Posttraumatic growth and resilience among survivors of cancer in young adulthood in Switzerland: a report from the Adolescent and Young Adult (AYA) Psychosocial Health Study

Posttraumatic growth and resilience among survivors of cancer in young adulthood in Switzerland: a report from the Adolescent and Young Adult (AYA) Psychosocial Health Study | 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 Research Article Posttraumatic growth and resilience among survivors of cancer in young adulthood in Switzerland: a report from the Adolescent and Young Adult (AYA) Psychosocial Health Study Céline Bolliger, Luzius Mader, Mohsen Mousavi, Marcel Blum, Beat Müller, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7774600/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose Survivors of young adult cancer (YACS) face distinct psychosocial challenges. Posttraumatic growth (PTG) and resilience may aid adaptation, though their relationship and relevance in this age group remain insufficiently understood. We aimed to (1) describe PTG and resilience among Swiss YACS and (2) investigate the associations of PTG with resilience, sociodemographic, and cancer-related characteristics. Methods We included survivors aged 21–39 years at diagnosis, diagnosed at least two years prior. We conducted a questionnaire survey using the Posttraumatic Growth Inventory (PTGI; range:0-105) and the Connor-Davidson Resilience Scale (CD-RISC 10; range:0–40). Data were analyzed using descriptive statistics and linear regression. Results A total of 131 YACS (62% female; mean age at study = 37.6 years, SD = 5.1) were included. The PTG sum score was 54.6 (SD = 23.0, range:1-101), and YACS reported most PTG in appreciation of life (mean = 3.3, 95% confidence interval: 3.2–3.6) and least in spiritual change (1.1, 0.9–1.3). The mean resilience score was 28.06 (SD = 5.91, range:10–39), and YACS reported the highest score for the item “Achieving goals despite obstacles” (3.2, 2.6-3.0), and the lowest for the item “see humorous side of things” (2.1, 2.0-2.3). PTG was higher among females and those who received chemotherapy, while resilience showed no significant association with PTG. Conclusion These findings suggest that PTG and resilience are distinct but complementary adaptation processes in YACS. With higher PTG linked to female gender and chemotherapy, and resilience showing no direct association with PTG, personalized psychosocial support remains essential to help survivors navigate their unique cancer experiences and promote well-being. Young adult cancer Survivorship Posttraumatic growth Resilience Figures Figure 1 Figure 2 1. Background Cancer in adolescents and young adults (AYAs; 15–39 years of age) differs from cancer in children or older adults in terms of tumor biology, distribution of cancer types, psychosocial needs, and late outcomes following treatment [ 1 – 4 ]. Thanks to better treatments, the 5-year survival rate increased to about 80% for AYAs diagnosed with cancer in Europe [ 5 , 6 ]. As survival rates improve, the number of AYA cancer survivors continues to grow, and it has become increasingly recognized that they represent a distinct group requiring targeted efforts to improve their lives during and after treatment [ 7 , 8 ]. These efforts are crucial, as many survivors continue to experience enduring physical and psychosocial consequences (so-called late effects) of their cancer diagnosis and treatment [ 9 , 10 ]. As a result, many survivors might experience negative consequences, including a higher risk of cardiovascular diseases, endocrine disorders and mental health disorders, social isolation, and significant disruptions in education and career planning [ 9 , 11 – 13 ]. Despite all the negative consequences of surviving cancer, literature has shown that dealing with a traumatic event, such as getting diagnosed with cancer, might have a silver lining: people might “benefit” from the experience and report growth, such as more appreciation for life or intensified personal relationships [ 14 – 16 ]. Posttraumatic growth (PTG) describes a salutogenetic concept and a phenomenon in which individuals experience changes that surpass their pre-existing state after facing a burdensome experience [ 17 ]. In fact, it leads to growth and meaning-making in five domains of a person’s life: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life [ 18 ]. A previous study in Swiss AYA cancer survivors aged 16 to 25 years at diagnosis has shown that all of the participants reported at least some PTG in the aftermath of cancer [ 19 ]. However, it did not cover the whole AYA age range up to 39 years. Another salutogenic concept is resilience, describing the phenomenon of the level of adaptation when facing adversity, trauma, tragedy, threats, or significant sources of stress [ 20 ]. In contrast, posttraumatic growth does not refer to maintaining functioning during adversity, but to positive psychological changes that arise from struggling with traumatic experiences and life disruption.[ 21 ] It is debated as to whether or not PTG is a form of resilience, and whether or not growth is superior to resilience [ 22 , 23 ]. A recent study described resilience as a relatively stable personality trait, rooted in dispositions such as optimism, emotional stability, and self-efficacy, which helps individuals cope with both everyday stress and traumatic experiences [ 24 ]. Despite the often presented positive relationship between PTG and resilience in cancer patients and survivors, the strength of this association appears to vary across studies [ 25 – 28 ]. A recent study with AYA cancer survivors found a strong positive correlation between PTG and resilience, indicating that higher resilience was associated with higher levels of PTG in this population [ 28 ]. Similarly, Gündoğmuş et al. (2022) observed a positive relationship between resilience and PTG in breast cancer patients, emphasizing the role of resilience in facilitating coping and adjustment [ 26 ]. In another study, also with breast cancer patients, PTG was again positively associated with resilience, although it explained only 4% of the variance in the resilience scores, pointing to a weaker connection [ 27 ]. Although research on PTG and resilience in AYA cancer survivors remains limited, these constructs may play a key role in supporting their adjustment after cancer. Understanding and fostering PTG and resilience in AYA cancer survivors is crucial to improving their long-term quality of life and ensuring they receive appropriate care if in need. The proposed study aims to (1) describe PTG and resilience among Swiss survivors of young adult cancer (YACS) and (2) investigate the associations between PTG, sociodemographic, and cancer-related characteristics and resilience. 2. Methods 2.1 Sample and Procedure Study participants were recruited from hospitals in the German-speaking part of Switzerland. The clinics were identified with the support of Swiss cancer registries, from which we received lists of doctors who treat AYAs with cancer in Switzerland. These doctors were contacted and asked to collaborate by identifying former patients (YACS) and inviting them to participate in the current study. Survivors aged 21–39 at diagnosis were eligible, as survivors aged 15–20 at diagnosis were already covered by the Swiss Childhood Cancer Survivor Study (SCCSSS) [ 29 ]. They were German-speaking and were treated in Switzerland and diagnosed between 2010 and 2019, and survived for at least two years after their diagnosis. Between February 2023 and June 2024, AYA cancer survivors were sent a study package, including the cover letter, the study information, a consent form, the questionnaire, as well as a link for the online questionnaire, and a pre-paid return envelope. After 6 weeks, a reminder letter was sent to those who had not responded. All procedures performed in this study were in accordance with the ethical standards of the responsible research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee Northwest and Central Switzerland (EKNZ 2022 − 01065, 12 October 2022). 2.2 Measurements In total, the survey consisted of 185 items and was developed using a combination of standardized and self-developed questions regarding the survivors’ psychosocial health and needs, and their socio-demographic and cancer-related characteristics. 2.2.1 Posttraumatic growth We assessed PTG using the German version of the Posttraumatic Growth Inventory (PTGI), which consists of 21 items and is well-validated [ 30 ]. It compromises five domains: Relating to others (7 items), New possibilities (5 items), Personal strength (4 items), Spiritual change (2 items), and Appreciation of life (3 items). Each item is rated using a 6-point Likert scale (0 = not at all to 5 = extremely). We calculated the mean for each of the five domains (possible range: 0–5) and the PTG sum score as the sum of all item scores (possible range: 0–105), with higher scores indicating higher levels of PTG. Based on previous publications, we categorized the answers into low (0,1), middle (2,3) and high (4,5) [ 15 , 19 ]. We replaced missing PTG values with the mean of the respective domain if at least half of the items within that domain were available. Participants with insufficient valid responses in a subscale (i.e., less than half of the items) were excluded from that specific subscale analysis. Finally, we calculated the PTG mean score being the mean of all item scores (possible range: 0–5). 2.2.2 Resilience Resilience was assessed using the German version of the Connor-Davidson Resilience Scale (CD-RISC 10) consisting of 10 items [ 31 ]. It assesses various aspects of resilience, including Adapt to change , Can deal with whatever comes , Coping with stress strengthens, See humorous side of things , Tend to bounce back after illness or hardship , You can achieve your goals, Under pressure, focus and think clearly , Not easily discouraged by failure , Think of self as strong person, Can handle unpleasant feelings. Each item is rated using a 5-point Likert scale (0 = not at all true to 4 = almost always true). We categorized the answers into low (0,1), middle (2), and high (3,4). Scores were computed by summing the responses, with missing responses (up to 3 items) imputed using the mean of the completed items; scores with fewer than 7 completed items were considered invalid [ 32 ]. The possible range of the total sum score is 0–40, with higher scores reflecting higher levels of resilience. 