast cancer, aged between 31 and 69 years, of whom 81% were postmenopausal. The study population had clinicopathological characteristics similar to those of the Swedish population diagnosed with breast cancer during the same study period, September 2018\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe findings showed that postmenopausal women (n\u0026thinsp;=\u0026thinsp;325) had lower levels of resilience one year after diagnosis than premenopausal women (n\u0026thinsp;=\u0026thinsp;74). In addition, higher levels of resilience were also observed in women with greater trust in treatment, satisfaction with treatment implementation, and a higher level of satisfaction with encounters between the team and the patient throughout the treatment process\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eUnivariate and multivariate regression analyses provided strong evidence of associations between resilience and all domains of HRQoL. One year after diagnosis, higher levels of resilience were observed to be associated with higher levels of HRQoL. This suggests that resilience is an important factor in maintaining HRQoL among women with breast cancer\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eVeličković et al.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e conducted a longitudinal study to investigate changes in HRQoL from diagnosis to one-year post-diagnosis in breast cancer patients and the influence of clinical, psychological, and sociodemographic variables. The study also examined the mediating and moderating effects of resilience on changes in health-related QOL.\u003c/p\u003e\n\u003cp\u003eThe study participants were newly diagnosed with breast cancer, aged between 31 and 89 years, and completed measures of health-related QOL, resilience, and sociodemographic variables at diagnosis (n\u0026thinsp;=\u0026thinsp;980) and one-year post-diagnosis (n\u0026thinsp;=\u0026thinsp;780). Clinical variables were extracted from the Swedish National Quality Registry for Breast Cancer\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eParticipants completed the resilience, HRQoL, and sociodemographic measures electronically or on paper at diagnosis and again one year after diagnosis\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe type of treatment the patients received had a significant impact on their HRQoL. Patients who underwent total mastectomy, chemotherapy, targeted therapy, and bisphosphonate therapy experienced a greater decline in HRQoL.\u003c/p\u003e\n\u003cp\u003eFurthermore, the most stressful period was the diagnosis, characterized by uncertainty and anticipation. The lowest score and the change in HRQoL are most likely indicative of the impact of the diagnostic process on patients' mental health. This underscores the need for individualized rehabilitation plans that address areas of daily functioning impairment, complementing medical treatment for breast cancer itself. The authors emphasize that even with improvements in mental HRQoL, this should not be neglected and should not be interpreted as an indication that psychosocial support is unnecessary\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eZhou et al. \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e evaluated predictors of HRQoL, including coping styles, perceived social support, and resilience, in 231 breast cancer patients aged between 25 and 78 years. The study indicated resilience as a significant mediator between confrontation/resignation (mean\u0026thinsp;=\u0026thinsp;52.60), perceived social support (mean\u0026thinsp;=\u0026thinsp;66.50), and coping styles such as confrontation (mean\u0026thinsp;=\u0026thinsp;19.05), avoidance (mean\u0026thinsp;=\u0026thinsp;16.96), and resignation (mean\u0026thinsp;=\u0026thinsp;10.82), in health-related quality of life (HRQoL). This suggests that resilience plays a crucial role in amplifying the positive influences of confrontation and perceived social support, or mitigating the negative influences of resignation, on HRQoL\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe correlation analysis demonstrated that confrontation was associated with better perceived social support and resilience, and higher levels of perceived social support were linked to greater resilience.\u003c/p\u003e\n\u003cp\u003eZhou et al. investigated the mediating roles of perceived social support and coping style (CS) in the relationship between resilience and HRQoL in Chinese women newly diagnosed with breast cancer (n\u0026thinsp;=\u0026thinsp;431). They observed that these women had low QoL, particularly in functional well-being, lower levels of resilience and perceived social support, and higher levels of avoidance and resignation in coping style. The patients' HRQoL was significantly influenced by resilience, perceived social support, and confrontational and resignation coping styles.\u003c/p\u003e\n\u003cp\u003eSoyer Er e Erkan\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e examined the association between psychological resilience, spiritual well-being, and supportive care needs in women with breast cancer. They found that resilience mediates the relationship between spiritual well-being and supportive care needs, contributing to a decrease in the latter. Additionally, the authors observed lower resilience and perceived social support, and a higher avoidant coping style.\u003c/p\u003e\n\u003cp\u003eTomić et al.\u003csup\u003e16\u003c/sup\u003e conducted a descriptive cross-sectional analytical study to determine the levels of social support and resilience in breast cancer patients. Moreover, they also investigated the effects of predictors on social support levels and whether resilience was a mediator between patients' sociodemographic and clinical characteristics and social support levels. Serbian women with breast cancer (n\u0026thinsp;=\u0026thinsp;236) were assessed using the PSS. The majority were over 65 years old (65.7%) and had completed primary school education (55.1%). About half (50.8%) were unemployed, and 61% lived in urban areas. Additionally, 71.2% reported having a partner, and 50.8% classified their socioeconomic level as average. The majority of treatments were completed in the last 3 years (64.4%), and half of them reported no stress in the last year. Combined treatment, including local and systemic methods, was administered to 67.8% of the study participants. Almost half of the participants (49.2% vs. 45.8%) experienced mild pain and fatigue.