Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
Shenzhen Clinical Medical School of Southern Medical University, Guangzhou, China.
J Cancer Res Clin Oncol. 2023 Dec;149(20):18005-18021. doi: 10.1007/s00432-023-05498-0. Epub 2023 Nov 18.
Resilience is an important regulating factor for anxiety and depression in breast cancer. The Managing Cancer and Living Meaningfully (CALM) intervention has been confirmed to improve anxiety and depression in patients, but the role of resilience is still unclear. This study explores this issue.
In this study, a cohort of 124 patients diagnosed with breast cancer was recruited and randomly assigned to either the intervention group (IG) or the control group (CG). In addition, we enrolled a group of cancer-free women (regular control group) and assessed their resilience. All patients were evaluated using the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT-B) and Perceived Stress Scale (PSS) at different time points. The primary outcomes were resilience, quality of life, anxiety, depression, and perceived stress. A repeated measures ANOVA was used to compare the scores of the IG and CG groups. The relationship between resilience and quality of life was analyzed using Pearson's correlation test. The paired-sample t-test was used to compare the changes in each score at different time points.
The intervention group showed significant differences in resilience, adamancy, optimism, tenacity, anxiety, depression, perceived stress and QOL scores before and after 6, 12, and 24 weeks (F = 17.411, F = 226.55, F = 29.096, F = 50.67, F = 82.662, F = 105.39, F = 62.66, F = 72.43, F = 34.561, respectively; P < 0.001). Compared to the control group, the intervention group demonstrated significant improvement in resilience and quality of life (t = -11.517, p < 0.001; t = - 4.929, p < 0.001), as well as a significant reduction in anxiety, depression, and perceived stress scores (t = 5.891, p < 0.001; t = 2.654, p < 0.001; t = 4.932, p < 0.001). In the intervention group, a significant positive correlation was observed between resilience in breast cancer survivors and quality of life (QOL) scores. (before CALM treatment: r = 0.3204, P = 0.0111; after 6 weeks: r = 0.3619, P = 0.0038; after 12 weeks: r = 0.3355, P = 0.0077; after 24 weeks: r = 0.2801, P = 0.0274).
A positive impact of the CALM intervention can be seen in improved resilience and reduced anxiety and depression, supporting its use as an effective psychological management tool and intervention strategy in the early stages of long-term breast cancer recovery.
韧性是乳腺癌患者焦虑和抑郁的重要调节因素。管理癌症和有意义地生活（CALM）干预已被证实可改善患者的焦虑和抑郁，但韧性的作用仍不清楚。本研究探讨了这一问题。
本研究招募了 124 名被诊断为乳腺癌的患者，并将他们随机分配到干预组（IG）或对照组（CG）。此外，我们还招募了一组无癌症的女性（常规对照组），并评估了她们的韧性。所有患者均在不同时间点使用 Connor-Davidson 韧性量表（CD-RISC）、医院焦虑和抑郁量表（HADS）、癌症治疗功能评估（FACT-B）和感知压力量表（PSS）进行评估。主要结局为韧性、生活质量、焦虑、抑郁和感知压力。采用重复测量方差分析比较 IG 和 CG 组的评分。采用 Pearson 相关检验分析韧性与生活质量的关系。采用配对样本 t 检验比较各评分在不同时间点的变化。
干预组在干预前、干预后 6、12、24 周时的韧性、固执、乐观、坚韧、焦虑、抑郁、感知压力和生活质量评分均有显著差异（F=17.411，F=226.55，F=29.096，F=50.67，F=82.662，F=105.39，F=62.66，F=72.43，F=34.561，均 P<0.001）。与对照组相比，干预组的韧性和生活质量显著改善（t=-11.517，p<0.001；t=-4.929，p<0.001），焦虑、抑郁和感知压力评分显著降低（t=5.891，p<0.001；t=2.654，p<0.001；t=4.932，p<0.001）。在干预组中，乳腺癌幸存者的韧性与生活质量评分呈显著正相关（CALM 治疗前：r=0.3204，P=0.0111；治疗后 6 周：r=0.3619，P=0.0038；治疗后 12 周：r=0.3355，P=0.0077；治疗后 24 周：r=0.2801，P=0.0274）。
CALM 干预可以看到韧性的积极影响，以及焦虑和抑郁的减少，支持将其作为长期乳腺癌康复早期阶段的有效心理管理工具和干预策略。