2.2.3 Sociodemographic and cancer-related characteristics Sociodemographic characteristics, including the survivors’ age at study (assessed continuously and categorized into 21–30, 31–39, ≥ 40 years), gender (female, male, diverse), highest educational achievement (compulsory schooling, vocational training, upper secondary education, university degree), employment status (full-time employed, part-time employed, homeworker, unemployed), partnership status (yes, no), and migration background (yes, no; survivors were classified as having a migration background if they were not Swiss citizens, not Swiss citizens since birth or were not born in Switzerland), were assessed in the questionnaire. For further analysis, we categorized the highest educational achievement into low (compulsory schooling, vocational training) and high (upper secondary education, university education), and employment status into employed (full-time, part-time) and other situations (homeworker, unemployed). We assessed information on diagnosis (classified according to the AYA cancer classification by Barr et al. [ 33 ]; leukemias and related disorders, lymphomas, CNS and other intracranial and intraspinal neoplasms, sarcomas, blood and lymphatic vessel tumors, nerve sheath tumors, gonadal and related tumors, melanoma malignant, carcinomas). For further analysis, we categorized information on diagnosis into carcinomas, gonadal tumors, lymphomas, and other tumors (leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma). We assessed information on age at diagnosis (assessed continuously and categorized into 21–30, 31–39 years), time since diagnosis (assessed continuously and categorized into 2–5, 6–9, 10–13 years), and treatment (hierarchically coded as surgery only, chemotherapy (may have had surgery), radiotherapy (may have had surgery and/or chemotherapy)), stem cell transplantation (may have had surgery and/or chemotherapy and /or radiotherapy). For further analysis, we categorized treatment hierarchically into surgery (surgery only), chemotherapy (may have had surgery), and radiotherapy and stem cell transplantation (may have had surgery and/or chemotherapy). We asked survivors whether they had experienced any late effects, cancer relapses, or second malignancies (yes, no). For n = 103 survivors, cancer-related data from the corresponding cancer registry were available. 2.3 Statistical analysis We performed all statistical analyses using Stata 19.0 (StataCorp, TX). First, descriptive statistics were calculated for demographic and cancer-related characteristics to describe the study population. We compared our YACS sample with the corresponding YACS population in Switzerland. Where cancer-related data from the questionnaire was missing (diagnosis: n = 2, year of diagnosis. n = 4, treatment: n = 3, relapse: n = 3, second cancer: n = 3), information was imputed using the cancer-related data from the cancer registries, where available. Additionally, we checked and validated the cancer-related data from the questionnaire for the survivors where we had data from the registry available and added information from the registry if the answer from the questionnaire was not complete (treatment: n = 19; no other disagreements). We used descriptive statistics and calculated chi-square tests for categorical variables to compare our YACS sample with the corresponding YACS population in Switzerland. For aim 1, we used descriptive statistics to describe PTG and resilience. We had to exclude n = 3 participants from the respective analysis as more than half of the items within one domain of the PTGI were missing. Regarding resilience, we replaced missing responses with the mean of the completed items if at least 7 items were completed (n = 4) and scores with fewer than 7 completed items were considered invalid (n = 3). For aim 2, we ran univariable and multivariable linear regression analyses to investigate the associations of PTG with resilience, sociodemographic, and cancer-related characteristics. All variables that were statistically significant at p < 0.1 in the univariable model were included in the multivariable model. P-values for categorical independent variables with more than two levels were calculated using the Wald test. Additionally, we conducted an explorative analysis of the associations of the resilience items with PTG. 3. Results 3.1 Sample characteristics We contacted 678 YACS and received 236 responses (34.8%). Of these, 175 (25.8%) were positive responses (e.g., we received either informed consent or the questionnaire), and 131 participants (19.3%) could be included in our analysis (Supplementary Information, Figure S1). The study population and the YACS population of Switzerland were similar regarding gender and age at diagnosis, but not regarding diagnosis, treatment, and second cancer (Supplementary Information, Table S1). The study sample included more gonadal tumors (24% vs. 16%) and fewer lymphomas (18% vs. 11%) and melanomas (8% vs. 14%), and more survivors treated with chemotherapy (33% vs. 16%), radiotherapy (37% vs. 21%), and stem cell transplantation (7% vs. 1%), and more with a second cancer (7% vs. 2%). Participating survivors had a mean age at study of 37.6 years (SD= 5.1, Table 1), and 81 (61.8%) of them were females. Most survivors had completed upper secondary education (n=53, 40.5%) and were employed full-time (n=56, 42.8%). Main diagnoses were carcinomas (n=52, 39.7%), gonadal tumors (n=31, 23.7%) and lymphomas (n=23, 17.5%). Table 1. Sociodemographic and cancer-related characteristics of study participants. Survivors of young adult cancer (n=131) n (%) % Sociodemographic characteristics Gender Female Male 81 50 61.8 38.2 Age at study 21-30 years 31-39 years ≥40 years 13 78 40 9.9 59.6 30.5 Migration background No Yes 126 5 96.2 3.8 Educational achievement Compulsory schooling Vocational training Upper secondary education University education 2 48 53 28 1.5 36.6 40.5 21.4 Employment status at study Employed full-time Employed part-time Homeworker Not employed 56 34 27 14 42.8 25.9 20.6 10.7 Partnership at study Yes No 102 29 77.9 22.1 Cancer-related characteristics Diagnosis (Barr et al. 2020) a Carcinomas Breast cancer Colorectal or anal cancer Thyroid cancer Pancreatic cancer Bladder cancer Gonadal tumors Lymphomas Other tumors b 52 33 12 5 1 1 31 23 25 39.7 25.2 9.1 3.8 0.8 0.8 23.7 17.5 19.1 Treatment c Surgery Chemotherapy Radiotherapy Stem cell transplantation 30 43 49 9 22.9 32.8 37.4 6.9 Age at diagnosis 21-30 years 31-39 years 50 81 38.2 61.8 Time since diagnosis 2-5 years 6-9 years 10-13 years 56 56 19 42.8 42.8 14.4 Late effects No Yes 86 45 65.7 34.3 Relapse No Yes 119 12 90.8 9.2 Second cancer No Yes 122 9 93.1 6.9 Mean SD Range Age at study (in years) 37.6 5.12 25-52 Age at diagnosis (in years) 31.3 5.04 21-40 Time since diagnosis (in years) 6.3 2.76 2-13 Abbreviations: CNS = central nervous system; n = number; SD = standard deviation a Cancer categories according to the cancer classification by Barr et al. [33] b The category “other tumors” consists of leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma. c Hierarchically coded: chemotherapy may include surgery, radiotherapy may include surgery and/or chemotherapy, stem cell transplantation may include surgery and/or chemotherapy and/or radiotherapy 3.2 Posttraumatic growth The mean PTG sum score was 54.6 (SD=23.0, range: 1-101), and the mean PTG mean score was 2.5 (SD=1.1, range: 1-5). YACS reported most PTG in Appreciation of life and least in Spiritual change (Figure 1). The four most endorsed items were from Appreciation of life : “My priorities about what is important in life” and “An appreciation for the value of my own in life”, from Relating to others “Knowing that I can count on people” and from Personal strengths : “Knowing that I can handle difficulties” (Supplementary Information, Figure S2). The three least endorsed items were from Spiritual change : “A better understanding of spiritual matters” and “I have stronger religious faith”, and from New possibilities : “New opportunities are available which wouldn’t have been otherwise”. 3.3 Resilience The mean resilience score was 28.1 (SD=5.9, range: 10-39). YACS reported the highest resilience scores within the item “You can achieve your goals” and least within the item “See humorous side of things” (Figure 2). The three most endorsed items of the CD-RISC 10 were: “You can achieve your goals”, “Adapt to change” and “Tend to bounce back after illness or hardship”. The three least endorsed items were: “Coping with stress strengthens”, ”Not easily discouraged by failure” and “See humorous side of things” (Supplementary Information, Figure S3). 3.4 Associations of PTG with sociodemographic and cancer-related characteristics, and resilience Table 2 shows the univariable and multivariable linear regressions investigating the associations of sociodemographic and cancer-related characteristics and resilience with PTG (PTG sum score). Female sex was significantly associated with higher PTG scores compared to male sex (10.08; p=0.038). Regarding treatment, participants who had received chemotherapy showed significantly higher PTG scores than those who had undergone surgery only (15.62; overall p=0.014). Table 2. Univariable and multivariable linear regressions investigating the associations of sociodemographic, cancer-related characteristics and resilience with PTG (PTG sum score). Univariable linear regression Multivariable linear regression Coeff. 95% CI p value Coeff. 95% CI p value e Sociodemographic characteristics Sex 0.001 0.038 Male Ref. Ref. Female 13.59 5.71 - 21.45 10.08 0.06 - 19.56 Age at study 0.705 21-30 years Ref. 31-≥41 years 2.16 -11.19 - 15.51 Migration background 0.383 No Ref. Yes -9.19 -29.96 - 11.59 Educational achievement a 0.945 Low Ref. High -0.29 -8.51 - 7.93 Employment status b 0.553 Employed Ref. Other situation 2.62 -6.10 - 11.34 Partnership 0.161 No -6.80 -16.35 - 2.74 Yes Ref. Cancer-related characteristics Diagnosis 0.0100 0.356 Carcinomas Ref. Ref. Gonadal tumors -14.29 -24.29 - -4.29 -7.49 -19.68 - 4.69 Lymphomas 4.89 -6.13 - 15.92 3.44 -7.50 - 14.38 Other tumors c -2.68 -13.40 - 8.04 1.99 -8.75 - 12.74 Treatment d 0.0085 0.014 Surgery Ref. Ref. Chemotherapy 16.27 5.76 - 26.79 15.62 5.03 - 26.22 Radiotherapy and stem cell transplantation 12.44 2.50 - 22.38 7.31 -2.89 - 17.50 Age at diagnosis 0.591 21-30 years Ref. 31-39 years 2.23 -5.98 - 10.44 Time since diagnosis 0.152 2.-5 years Ref. 6-13 years 5.83 -2.17 - 13.83 Late effects 0.604 No Ref. Yes 2.21 -6.19 - 10.61 Relapse 0.325 No Ref. Yes 6.89 -6.04 - 20.67 Second cancer No Yes Ref. 5.36 -10.4 - 21.12 0.502 CD-RISC 10 Resilience sum score 0.28 -0.39 - 0.96 0.408 *CI= confidence interval, Coeff. = coefficient, Ref. = reference category. Note: Bold font indicates statistically significant results. a Educational achievement: low includes compulsory schooling and vocational training; high includes upper secondary education and university education b Employment status at study: Employed includes full-time and part-time employment. Other situations included homeworkers and those not employed. c The category “other tumors” consists of leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma. d Treatment was coded hierarchically as “surgery only”; “chemotherapy (may have had surgery)”; radiotherapy and stem cell transplantation (may have had surgery and/or chemotherapy)”. e P-values for categorical independent variables with multiple levels were calculated using the Wald test. In our explorative analysis on the resilience items, the items Adapt to change (p=0.035) and See humorous side of things (p=0.029) were statistically significantly associated with PTG (Supplementary Information, Table S2). 