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis integrative literature review utilized the Mesh Terms \"psychological resilience AND breast cancer\" and \"resilience AND breast cancer\". It included articles published in English from 2019 to 2024 in the PubMed, Virtual Health Library (BVS), and ScienceDirect databases, using the Boolean operator AND to combine the search terms.\u003c/p\u003e \u003cp\u003e\u0026ldquo;An integrative review synthesizes and evaluates current knowledge of a topic to provide new insights therein. An integrative review enables the synthesis of knowledge from across research approaches in a fragmented field\u0026rdquo;\u003csup\u003e17\u003c/sup\u003e.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAn integrative review expands and diversifies knowledge on a topic by integrating knowledge from across the areas of practice that study it, and how, and why the topic has been studied in each area. The integrative review borrows techniques from other knowledge-synthesis vehicles: it collects and evaluates studies (systematic review), describes the landscape of research on a topic (narrative review), evaluates study conclusions regarding specific constructs (meta-analysis), and determines implications for how and why a topic should be studied (theory) moving forward. The representation and knowledge synthesis across different types of practice, however, change the way these common processes are executed. (Cronin e George, 2023, p.169). \u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e The review included cross-sectional and longitudinal studies with open access in the databases, which dealt exclusively with the topic of psychological resilience in women with breast cancer, published in English and Portuguese in full text.\u003c/p\u003e \u003cp\u003eFurthermore, articles were excluded if they did not return the designated search terms, were letters to the editor, lacked abstracts, or were duplicates within databases. The review also excluded articles focused on Covid-19, without open access, validating research instruments, or exploring psychometric properties of questionnaires. Studies on other cancer types, existing literature reviews (integrative, systematic, bibliometric), and any results outside the research topic were also excluded.\u003c/p\u003e \u003cp\u003eThe research, conducted on January 4, 2024, identified a total of 319 records. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.\u003c/p\u003e \u003cp\u003eFollowing the database search, a screening based on titles was conducted to identify articles that contained the terms \"breast cancer\" and \"psychological resilience\" (resilience) and met the inclusion criteria. As a result, this process yielded 38 articles, of which 9 were duplicates and 15 were not open access, leaving 14 eligible articles for full-text review. All 14 eligible articles were included in the final analysis\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 14 articles were included in this study. These articles were selected from an initial pool of 319 identified through a PRISMA-compliant analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe articles included in the study are listed in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eThe majority of the included studies (86.41%) were cross-sectional, with only two longitudinal studies (14.28%)\u003csup\u003e3,8\u003c/sup\u003e. All studies (both cross-sectional and longitudinal)\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e employed a 95% confidence interval (CI).\u003c/p\u003e \u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable\u0026nbsp;2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"SmallCaps\"\u003eArticles selected for use\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAuthor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCountry\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType of study\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbdollahi et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIran\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVeličković et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSweden\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLongitudinal study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSoyer Er and Erkan \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eT\u0026uuml;rkiye\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eZhou et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReis, Panobiano, Geadim \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrazil\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMohlin et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSwitzerland\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLongitudinal study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWalton et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAl Eid et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSaudi Arabia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBoskailo et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBosnia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCarr et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eZhu et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCerezo et al \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eZhou, Ning, Wang e Li \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTomić et al \u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSerbia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCross-sectional study.