4. Discussion In our study, we found that Swiss YACS reported middle to high levels of PTG and resilience. Female survivors and those who had received chemotherapy reported higher PTG. Resilience was not associated with PTG. (A)YAs with cancer are diagnosed during a unique period of their life, full of psychosocial changes. The moderate PTG levels of our YACS sample are comparable to a recent Swiss study, reporting moderate PTG levels in Swiss AYA cancer survivors [19]. A systematic review in AYA cancer patients reported generally moderate resilience levels, similar to ours [34]. Female participants reported significantly higher PTG compared to males. There are mixed results in the literature regarding sex and the development of PTG [14,19,35,36]. One possible explanation of our finding might be that women may be more likely than men to engage in emotional disclosure and receive social support, which have been linked to increased PTG [37]. In line with previous studies showing that receiving chemotherapy or experiencing unexpected complications during treatment was associated with higher levels of PTG, our study also found that YACS who underwent chemotherapy reported significantly higher levels of PTG than those treated with surgery only [35,38,39]. This finding aligns with the theoretical assumption that more threatening or life-disrupting experiences may trigger stronger PTG responses by encouraging deeper cognitive engagement and emotional processing [22]. Accordingly, the longer duration of chemotherapy may offer more opportunity for such processing, thereby facilitating PTG. Supporting this, Danhauer et al. (2015) found that breast cancer survivors who reported higher levels of PTG were more likely to have received chemotherapy compared to those with very low PTG [40]. Similarly, a recent study showed that breast cancer patients perceived chemotherapy as more emotionally burdensome and threatening than surgery, which may increase the potential for trauma-related reappraisal and growth [41]. There are differing findings on the relationship between resilience and PTG across different populations (e.g., cancer patients and survivors, persons after childhood abuse) [42,43], and our results contribute to this complexity. Most studies found that there is a positive relationship between resilience and PTG, meaning that a more resilient individual also reported a higher level of PTG [25,44]. For instance, a recent study among female patients with breast cancer found that resilience was only positively associated with PTG in patients who considered cancer as a traumatic experience [26]. Another study identified a curvilinear relationship between resilience and PTG, whereby moderate levels of resilience were associated with the highest PTG levels, suggesting that low resilience may result in emotional overwhelm, while high resilience might limit the cognitive and emotional processing required for growth [45]. Furthermore, Seiler et al. suggested that the relationship between resilience and PTG may follow distinct temporal trajectories along the cancer continuum, with resilience playing a more prominent role during the acute treatment phase, while PTG tends to emerge later, particularly during long-term survivorship [46]. This may also help explain the lack of significant association found in our survivor sample, even though resilience as a whole was moderate to high, as were reported levels of PTG. Another explanation may lie in the theoretical distinction between resilience and PTG. While resilience often reflects a return to baseline functioning after adversity, like a bounce back, PTG involves deeper cognitive transformation and meaning reconstruction through struggle [22,46]. Even though they are both salutogenic constructs, this may lead to different pathways of adaptation [47,48]. Additionally, a study including AYA cancer patients showed that resilience was positively correlated with quality of life and life satisfaction, but did not consistently predict the development of PTG [34]. Resilience is a multifaceted construct, indicating that some but not all components of resilience may be associated with PTG. In our exploratory analysis, the humor-related item “See humorous side of things” from the resilience scale was positively associated with PTG, despite its overall low endorsement in our YACS sample. This supports previous findings that cognitive reappraisal strategies, including humor, can promote PTG by facilitating emotional regulation, maintaining perspective, and fostering meaning-making [49]. The non-association of PTG and resilience in our study could reflect both theoretical and measurement complexities: standard resilience measures may not capture the dimensions associated with PTG, and the timing of assessment (cross-sectional versus longitudinal) may obscure dynamic relationships. 4.1 Strengths and limitations A major strength of our study among YACS is the use of internationally established and psychometrically validated instruments, the PTGI for posttraumatic growth and the CD-RISC-10 for resilience, ensuring both methodological rigor and comparability with international research. Moreover, the study benefited from collaboration with four different Swiss clinics, which facilitated participant recruitment. Besides the strengths of the study, several limitations should be acknowledged. Firstly, the sample size was relatively small and limited to German-speaking participants, which may reduce the generalizability of findings for other language regions within Switzerland or other countries. Despite the similarity of our sample to the Swiss YACS population regarding gender and age at diagnosis, substantial differences in diagnosis, treatment, and second cancer history may affect the transferability of our results to the broader Swiss survivor population. Although the inclusion of four clinics facilitated recruitment, the number of participating institutions remained limited due to legal and organizational hurdles, which restricted broader outreach and may have introduced selection bias. Secondly, comparison between responders and non-responders was not possible, as former patients were contacted directly by the clinics, and data protection regulations prohibited us from accessing their identities prior to receiving written informed consent. Thirdly, the cross-sectional design of our study limits conclusions regarding the directionality or causality of the observed associations. 4.2 Clinical implications Based on our findings, several clinical implications emerge that may help inform supportive care practices for YACS. Tailor psychosocial support to different adaptive pathways : Our findings suggest that resilience and PTG represent distinct processes. Psychosocial programs should therefore differentiate between recovery-focused and growth-oriented support. For example, resilience training might focus on strengthening stable coping capacities, while PTG interventions could encourage deeper reflection and meaning-making [48]. Recognize the individual variation in PTG experiences : Given the wide range of PTG levels in our sample, psychosocial care should acknowledge that not all YACS experience the same levels of PTG. Some cancer patients or survivors may perceive growth, while others might feel pressured to report positive changes or experience illusory growth [50,51]. Furthermore, our finding that female participants reported higher PTG than males highlights the need to consider gender-specific experiences and coping styles in post-cancer care. Thus, professionals should avoid assuming universal PTG and instead adopt a sensitive, individualized approach that validates both positive and negative post-cancer experiences. Address the emotional impact of intensive treatments such as chemotherapy : Survivorship care should provide space for reflection and guided processing for those who underwent intensive treatments, acknowledging both the psychological burden and potential for positive change. Together, these implications emphasize the importance of nuanced, individualized psychosocial care that recognizes the diverse ways young adult cancer survivors respond to their experiences, whether through resilience, PTG, or both, and supports them accordingly across the survivorship trajectory. This may include subtle, low-threshold support formats (e.g., poster, flyer) to respect individual readiness and preferences. 5. Conclusion In our study, Swiss YACS reported middle to high levels of PTG and resilience. PTG was higher among females and those who received chemotherapy, while resilience showed no significant association with PTG. These findings support the hypothesis that PTG and resilience are distinct adaptation processes. While resilience may reflect returning to baseline functioning, PTG may involve deeper psychological change. Tailoring support to individual experiences can help YACS navigate the complex psychological aftermath of cancer more effectively. Abbreviations AYAs Adolescent and young adults CI Confidence interval CNS Central nervous system OR Odds ratio Ref Reference category N, n Number YACS Young adult cancer survivors Declarations Acknowledgments : We thank Angela Pfister for her support within the Psychosocial Health Study and Dr. Daniela Dyntar for her expertise and contributions to the conceptualization of the study. We are grateful to Kantonsspital Luzern, Kantonsspital Baselland, Kantonsspital Olten, and Bürgerspital Solothurn for their collaboration for the participant recruitment. We also thank Registro Cantonale dei Tumori, Krebsregister Ostschweiz, Krebsregister Bern Solothurn, Krebsregister der Kantone Zürich, Zug, Schaffhausen und Schwyz, Zentralschweizer Krebsregister, Krebsregister beider Basel, Krebsregister Graubünden-Glarus, and Stiftung Krebsregister Aargau for their support for clinic recruitment and the provision of cancer-related data. Finally, we sincerely thank all participating survivors for their time and valuable contribution to this study. Funding Palatin Foundation (Nr. 0028/2020), Krebsliga Zentralschweiz, and Avenira Foundation. Conflicts of Interest The authors declare no conflict of interest. Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Code availability (software application or custom code): Not applicable Ethics approval All procedures performed in this study were in accordance with the ethical standards of the responsible research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee Northwest and Central Switzerland (EKNZ 2022-01065, 12 October 2022). Consent to participate Written informed consent was obtained on paper from all individual participants included in the study. Authors' contributions Conceptualization and design of the work: Katharina Roser. Methodology: Katharina Roser and Céline Bolliger; Formal analysis: Céline Bolliger. Investigation, Beat Müller, Marcus Vetter, and Katharina Roser. Resources: Luzius Mader, Mohsen Mousavi, Marcel Blum and Katharina Roser. Data curation: Céline Bolliger and Katharina Roser. Writing original draft preparation: Céline Bolliger. Writing review and editing: all authors. Visualization: Céline Bolliger. Supervision: Katharina Roser. Project administration: Céline Bolliger and Katharina Roser. Funding acquisition: Katharina Roser All authors have read and agreed to the published version of the manuscript. References Stark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, et al. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care Engl. 2015/08/05 ed. 2016 May;25(3):419–27. Bleyer A, Ferrari A, Whelan J, Barr RD. 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Post-Traumatic Growth and Resilience in Adolescent and Young Adult Cancer Patients: An Overview. J Adolesc Young Adult Oncol. 2018 Feb;7(1):1–14. Tedeschi RG, Calhoun LG. TARGET ARTICLE: “Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.” Psychol Inq. 2004 Jan;15(1):1–18. Tedeschi RG, Park CL, Calhoun LG, editors. Posttraumatic Growth: Positive Changes in the Aftermath of Crisis. New York: Routledge; 1998. 267 p. Bolliger C, Holmer P, Dehler S, Roser K, Michel G. Posttraumatic growth and illness perception in survivors of adolescent and young adult cancer. Discov Oncol. 2023 Oct 30;14(1):194. VandenBos GR, editor. APA dictionary of psychology (2nd ed.). Washington: American Psychological Association; 2015. Elam T, Taku K. Differences Between Posttraumatic Growth and Resiliency: Their Distinctive Relationships With Empathy and Emotion Recognition Ability. Front Psychol. 2022 Mar 28;13. Tedeschi RG, Calhoun LG, Cann A. 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Resilience’s impact on quality of life and post-traumatic growth in breast cancer patients during treatment. Breast Cancer. 2024 Sep 1;31(5):807–14. Atay Turan S, Sarvan S, Akcan A, Guler E, Say B. Adolescent and young adult survivors of cancer: relationship between resilience and post-traumatic growth. Curr Psychol. 2023 Oct 1;42(29):25870–9. Kuehni CE, Rueegg CS, Michel G, Rebholz CE, Strippoli MPF, Niggli FK, et al. Cohort Profile: The Swiss Childhood Cancer Survivor Study. Int J Epidemiol. 2012 Dec 1;41(6):1553–64. Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455–71. Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. CD-RISC: About [Internet]. [cited 2025 Jul 8]. Available from: https://www.connordavidson-resiliencescale.com/faq.php Barr RD, Ries LAG, Trama A, Gatta G, Steliarova‐Foucher E, Stiller CA, et al. A system for classifying cancers diagnosed in adolescents and young adults. Cancer. 2020 Nov;126(21):4634–59. Greup SR, Kaal SEJ, Jansen R, Manten-Horst E, Thong MSY, van der Graaf WTA, et al. Post-Traumatic Growth and Resilience in Adolescent and Young Adult Cancer Patients: An Overview. J Adolesc Young Adult Oncol. 2018 Feb;7(1):1–14. McDonnell GA, Pope AW, Schuler TA, Ford JS. The relationship between cancer-related worry and posttraumatic growth in adolescent and young adult cancer survivors. Psychooncology. 2018;27(9):2155–64. Barrett-Bernstein M, Wurz A, Brunet J. Posttraumatic growth and its correlates among survivors of adolescent and young adult cancer: A brief report. J Psychosoc Oncol. 2020 Mar 3;38(2):228–34. Vishnevsky T, Cann A, Calhoun LG, Tedeschi RG, Demakis GJ. Gender Differences in Self-Reported Posttraumatic Growth: A Meta-Analysis. Psychol Women Q. 2010 Mar 1;34(1):110–20. Park CL, Cho D. Spiritual well-being and spiritual distress predict adjustment in adolescent and young adult cancer survivors. Psychooncology. 2017;26(9):1293–300. Gunst DCM, Kaatsch P, Goldbeck L. Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer. 2016 Nov;24(11):4607–15. Danhauer SC, Russell G, Case LD, Sohl SJ, Tedeschi RG, Addington EL, et al. Trajectories of Posttraumatic Growth and Associated Characteristics in Women with Breast Cancer. Ann Behav Med. 2015 Oct 1;49(5):650–9. Huang S, Huang M, Long F, Wang F. Post-traumatic growth experience of breast cancer patients: A qualitative systematic review and meta-synthesis. PLOS ONE. 2025 Jan 23;20(1):e0316108. Levine SZ, Laufer A, Stein E, Hamama-Raz Y, Solomon Z. Examining the relationship between resilience and posttraumatic growth. J Trauma Stress. 2009;22(4):282–6. Widyorini E, Roswita MY, Primastuti E, Wijaya DA. The Role of Resilience towards the Correlation between Adverse Childhood Experiences and Post-Traumatic Growth. 2022. Duan W, Guo P, Gan P. Relationships among Trait Resilience, Virtues, Post-traumatic Stress Disorder, and Post-traumatic Growth. Kavushansky A, editor. PLOS ONE. 2015 May 1;10(5):e0125707. Kaye-Tzadok A, Davidson-Arad B. Posttraumatic growth among women survivors of childhood sexual abuse: Its relation to cognitive strategies, posttraumatic symptoms, and resilience. Psychol Trauma Theory Res Pract Policy. 2016 Sep;8(5):550–8. Seiler A, Jenewein J. Resilience in Cancer Patients. Front Psychiatry. 2019 Apr 5;10. Levine SZ, Laufer A, Stein E, Hamama-Raz Y, Solomon Z. Examining the relationship between resilience and posttraumatic growth. J Trauma Stress. 2009 Aug;22(4):282–6. Infurna FJ, Jayawickreme E. Fixing the Growth Illusion: New Directions for Research in Resilience and Posttraumatic Growth. Curr Dir Psychol Sci. 2019 Apr 1;28(2):152–8. Sierra-Murguía M, Guevara-Sanginés ML, Navarro-Contreras G, Peralta-Castillo G, Padilla-Rico A, González-Alcocer L, et al. Relationship between Thought Style, Emotional Response, Post-Traumatic Growth (PTG), and Biomarkers in Cancer Patients. Int J Environ Res Public Health. 2024 Jun;21(6):763. Matsui T, Taku K. A Review of Posttraumatic Growth and Help-Seeking Behavior in Cancer Survivors: Effects of Distal and Proximate Culture. Jpn Psychol Res. 2016;58(1):142–62. Sumalla EC, Ochoa C, Blanco I. Posttraumatic growth in cancer: reality or illusion? Clin Psychol Rev. 2008/11/11 ed. 2009 Feb;29(1):24–33. Additional Declarations No competing interests reported. Supplementary Files 20251003SupplementaryMaterialAYAPTGResiliencefinal.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Apr, 2026 Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 15 Feb, 2026 Reviewers invited by journal 05 Nov, 2025 Editor assigned by journal 05 Nov, 2025 Submission checks completed at journal 07 Oct, 2025 First submitted to journal 03 Oct, 2025 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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05:57:06","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":152400,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7774600/v1/82862f43b3e2ffa96eddb23c.html"},{"id":96046800,"identity":"febb309a-4a5d-4186-93cb-ae2ec457ac2f","added_by":"auto","created_at":"2025-11-17 05:57:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109930,"visible":true,"origin":"","legend":"\u003cp\u003eMeans and 95% confidence intervals (CI) of the PTG mean score and the PTG domains measured by the PTGI.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7774600/v1/38740445902acc4609207717.png"},{"id":96046829,"identity":"ad6e6351-d8be-45d1-ad74-cdc2479157ab","added_by":"auto","created_at":"2025-11-17 05:57:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":150003,"visible":true,"origin":"","legend":"\u003cp\u003eMeans and 95% confidence intervals (CI) of the resilience items measured by the CD-RISC 10.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7774600/v1/28c7840968ff6374e40478df.png"},{"id":96246753,"identity":"11fe35e0-9f78-40de-8913-e085c4a7b6cb","added_by":"auto","created_at":"2025-11-19 07:26:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1587723,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7774600/v1/bd0e54f5-5a7b-46d9-8f0f-a5d0da44e6de.pdf"},{"id":96046816,"identity":"07fda824-e205-4aa3-872c-0e88cec7941b","added_by":"auto","created_at":"2025-11-17 05:57:06","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":228289,"visible":true,"origin":"","legend":"","description":"","filename":"20251003SupplementaryMaterialAYAPTGResiliencefinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-7774600/v1/5dfd1449b711ea517b8143b5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Posttraumatic growth and resilience among survivors of cancer in young adulthood in Switzerland: a report from the Adolescent and Young Adult (AYA) Psychosocial Health Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eCancer in \u003cem\u003eadolescents and young adults\u003c/em\u003e (AYAs; 15\u0026ndash;39 years of age) differs from cancer in children or older adults in terms of tumor biology, distribution of cancer types, psychosocial needs, and late outcomes following treatment [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Thanks to better treatments, the 5-year survival rate increased to about 80% for AYAs diagnosed with cancer in Europe [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As survival rates improve, the number of AYA cancer survivors continues to grow, and it has become increasingly recognized that they represent a distinct group requiring targeted efforts to improve their lives during and after treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These efforts are crucial, as many survivors continue to experience enduring physical and psychosocial consequences (so-called late effects) of their cancer diagnosis and treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As a result, many survivors might experience negative consequences, including a higher risk of cardiovascular diseases, endocrine disorders and mental health disorders, social isolation, and significant disruptions in education and career planning [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite all the negative consequences of surviving cancer, literature has shown that dealing with a traumatic event, such as getting diagnosed with cancer, might have a silver lining: people might \u0026ldquo;benefit\u0026rdquo; from the experience and report growth, such as more appreciation for life or intensified personal relationships [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Posttraumatic growth (PTG) describes a salutogenetic concept and a phenomenon in which individuals experience changes that surpass their pre-existing state after facing a burdensome experience [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In fact, it leads to growth and meaning-making in five domains of a person\u0026rsquo;s life: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A previous study in Swiss AYA cancer survivors aged 16 to 25 years at diagnosis has shown that all of the participants reported at least some PTG in the aftermath of cancer [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, it did not cover the whole AYA age range up to 39 years.\u003c/p\u003e\u003cp\u003eAnother salutogenic concept is resilience, describing the phenomenon of the level of adaptation when facing adversity, trauma, tragedy, threats, or significant sources of stress [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In contrast, posttraumatic growth does not refer to maintaining functioning during adversity, but to positive psychological changes that arise from struggling with traumatic experiences and life disruption.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] It is debated as to whether or not PTG is a form of resilience, and whether or not growth is superior to resilience [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A recent study described resilience as a relatively stable personality trait, rooted in dispositions such as optimism, emotional stability, and self-efficacy, which helps individuals cope with both everyday stress and traumatic experiences [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the often presented positive relationship between PTG and resilience in cancer patients and survivors, the strength of this association appears to vary across studies [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A recent study with AYA cancer survivors found a strong positive correlation between PTG and resilience, indicating that higher resilience was associated with higher levels of PTG in this population [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, G\u0026uuml;ndoğmuş et al. (2022) observed a positive relationship between resilience and PTG in breast cancer patients, emphasizing the role of resilience in facilitating coping and adjustment [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In another study, also with breast cancer patients, PTG was again positively associated with resilience, although it explained only 4% of the variance in the resilience scores, pointing to a weaker connection [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough research on PTG and resilience in AYA cancer survivors remains limited, these constructs may play a key role in supporting their adjustment after cancer. Understanding and fostering PTG and resilience in AYA cancer survivors is crucial to improving their long-term quality of life and ensuring they receive appropriate care if in need.\u003c/p\u003e\u003cp\u003eThe proposed study aims to (1) describe PTG and resilience among Swiss survivors of young adult cancer (YACS) and (2) investigate the associations between PTG, sociodemographic, and cancer-related characteristics and resilience.