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eFont: Search data (2024)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAnalysis of publication dates revealed that 2022 was the year with the highest number of studies (n\u0026thinsp;=\u0026thinsp;6, 42.85%), followed by 2023 with four publications (28.57%), two publications in 2021 (14.28%), while 2020 and 2019 each contributed with one study (7.14%, respectively).\u003c/p\u003e \u003cp\u003eOne year following breast cancer diagnosis, resilience exhibits a positive association with HRQoL\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Another component of HRQoL is physical health, which decreases one year after the diagnosis, while mental health-related QOL improves\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn contrast to findings from other studies, Boskailo et al.'s\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e investigation did not reveal a significant association between resilience levels and QOL in breast cancer patients, even though the self-care mechanism is implied in the relationship between resilience and QOL.\u003c/p\u003e \u003cp\u003eAt the time of diagnosis, conducting a biopsychosocial assessment can help identify women in need of additional support. This assessment can facilitate the development of a multidimensional treatment plan that assists patients in overcoming daily challenges\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and enhancing the positive influences of resilience on their HRQoL\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Psychoeducational interventions should be prioritized to reduce reproductive concerns\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWomen who have had cancer need resilience to face the challenges posed by society, alongside the support of their families\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, and the need to incorporate spirituality in their lives, as it positively can positively enhance their resilience\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding the fertility of breast cancer patients of childbearing age, Carr et al.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e emphasize the need for the development of psychological interventions to support and assist these women in addressing their existential distress, which arises from the potential impact of cancer treatment on their fertility.\u003c/p\u003e \u003cp\u003ePsychological resilience plays a crucial role in reducing the support needs of breast cancer patients, positively impacting their well-being and spirituality\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, it is essential for healthcare professionals to assess the resilience needs of breast cancer survivors and provide high-quality oncological care through individualized evaluation of each patient\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study aimed to investigate the process of psychological resilience in women with breast cancer through an integrative literature review, using the Prisma guideline for selection and evaluation of the articles included.\u003c/p\u003e \u003cp\u003eTherefore, analysis of 14 articles revealed that a strong social support network, including healthcare providers, friends, and family is positively associated with psychological resilience. Additionally, the absence of pre-existing mental health conditions, such as anxiety and depression, and good HRQoL emerged as contributing factors\u003c/p\u003e \u003cp\u003eThe findings indicate the importance of the multidisciplinary team in acknowledging patients' need to process the experience and providing support when resilience mechanisms are not functioning effectively.\u003c/p\u003e \u003cp\u003eYounger women in their reproductive years may face a more challenging resilience process due to social pressure to have children. Conversely, older women may exhibit better psychological resilience as a result of having already established their families\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to the previously discussed findings, the main contribution of a literature review is to consolidate knowledge and understanding on a particular topic, starting with its definition. In this case, resilience is defined as the ability to face and respond positively to adversities and their potential negative outcomes\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. This concept applies to breast cancer \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, which involves surgery, chemotherapy, radiotherapy, and hormone therapy. Each of these interventions can exert a significant impact on women's psyche, affecting not only their self-image but also their self-esteem, self-concept, sexuality, and both psychological and psychiatric well-being.\u003c/p\u003e \u003cp\u003eThe limitations of this study include the small and inconsistent volume of articles published on the topic of psychological resilience and breast cancer within the period of 2019 to 2024, despite the initially large number of articles selected (n\u0026thinsp;=\u0026thinsp;319). Moreover, another limitation is the scarcity of longitudinal studies, with only two identified compared to twelve cross-sectional studies.\u003c/p\u003e \u003cp\u003eIn Brazil, as in other countries, cross-sectional studies are more common (12 in this review versus two longitudinal studies) due to the ease of carrying them out and the lower cost involved, for example. Therefore, further longitudinal studies are needed, such as the one currently being conducted by this author, which aims to evaluate the resilience process in women with breast cancer in Brazil over the course of a year, with quarterly reassessments. This approach will enable a comprehensive understanding of the resilience trajectory of these patients from the time of diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eContribution\u003c/h2\u003e \u003cp\u003e MF conducted the literature review and wrote the article. LM reviewed the article and contributed to the development of the \u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ediscussion\u003c/span\u003e section.