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Sample and Procedure\u003c/h2\u003e\u003cp\u003eStudy participants were recruited from hospitals in the German-speaking part of Switzerland. The clinics were identified with the support of Swiss cancer registries, from which we received lists of doctors who treat AYAs with cancer in Switzerland. These doctors were contacted and asked to collaborate by identifying former patients (YACS) and inviting them to participate in the current study. Survivors aged 21\u0026ndash;39 at diagnosis were eligible, as survivors aged 15\u0026ndash;20 at diagnosis were already covered by the Swiss Childhood Cancer Survivor Study (SCCSSS) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. They were German-speaking and were treated in Switzerland and diagnosed between 2010 and 2019, and survived for at least two years after their diagnosis. Between February 2023 and June 2024, AYA cancer survivors were sent a study package, including the cover letter, the study information, a consent form, the questionnaire, as well as a link for the online questionnaire, and a pre-paid return envelope. After 6 weeks, a reminder letter was sent to those who had not responded. All procedures performed in this study were in accordance with the ethical standards of the responsible research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee Northwest and Central Switzerland (EKNZ 2022\u0026thinsp;\u0026minus;\u0026thinsp;01065, 12 October 2022).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Measurements\u003c/h2\u003e\u003cp\u003eIn total, the survey consisted of 185 items and was developed using a combination of standardized and self-developed questions regarding the survivors\u0026rsquo; psychosocial health and needs, and their socio-demographic and cancer-related characteristics.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 Posttraumatic growth\u003c/h2\u003e\u003cp\u003eWe assessed PTG using the German version of the Posttraumatic Growth Inventory (PTGI), which consists of 21 items and is well-validated [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It compromises five domains: \u003cem\u003eRelating to others\u003c/em\u003e (7 items), \u003cem\u003eNew possibilities\u003c/em\u003e (5 items), \u003cem\u003ePersonal strength\u003c/em\u003e (4 items), \u003cem\u003eSpiritual change\u003c/em\u003e (2 items), and \u003cem\u003eAppreciation of life\u003c/em\u003e (3 items). Each item is rated using a 6-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all to 5\u0026thinsp;=\u0026thinsp;extremely). We calculated the mean for each of the five domains (possible range: 0\u0026ndash;5) and the PTG sum score as the sum of all item scores (possible range: 0\u0026ndash;105), with higher scores indicating higher levels of PTG. Based on previous publications, we categorized the answers into low (0,1), middle (2,3) and high (4,5) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We replaced missing PTG values with the mean of the respective domain if at least half of the items within that domain were available. Participants with insufficient valid responses in a subscale (i.e., less than half of the items) were excluded from that specific subscale analysis. Finally, we calculated the PTG mean score being the mean of all item scores (possible range: 0\u0026ndash;5).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Resilience\u003c/h2\u003e\u003cp\u003eResilience was assessed using the German version of the Connor-Davidson Resilience Scale (CD-RISC 10) consisting of 10 items [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It assesses various aspects of resilience, including \u003cem\u003eAdapt to change\u003c/em\u003e, \u003cem\u003eCan deal with whatever comes\u003c/em\u003e, \u003cem\u003eCoping with stress strengthens, See humorous side of things\u003c/em\u003e, \u003cem\u003eTend to bounce back after illness or hardship\u003c/em\u003e, \u003cem\u003eYou can achieve your goals, Under pressure, focus and think clearly\u003c/em\u003e, \u003cem\u003eNot easily discouraged by failure\u003c/em\u003e, \u003cem\u003eThink of self as strong person, Can handle unpleasant feelings.\u003c/em\u003e Each item is rated using a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all true to 4\u0026thinsp;=\u0026thinsp;almost always true). We categorized the answers into low (0,1), middle (2), and high (3,4). Scores were computed by summing the responses, with missing responses (up to 3 items) imputed using the mean of the completed items; scores with fewer than 7 completed items were considered invalid [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The possible range of the total sum score is 0\u0026ndash;40, with higher scores reflecting higher levels of resilience.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Sociodemographic and cancer-related characteristics\u003c/h2\u003e\u003cp\u003eSociodemographic characteristics, including the survivors\u0026rsquo; age at study (assessed continuously and categorized into 21\u0026ndash;30, 31\u0026ndash;39, \u0026ge;\u0026thinsp;40 years), gender (female, male, diverse), highest educational achievement (compulsory schooling, vocational training, upper secondary education, university degree), employment status (full-time employed, part-time employed, homeworker, unemployed), partnership status (yes, no), and migration background (yes, no; survivors were classified as having a migration background if they were not Swiss citizens, not Swiss citizens since birth or were not born in Switzerland), were assessed in the questionnaire. For further analysis, we categorized the highest educational achievement into low (compulsory schooling, vocational training) and high (upper secondary education, university education), and employment status into employed (full-time, part-time) and other situations (homeworker, unemployed).\u003c/p\u003e\u003cp\u003eWe assessed information on diagnosis (classified according to the AYA cancer classification by Barr et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; leukemias and related disorders, lymphomas, CNS and other intracranial and intraspinal neoplasms, sarcomas, blood and lymphatic vessel tumors, nerve sheath tumors, gonadal and related tumors, melanoma malignant, carcinomas). For further analysis, we categorized information on diagnosis into carcinomas, gonadal tumors, lymphomas, and other tumors (leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma). We assessed information on age at diagnosis (assessed continuously and categorized into 21\u0026ndash;30, 31\u0026ndash;39 years), time since diagnosis (assessed continuously and categorized into 2\u0026ndash;5, 6\u0026ndash;9, 10\u0026ndash;13 years), and treatment (hierarchically coded as surgery only, chemotherapy (may have had surgery), radiotherapy (may have had surgery and/or chemotherapy)), stem cell transplantation (may have had surgery and/or chemotherapy and /or radiotherapy). For further analysis, we categorized treatment hierarchically into surgery (surgery only), chemotherapy (may have had surgery), and radiotherapy and stem cell transplantation (may have had surgery and/or chemotherapy). We asked survivors whether they had experienced any late effects, cancer relapses, or second malignancies (yes, no). For n\u0026thinsp;=\u0026thinsp;103 survivors, cancer-related data from the corresponding cancer registry were available.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\u003cp\u003eWe performed all statistical analyses using Stata 19.0 (StataCorp, TX). First, descriptive statistics were calculated for demographic and cancer-related characteristics to describe the study population. We compared our YACS sample with the corresponding YACS population in Switzerland. Where cancer-related data from the questionnaire was missing (diagnosis: n\u0026thinsp;=\u0026thinsp;2, year of diagnosis. n\u0026thinsp;=\u0026thinsp;4, treatment: n\u0026thinsp;=\u0026thinsp;3, relapse: n\u0026thinsp;=\u0026thinsp;3, second cancer: n\u0026thinsp;=\u0026thinsp;3), information was imputed using the cancer-related data from the cancer registries, where available. Additionally, we checked and validated the cancer-related data from the questionnaire for the survivors where we had data from the registry available and added information from the registry if the answer from the questionnaire was not complete (treatment: n\u0026thinsp;=\u0026thinsp;19; no other disagreements). We used descriptive statistics and calculated chi-square tests for categorical variables to compare our YACS sample with the corresponding YACS population in Switzerland.\u003c/p\u003e\u003cp\u003eFor aim 1, we used descriptive statistics to describe PTG and resilience. We had to exclude n\u0026thinsp;=\u0026thinsp;3 participants from the respective analysis as more than half of the items within one domain of the PTGI were missing. Regarding resilience, we replaced missing responses with the mean of the completed items if at least 7 items were completed (n\u0026thinsp;=\u0026thinsp;4) and scores with fewer than 7 completed items were considered invalid (n\u0026thinsp;=\u0026thinsp;3).\u003c/p\u003e\u003cp\u003eFor aim 2, we ran univariable and multivariable linear regression analyses to investigate the associations of PTG with resilience, sociodemographic, and cancer-related characteristics. All variables that were statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariable model were included in the multivariable model. P-values for categorical independent variables with more than two levels were calculated using the Wald test. Additionally, we conducted an explorative analysis of the associations of the resilience items with PTG.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003ch2\u003e3.1 \u003cstrong\u003eSample characteristics\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe contacted 678 YACS and received 236 responses (34.8%). Of these, 175 (25.8%) were positive responses (e.g., we received either informed consent or the questionnaire), and 131 participants (19.3%) could be included in our analysis (Supplementary Information, Figure S1). The study population and the YACS population of Switzerland were similar regarding gender and age at diagnosis, but not regarding diagnosis, treatment, and second cancer (Supplementary Information, Table S1). The study sample included more gonadal tumors (24% vs. 16%) and fewer lymphomas (18% vs. 11%) and melanomas (8% vs. 14%), and more survivors treated with chemotherapy (33% vs. 16%), radiotherapy (37% vs. 21%), and stem cell transplantation (7% vs. 1%), and more with a second cancer (7% vs. 2%).\u003c/p\u003e\n\u003cp\u003eParticipating survivors had a mean age at study of 37.6 years (SD= 5.1, Table 1), and 81 (61.8%) of them were females. Most survivors had completed upper secondary education (n=53, 40.5%) and were employed full-time (n=56, 42.8%). Main diagnoses were carcinomas (n=52, 39.7%), gonadal tumors (n=31, 23.7%) and lymphomas (n=23, 17.5%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Sociodemographic and cancer-related characteristics of study participants.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eSurvivors of young adult cancer (n=131)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 566px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSociodemographic characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at study\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e21-30 years\u003c/p\u003e\n \u003cp\u003e31-39 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003cp\u003e59.6\u003c/p\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMigration background\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e126\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational achievement\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCompulsory schooling\u003c/p\u003e\n \u003cp\u003eVocational training\u003c/p\u003e\n \u003cp\u003eUpper secondary education\u003c/p\u003e\n \u003cp\u003eUniversity education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status at study\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEmployed full-time\u003c/p\u003e\n \u003cp\u003eEmployed part-time\u003c/p\u003e\n \u003cp\u003eHomeworker\u003c/p\u003e\n \u003cp\u003eNot employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartnership at study\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003cp\u003e29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77.9\u003c/p\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 566px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCancer-related characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e (Barr et al. 2020)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCarcinomas\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBreast cancer\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eColorectal or anal cancer\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThyroid cancer\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePancreatic cancer\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBladder cancer\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eGonadal tumors\u003c/p\u003e\n \u003cp\u003eLymphomas\u003c/p\u003e\n \u003cp\u003eOther tumors\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e33\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e12\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e25.2\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e9.1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e3.8\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.8\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.8\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003cp\u003eRadiotherapy\u003c/p\u003e\n \u003cp\u003eStem cell transplantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003cp\u003e37.4\u003c/p\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e21-30 years\u003c/p\u003e\n \u003cp\u003e31-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime since diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e2-5 years\u003c/p\u003e\n \u003cp\u003e6-9 years\u003c/p\u003e\n \u003cp\u003e10-13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate effects\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65.7\u003c/p\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.8\u003c/p\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e122\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at study\u0026nbsp;\u003c/strong\u003e(in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e25-52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis\u0026nbsp;\u003c/strong\u003e(in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e21-40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime since diagnosis\u0026nbsp;\u003c/strong\u003e(in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2-13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CNS = central nervous system; n = number; SD = standard deviation\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eCancer categories according to the cancer classification by Barr et al. [33]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u0026nbsp;\u003c/sup\u003eThe category \u0026ldquo;other tumors\u0026rdquo; consists of leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Hierarchically coded: chemotherapy may include surgery, radiotherapy may include surgery and/or chemotherapy, stem cell transplantation may include surgery and/or chemotherapy and/or radiotherapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Posttraumatic growth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean PTG sum score was 54.6 (SD=23.0, range: 1-101), and the mean PTG mean score was 2.5 (SD=1.1, range: 1-5). YACS reported most PTG in \u003cem\u003eAppreciation of life\u003c/em\u003e and least in \u003cem\u003eSpiritual change\u003c/em\u003e (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe four most endorsed items were from \u003cem\u003eAppreciation of life\u003c/em\u003e: \u0026ldquo;My priorities about what is important in life\u0026rdquo; and \u0026ldquo;An appreciation for the value of my own in life\u0026rdquo;, from \u003cem\u003eRelating to others\u003c/em\u003e \u0026ldquo;Knowing that I can count on people\u0026rdquo; and from \u003cem\u003ePersonal strengths\u003c/em\u003e: \u0026ldquo;Knowing that I can handle difficulties\u0026rdquo; (Supplementary Information, Figure S2). The three least endorsed items were from \u003cem\u003eSpiritual change\u003c/em\u003e: \u0026ldquo;A better understanding of spiritual matters\u0026rdquo; and \u0026ldquo;I have stronger religious faith\u0026rdquo;, and from \u003cem\u003eNew possibilities\u003c/em\u003e: \u0026ldquo;New opportunities are available which wouldn\u0026rsquo;t have been otherwise\u0026rdquo;.\u003c/p\u003e\n\u003ch2\u003e3.3 \u003cstrong\u003eResilience\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe mean resilience score was 28.1 (SD=5.9, range: 10-39). YACS reported the highest resilience scores within the item \u0026ldquo;You can achieve your goals\u0026rdquo; and least within the item \u0026ldquo;See humorous side of things\u0026rdquo; (Figure 2).\u003c/p\u003e\n\u003cp\u003eThe three most endorsed items of the CD-RISC 10 were: \u0026ldquo;You can achieve your goals\u0026rdquo;, \u0026ldquo;Adapt to change\u0026rdquo; and \u0026ldquo;Tend to bounce back after illness or hardship\u0026rdquo;. The three least endorsed items were: \u0026ldquo;Coping with stress strengthens\u0026rdquo;, \u0026rdquo;Not easily discouraged by failure\u0026rdquo; and \u0026ldquo;See humorous side of things\u0026rdquo; (Supplementary Information, Figure S3).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e3.4 Associations of PTG with sociodemographic and cancer-related characteristics, and resilience\u003c/h2\u003e\n\u003cp\u003eTable 2 shows the univariable and multivariable linear regressions investigating the associations of sociodemographic and cancer-related characteristics and resilience with PTG (PTG sum score). Female sex was significantly associated with higher PTG scores compared to male sex (10.08; p=0.038). Regarding treatment, participants who had received chemotherapy showed significantly higher PTG scores than those who had undergone surgery only (15.62; overall p=0.014).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Univariable and multivariable linear regressions investigating the associations of sociodemographic, cancer-related characteristics and resilience with PTG (PTG sum score).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eUnivariable linear regression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eMultivariable linear regression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eCoeff.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eCoeff.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ep value\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eSociodemographic characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e13.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.71 - 21.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e10.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.06 - 19.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e21-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e31-\u0026ge;41 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-11.19 - 15.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMigration background\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-9.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-29.96 - 11.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational achievement\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-8.51 - 7.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eOther situation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-6.10 - 11.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartnership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-6.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-16.35 - 2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eCancer-related characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eCarcinomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eGonadal tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-14.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-24.29 - -4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-7.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-19.68 - 4.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eLymphomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-6.13 - 15.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-7.50 - 14.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eOther tumors\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-13.40 - 8.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-8.75 - 12.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0085\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e16.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.76 - 26.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5.03 - 26.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eRadiotherapy and stem cell transplantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e12.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.50 - 22.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.89 - 17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e21-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e31-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-5.98 - 10.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime since diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e2.-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e6-13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-2.17 - 13.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-6.19 - 10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelapse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-6.04 - 20.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-10.4 - 21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCD-RISC 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eResilience sum score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.39 - 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*CI= confidence interval, Coeff. = coefficient, Ref. = reference category.\u003c/p\u003e\n\u003cp\u003eNote: Bold font indicates statistically significant results.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Educational achievement: low includes compulsory schooling and vocational training; high includes upper secondary education and university education\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Employment status at study: Employed includes full-time and part-time employment. Other situations included homeworkers and those not employed.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e The category \u0026ldquo;other tumors\u0026rdquo; consists of leukemias, CNS neoplasms, sarcomas, nerve sheath tumors, and malignant melanoma.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u003c/sup\u003e Treatment was coded hierarchically as \u0026ldquo;surgery only\u0026rdquo;; \u0026ldquo;chemotherapy (may have had surgery)\u0026rdquo;; radiotherapy and stem cell transplantation (may have had surgery and/or chemotherapy)\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ee\u003c/sup\u003e P-values for categorical independent variables with multiple levels were calculated using the Wald test.