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eDeclaration of interests\u003c/h2\u003e \u003cp\u003eWe declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMF conducted the literature review and wrote the article. LM reviewed the article and contributed to the development of the discussion section.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e To Fabricio Saad in reviewed the article and contributed to the development of the discussion section.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Institute (INCA). 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Rev Enfer Centro-Oeste Mineiro 9:e2758. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.19175/recom.v9i0.2758\u003c/span\u003e\u003cspan address=\"10.19175/recom.v9i0.2758\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohlin \u0026Aring;, Bendahl PO, Hegardt C, Richter C, Hallberg IR, Ryd\u0026eacute;n L (2021) Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study. Cancers (Basel) 13(9):2233. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/cancers13092233\u003c/span\u003e\u003cspan address=\"10.3390/cancers13092233\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalton M, Lee P Lived Experience of Adult Female Cancer Survivors to Discover Common Protective Resilience Factors to Cope with Cancer Experience and to Identify Potential Barriers to Resilience. Indian J Palliat Care 2023 Apr-Jun ;29(2):186\u0026ndash;194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.25259/IJPC_214_2022\u003c/span\u003e\u003cspan address=\"10.25259/IJPC_214_2022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Eid NA, Alqahtani MM, Marwa K, Arnout BA, Alswailem HS, Al Toaimi AA, Religiosity (2020) Psychological Resilience, and Mental Health Among Breast Cancer Patients in Kingdom of Saudi Arabia. Breast Cancer (Auckl) 14:1178223420903054. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1178223420903054\u003c/span\u003e\u003cspan address=\"10.1177/1178223420903054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoškailo E, Franjić D, Jurić I, Kiseljaković E, Marijanović I, Babić D (2021 Spring-Summer) Resilience and Quality of Life of Patients with Breast Cancer. Psychiatr Danub 33(Suppl 4):572\u0026ndash;579\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarr AL, Roberts S, Bonnell LN, Kolva E (2022) Existential distress and meaning making among female breast cancer patients with cancer-related fertility concerns. 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BMJ Open 13(2):e068126. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2022-068126\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2022-068126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCerezo MV, \u0026Aacute;lvarez-Olmo A, Rueda P (2022) General Health and Resilience of Breast Cancer Patients: The Mediator Role of Affective Well-Being. Int J Environ Res Public Health 19(9):5398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19095398\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19095398\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCronin MAe, George E (2023) O porqu\u0026ecirc; e como da revis\u0026atilde;o integrativa. M\u0026eacute;todos de Pesquisa Organizacional 26(1):168\u0026ndash;192. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eDoi.org/10.1177/1094428120935507\u003c/span\u003e\u003cspan address=\"Doi.10.1177/1094428120935507\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"psychological resilience, breast cancer, women","lastPublishedDoi":"10.21203/rs.3.rs-4864236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4864236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBreast cancer is the second cancer among women in Brazil, with 66,280 new cases in 2022 and estimated 72,000 new cases by 2025, according to data from the Brazilian National Institute of Cancer. On the other hand, there are a few studies of psychological resilience in Brazilian women with breast cancer. The aim of this study was to investigate the psychological resilience process in breast cancer patients. An integrative review was conducted using databases such as PubMed, the Virtual Health Library (BVS), and ScienceDirect. The search included articles published between 2019 and 2024 in Portuguese, English, and Spanish. The following mesh terms were included: psychological resilience and breast cancer. The selection and analysis of articles followed the PRISMA guidelines. Of the 319 articles firstly selected, 39 were used in review. Of these, 14 included articles indicate that lack of support during breast cancer treatment can lead to adverse psychological consequences, thereby hindering resilience. The patients demonstrate hight level of anxiety, depression, decrease in self-esteem and self-concept, loss, or low fertility during the treatment in young women in childbearing age, which represents a significant concern for this population. For all breast cancer patients, the presence of external support, such as having family, friends, financial resources, and a support to carry out the treatment, prove to be relevant in maintaining mental health, thus enabling positive resilience.\u003c/p\u003e","manuscriptTitle":"Psychological Resilience and Breast Cancer: An Integrative Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-13 01:55:12","doi":"10.21203/rs.3.rs-4864236/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55bde43e-797f-49fa-b15f-74f2350a3965","owner":[],"postedDate":"August 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-13T01:55:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-13 01:55:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4864236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4864236","identity":"rs-4864236","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}