\u003c/p\u003e\n\u003cp\u003eIn our explorative analysis on the resilience items, the items \u003cem\u003eAdapt to change\u003c/em\u003e (p=0.035) and \u003cem\u003eSee humorous side of\u003c/em\u003e things (p=0.029) were statistically significantly associated with PTG (Supplementary Information, Table S2).\u003c/p\u003e"},{"header":"4.\tDiscussion","content":"\u003cp\u003eIn our study, we found that Swiss YACS reported middle to high levels of PTG and resilience. Female survivors and those who had received chemotherapy reported higher PTG. Resilience was not associated with PTG.\u003c/p\u003e\n\u003cp\u003e(A)YAs with cancer are diagnosed during a unique period of their life, full of psychosocial changes. The moderate PTG levels of our YACS sample are comparable to a recent Swiss study, reporting moderate PTG levels in Swiss AYA cancer survivors [19]. A systematic review in AYA cancer patients reported generally moderate resilience levels, similar to ours [34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFemale participants reported significantly higher PTG compared to males. There are mixed results in the literature regarding sex and the development of PTG [14,19,35,36]. One possible explanation of our finding might be that women may be more likely than men to engage in emotional disclosure and receive social support, which have been linked to increased PTG [37].\u003c/p\u003e\n\u003cp\u003eIn line with previous studies showing that receiving chemotherapy or experiencing unexpected complications during treatment was associated with higher levels of PTG, our study also found that YACS who underwent chemotherapy reported significantly higher levels of PTG than those treated with surgery only [35,38,39]. This finding aligns with the theoretical assumption that more threatening or life-disrupting experiences may trigger stronger PTG responses by encouraging deeper cognitive engagement and emotional processing [22]. Accordingly, the longer duration of chemotherapy may offer more opportunity for such processing, thereby facilitating PTG. Supporting this, Danhauer et al. (2015) found that breast cancer survivors who reported higher levels of PTG were more likely to have received chemotherapy compared to those with very low PTG [40]. Similarly, a recent study showed that breast cancer patients perceived chemotherapy as more emotionally burdensome and threatening than surgery, which may increase the potential for trauma-related reappraisal and growth [41].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are differing findings on the relationship between resilience and PTG across different populations (e.g., cancer patients and survivors, persons after childhood abuse) [42,43], and our results contribute to this complexity. Most studies found that there is a positive relationship between resilience and PTG, meaning that a more resilient individual also reported a higher level of PTG [25,44]. For instance, a recent study among female patients with breast cancer found that resilience was only positively associated with PTG in patients who considered cancer as a traumatic experience [26]. Another study identified a curvilinear relationship between resilience and PTG, whereby moderate levels of resilience were associated with the highest PTG levels, suggesting that low resilience may result in emotional overwhelm, while high resilience might limit the cognitive and emotional processing required for growth [45]. Furthermore, Seiler et al. suggested that the relationship between resilience and PTG may follow distinct temporal trajectories along the cancer continuum, with resilience playing a more prominent role during the acute treatment phase, while PTG tends to emerge later, particularly during long-term survivorship [46]. This may also help explain the lack of significant association found in our survivor sample, even though resilience as a whole was moderate to high, as were reported levels of PTG. Another explanation may lie in the theoretical distinction between resilience and PTG. While resilience often reflects a return to baseline functioning after adversity, like a bounce back, PTG involves deeper cognitive transformation and meaning reconstruction through struggle [22,46]. Even though they are both salutogenic constructs, this may lead to different pathways of adaptation [47,48]. Additionally, a study including AYA cancer patients showed that resilience was positively correlated with quality of life and life satisfaction, but did not consistently predict the development of PTG [34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience is a multifaceted construct, indicating that some but not all components of resilience may be associated with PTG. In our exploratory analysis, the humor-related item “See humorous side of things” from the resilience scale was positively associated with PTG, despite its overall low endorsement in our YACS sample. This supports previous findings that cognitive reappraisal strategies, including humor, can promote PTG by facilitating emotional regulation, maintaining perspective, and fostering meaning-making [49].\u003c/p\u003e\n\u003cp\u003eThe non-association of PTG and resilience in our study could reflect both theoretical and measurement complexities: standard resilience measures may not capture the dimensions associated with PTG, and the timing of assessment (cross-sectional versus longitudinal) may obscure dynamic relationships.\u003c/p\u003e\n\u003ch2\u003e4.1 Strengths and limitations\u003c/h2\u003e\n\u003cp\u003eA major strength of our study among YACS is the use of internationally established and psychometrically validated instruments, the PTGI for posttraumatic growth and the CD-RISC-10 for resilience, ensuring both methodological rigor and comparability with international research. Moreover, the study benefited from collaboration with four different Swiss clinics, which facilitated participant recruitment.\u003c/p\u003e\n\u003cp\u003eBesides the strengths of the study, several limitations should be acknowledged. Firstly, the sample size was relatively small and limited to German-speaking participants, which may reduce the generalizability of findings for other language regions within Switzerland or other countries. Despite the similarity of our sample to the Swiss YACS population regarding gender and age at diagnosis, substantial differences in diagnosis, treatment, and second cancer history may affect the transferability of our results to the broader Swiss survivor population. Although the inclusion of four clinics facilitated recruitment, the number of participating institutions remained limited due to legal and organizational hurdles, which restricted broader outreach and may have introduced selection bias. Secondly, comparison between responders and non-responders was not possible, as former patients were contacted directly by the clinics, and data protection regulations prohibited us from accessing their identities prior to receiving written informed consent. Thirdly, the cross-sectional design of our study limits conclusions regarding the directionality or causality of the observed associations.\u003c/p\u003e\n\u003ch2\u003e4.2 Clinical implications\u003c/h2\u003e\n\u003cp\u003eBased on our findings, several clinical implications emerge that may help inform supportive care practices for YACS.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eTailor psychosocial support to different adaptive pathways\u003c/strong\u003e: Our findings suggest that resilience and PTG represent distinct processes. Psychosocial programs should therefore differentiate between recovery-focused and growth-oriented support. For example, resilience training might focus on strengthening stable coping capacities, while PTG interventions could encourage deeper reflection and meaning-making [48].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRecognize the individual variation in PTG experiences\u003c/strong\u003e: Given the wide range of PTG levels in our sample, psychosocial care should acknowledge that not all YACS experience the same levels of PTG. Some cancer patients or survivors may perceive growth, while others might feel pressured to report positive changes or experience illusory growth [50,51]. Furthermore, our finding that female participants reported higher PTG than males highlights the need to consider gender-specific experiences and coping styles in post-cancer care. Thus, professionals should avoid assuming universal PTG and instead adopt a sensitive, individualized approach that validates both positive and negative post-cancer experiences.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAddress the emotional impact of intensive treatments such as chemotherapy\u003c/strong\u003e: Survivorship care should provide space for reflection and guided processing for those who underwent intensive treatments, acknowledging both the psychological burden and potential for positive change.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTogether, these implications emphasize the importance of nuanced, individualized psychosocial care that recognizes the diverse ways young adult cancer survivors respond to their experiences, whether through resilience, PTG, or both, and supports them accordingly across the survivorship trajectory. This may include subtle, low-threshold support formats (e.g., poster, flyer) to respect individual readiness and preferences.\u003c/p\u003e"},{"header":"5.\tConclusion","content":"\u003cp\u003eIn our study, Swiss YACS reported middle to high levels of PTG and resilience. PTG was higher among females and those who received chemotherapy, while resilience showed no significant association with PTG. These findings support the hypothesis that PTG and resilience are distinct adaptation processes. While resilience may reflect returning to baseline functioning, PTG may involve deeper psychological change. Tailoring support to individual experiences can help YACS navigate the complex psychological aftermath of cancer more effectively.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAYAs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Adolescent and young adults\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Confidence interval\u003c/p\u003e\n\u003cp\u003eCNS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central nervous system\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds ratio\u003c/p\u003e\n\u003cp\u003eRef\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Reference category\u003c/p\u003e\n\u003cp\u003eN, n\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Number\u003c/p\u003e\n\u003cp\u003eYACS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Young adult cancer survivors\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: We thank Angela Pfister for her support within the Psychosocial Health Study and Dr. Daniela Dyntar for her expertise and contributions to the conceptualization of the study. We are grateful to Kantonsspital Luzern, Kantonsspital Baselland, Kantonsspital Olten, and B\u0026uuml;rgerspital Solothurn for their collaboration for the participant recruitment. We also thank Registro Cantonale dei Tumori, Krebsregister Ostschweiz, Krebsregister Bern Solothurn, Krebsregister der Kantone Z\u0026uuml;rich, Zug, Schaffhausen und Schwyz, Zentralschweizer Krebsregister, Krebsregister beider Basel, Krebsregister Graub\u0026uuml;nden-Glarus, and Stiftung Krebsregister Aargau for their support for clinic recruitment and the provision of cancer-related data. Finally, we sincerely thank all participating survivors for their time and valuable contribution to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e Palatin Foundation (Nr. 0028/2020), Krebsliga Zentralschweiz, and Avenira Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e (software application or custom code): Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e All procedures performed in this study were in accordance with the ethical standards of the responsible research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee Northwest and Central Switzerland (EKNZ 2022-01065, 12 October 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e Written informed consent was obtained on paper from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e Conceptualization and design of the work: Katharina Roser. Methodology: Katharina Roser and C\u0026eacute;line Bolliger; Formal analysis: C\u0026eacute;line Bolliger. Investigation, Beat M\u0026uuml;ller, Marcus Vetter, and Katharina Roser. Resources: Luzius Mader, Mohsen Mousavi, Marcel Blum and Katharina Roser. Data curation: C\u0026eacute;line Bolliger and Katharina Roser. Writing original draft preparation: C\u0026eacute;line Bolliger. Writing review and editing: all authors. Visualization: C\u0026eacute;line Bolliger. Supervision: Katharina Roser. Project administration: C\u0026eacute;line Bolliger and Katharina Roser. Funding acquisition: Katharina Roser\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, et al. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care Engl. 2015/08/05 ed. 2016 May;25(3):419\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eBleyer A, Ferrari A, Whelan J, Barr RD. Global assessment of cancer incidence and survival in adolescents and young adults. Pediatr Blood Cancer. 2017 Sep;64(9). \u003c/li\u003e\n\u003cli\u003eFidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20\u0026ndash;39 years worldwide in 2012: a population-based study. 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Resilience as a Personality Trait and Stress Coping Styles: A Cross-Sectional Analysis of a Paramedic Student Cohort. J Clin Med. 2025 Jan;14(6):1878. \u003c/li\u003e\n\u003cli\u003eBensimon M. Elaboration on the association between trauma, PTSD and posttraumatic growth: The role of trait resilience. Personal Individ Differ. 2012 May 1;52(7):782\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGundogmus AG, Katar KS, Orsel S, Ozturk G, Yilmaz KB. The relationship of potential biomarkers with psychological resilience and post-traumatic growth in female patients with breast cancer. PLOS ONE. 2022 Dec 16;17(12):e0277119. \u003c/li\u003e\n\u003cli\u003eDuran S, Varol U, Tekir \u0026Ouml;, Soyt\u0026uuml;rk AH. Resilience\u0026rsquo;s impact on quality of life and post-traumatic growth in breast cancer patients during treatment. Breast Cancer. 2024 Sep 1;31(5):807\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eAtay Turan S, Sarvan S, Akcan A, Guler E, Say B. Adolescent and young adult survivors of cancer: relationship between resilience and post-traumatic growth. Curr Psychol. 2023 Oct 1;42(29):25870\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKuehni CE, Rueegg CS, Michel G, Rebholz CE, Strippoli MPF, Niggli FK, et al. Cohort Profile: The Swiss Childhood Cancer Survivor Study. Int J Epidemiol. 2012 Dec 1;41(6):1553\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eTedeschi RG, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eConnor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eCD-RISC: About [Internet]. [cited 2025 Jul 8]. Available from: https://www.connordavidson-resiliencescale.com/faq.php\u003c/li\u003e\n\u003cli\u003eBarr RD, Ries LAG, Trama A, Gatta G, Steliarova‐Foucher E, Stiller CA, et al. A system for classifying cancers diagnosed in adolescents and young adults. Cancer. 2020 Nov;126(21):4634\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eGreup SR, Kaal SEJ, Jansen R, Manten-Horst E, Thong MSY, van der Graaf WTA, et al. Post-Traumatic Growth and Resilience in Adolescent and Young Adult Cancer Patients: An Overview. J Adolesc Young Adult Oncol. 2018 Feb;7(1):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eMcDonnell GA, Pope AW, Schuler TA, Ford JS. The relationship between cancer-related worry and posttraumatic growth in adolescent and young adult cancer survivors. Psychooncology. 2018;27(9):2155\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eBarrett-Bernstein M, Wurz A, Brunet J. Posttraumatic growth and its correlates among survivors of adolescent and young adult cancer: A brief report. J Psychosoc Oncol. 2020 Mar 3;38(2):228\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eVishnevsky T, Cann A, Calhoun LG, Tedeschi RG, Demakis GJ. Gender Differences in Self-Reported Posttraumatic Growth: A Meta-Analysis. Psychol Women Q. 2010 Mar 1;34(1):110\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003ePark CL, Cho D. Spiritual well-being and spiritual distress predict adjustment in adolescent and young adult cancer survivors. Psychooncology. 2017;26(9):1293\u0026ndash;300. \u003c/li\u003e\n\u003cli\u003eGunst DCM, Kaatsch P, Goldbeck L. Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer. 2016 Nov;24(11):4607\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eDanhauer SC, Russell G, Case LD, Sohl SJ, Tedeschi RG, Addington EL, et al. Trajectories of Posttraumatic Growth and Associated Characteristics in Women with Breast Cancer. Ann Behav Med. 2015 Oct 1;49(5):650\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHuang S, Huang M, Long F, Wang F. Post-traumatic growth experience of breast cancer patients: A qualitative systematic review and meta-synthesis. PLOS ONE. 2025 Jan 23;20(1):e0316108. \u003c/li\u003e\n\u003cli\u003eLevine SZ, Laufer A, Stein E, Hamama-Raz Y, Solomon Z. Examining the relationship between resilience and posttraumatic growth. J Trauma Stress. 2009;22(4):282\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWidyorini E, Roswita MY, Primastuti E, Wijaya DA. The Role of Resilience towards the Correlation between Adverse Childhood Experiences and Post-Traumatic Growth. 2022.\u003c/li\u003e\n\u003cli\u003eDuan W, Guo P, Gan P. Relationships among Trait Resilience, Virtues, Post-traumatic Stress Disorder, and Post-traumatic Growth. Kavushansky A, editor. PLOS ONE. 2015 May 1;10(5):e0125707. \u003c/li\u003e\n\u003cli\u003eKaye-Tzadok A, Davidson-Arad B. Posttraumatic growth among women survivors of childhood sexual abuse: Its relation to cognitive strategies, posttraumatic symptoms, and resilience. Psychol Trauma Theory Res Pract Policy. 2016 Sep;8(5):550\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSeiler A, Jenewein J. Resilience in Cancer Patients. Front Psychiatry. 2019 Apr 5;10. \u003c/li\u003e\n\u003cli\u003eLevine SZ, Laufer A, Stein E, Hamama-Raz Y, Solomon Z. Examining the relationship between resilience and posttraumatic growth. J Trauma Stress. 2009 Aug;22(4):282\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eInfurna FJ, Jayawickreme E. Fixing the Growth Illusion: New Directions for Research in Resilience and Posttraumatic Growth. Curr Dir Psychol Sci. 2019 Apr 1;28(2):152\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSierra-Murgu\u0026iacute;a M, Guevara-Sangin\u0026eacute;s ML, Navarro-Contreras G, Peralta-Castillo G, Padilla-Rico A, Gonz\u0026aacute;lez-Alcocer L, et al. Relationship between Thought Style, Emotional Response, Post-Traumatic Growth (PTG), and Biomarkers in Cancer Patients. Int J Environ Res Public Health. 2024 Jun;21(6):763. \u003c/li\u003e\n\u003cli\u003eMatsui T, Taku K. A Review of Posttraumatic Growth and Help-Seeking Behavior in Cancer Survivors: Effects of Distal and Proximate Culture. Jpn Psychol Res. 2016;58(1):142\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eSumalla EC, Ochoa C, Blanco I. Posttraumatic growth in cancer: reality or illusion? Clin Psychol Rev. 2008/11/11 ed. 2009 Feb;29(1):24\u0026ndash;33. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Young adult cancer, Survivorship, Posttraumatic growth, Resilience","lastPublishedDoi":"10.21203/rs.3.rs-7774600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7774600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eSurvivors of young adult cancer (YACS) face distinct psychosocial challenges. Posttraumatic growth (PTG) and resilience may aid adaptation, though their relationship and relevance in this age group remain insufficiently understood. We aimed to (1) describe PTG and resilience among Swiss YACS and (2) investigate the associations of PTG with resilience, sociodemographic, and cancer-related characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe included survivors aged 21\u0026ndash;39 years at diagnosis, diagnosed at least two years prior. We conducted a questionnaire survey using the Posttraumatic Growth Inventory (PTGI; range:0-105) and the Connor-Davidson Resilience Scale (CD-RISC 10; range:0\u0026ndash;40). Data were analyzed using descriptive statistics and linear regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 131 YACS (62% female; mean age at study\u0026thinsp;=\u0026thinsp;37.6 years, SD\u0026thinsp;=\u0026thinsp;5.1) were included. The PTG sum score was 54.6 (SD\u0026thinsp;=\u0026thinsp;23.0, range:1-101), and YACS reported most PTG in appreciation of life (mean\u0026thinsp;=\u0026thinsp;3.3, 95% confidence interval: 3.2\u0026ndash;3.6) and least in spiritual change (1.1, 0.9\u0026ndash;1.3). The mean resilience score was 28.06 (SD\u0026thinsp;=\u0026thinsp;5.91, range:10\u0026ndash;39), and YACS reported the highest score for the item \u0026ldquo;Achieving goals despite obstacles\u0026rdquo; (3.2, 2.6-3.0), and the lowest for the item \u0026ldquo;see humorous side of things\u0026rdquo; (2.1, 2.0-2.3). PTG was higher among females and those who received chemotherapy, while resilience showed no significant association with PTG.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThese findings suggest that PTG and resilience are distinct but complementary adaptation processes in YACS. With higher PTG linked to female gender and chemotherapy, and resilience showing no direct association with PTG, personalized psychosocial support remains essential to help survivors navigate their unique cancer experiences and promote well-being.\u003c/p\u003e","manuscriptTitle":"Posttraumatic growth and resilience among survivors of cancer in young adulthood in Switzerland: a report from the Adolescent and Young Adult (AYA) Psychosocial Health Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 05:57:00","doi":"10.21203/rs.3.rs-7774600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"165234557549599125458386978958800153981","date":"2026-04-16T07:13:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T13:30:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262321174166585370092299765304163791700","date":"2026-02-15T23:05:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-06T00:13:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T00:11:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-07T23:10:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-10-03T15:10:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"01d338c7-fdb3-460f-b580-23d17d511bf4","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T05:57:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 05:57:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7774600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7774600","identity":"rs-7774600","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}