Factors influencing resilience in patients with advanced cancer: A cross-sectional study


influencing factors
patients with advanced cancer

How to Cite

Niamhom, P., Wonghongkul, T., Chaiard, J., & Srirat, C. Factors influencing resilience in patients with advanced cancer: A cross-sectional study. Belitung Nursing Journal, 9(3). https://doi.org/10.33546/bnj.2553


Background: Advanced cancer and its treatments lead to various detrimental impacts on patients. Resilience is an important ability to adapt to such adversity, but there is limited information about its influencing factors, specifically in patients with advanced cancer.

Objective: This study aimed to examine the influence of social support, depression, anxiety, hope, optimism, spiritual well-being, religious belief,and hardiness on resilience among adults with advanced cancer.

Methods: This cross-sectional research used multi-stage sampling to select 288 participants from a university hospital and three tertiary hospitalsin northern Thailand. Data were collected using a demographic data collection form, the Hospital Anxiety and Depression Scale (HADS), the Thai version of the Social Support Questionnaire (SSQ), the Herth Hope Index (HHI), Life Orientation Test-Revised (LOT-R), Buddhist Belief Questionnaire, Health-Related Hardiness Scale (HRHS), and Connor-Davidson Resilience Scale (CD-RISC), from February 2021 to February 2022. Data were analyzed using descriptive statistics, Pearson correlation, and regression analysis.

Results: Depression (r = -0.47, p <0.01) and anxiety (r = -0.39, p <0.01) had a significant negative relationship with resilience. Spiritual well-being(r = 0.74, p <0.01), hope (r = 0.67, p <0.01), religious belief (r = 0.53, p <0.01), optimism (r = 0.40, p <0.01), social support (r = 0.33, p <0.01), and hardiness (r = 0.21, p <0.01) had significant positive relationships with resilience. Only hope (β = 0.29, p <0.01) and spiritual well-being (β = 0.59, p<0.01) together influenced resilience by 64.70%.

Conclusion: Spiritual well-being and hope are crucial to resilience in patients with advanced cancer. Nurses should provide spiritual support to strengthen patients’ ability to adapt successfully to life with advanced cancer.



Copyright (c) 2023 Pimonpan Niamhom, Tipaporn Wonghongkul, Jindarat Chaiard, Chomphoonut Srirat

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Al Eid, N. A., Alqahtani, M. M. J., Marwa, K., Arnout, B. A., Alswailem, H. S., & Al Toaimi, A. A. (2020). Religiosity, psychological resilience, and mental health among breast cancer patients in Kingdom of Saudi Arabia. Breast Cancer: Basic and Clinical Research, 14, 1178223420903054. https://doi.org/10.1177%2F1178223420903054

Aman, F., & Akhtar, N. (2020). Religious coping, resilience and spiritual well-being among women with breast cancer; comparison of different age groups and different stages of cancer. Journal of Postgraduate Medical Institute, 34(3), 149–153.

Bittencourt, N. C. C. d. M., Santos, K. A., Mesquita, M. G. d. R., Silva, V. G. d., Telles, A. C., & Silva, M. M. d. (2021). Signs and symptoms manifested by patients in palliative cancer care in homecare: Integrative review. Escola Anna Nery, 25(4). https://doi.org/10.1590/2177-9465-EAN-2020-0520

Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185-216. https://doi.org/10.1177/135910457000100301

Cancer Council NSW. (2018). Advanced cancer. https://www.cancercouncil.com.au/cancer-information/advanced-cancer/

Cancer Research UK. (2022). Worldwide cancer statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/worldwide-cancer

Chen, J., You, H., Liu, Y., Kong, Q., Lei, A., & Guo, X. (2021). Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China. Medicine, 100(1), e24264. https://doi.org/10.1097%2FMD.0000000000024264

Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and Anxiety, 18(2), 76-82. https://doi.org/10.1002/da.10113

Costa, D. T., Silva, D. M. R. d., Cavalcanti, I. D. L., Gomes, E. T., Vasconcelos, J. L. d. A., & Carvalho, M. V. G. d. (2019). Religious/spiritual coping and level of hope in patients with cancer in chemotherapy. Revista Brasileira de Enfermagem, 72, 640-645. https://doi.org/10.1590/0034-7167-2018-0358

Department of Religious Affairs. (2020). Buddhism. https://e-service.dra.go.th/religion/buddhism?type=10

Fradelos, E. C., Latsou, D., Mitsi, D., Tsaras, K., Lekka, D., Lavdaniti, M., Tzavella, F., & Papathanasiou, I. V. (2018). Assessment of the relation between religiosity, mental health, and psychological resilience in breast cancer patients. Contemporary Oncology/Współczesna Onkologia, 22(3), 172-177. https://doi.org/10.5114/wo.2018.78947

Gallagher, M. W., Long, L. J., Richardson, A., & D’Souza, J. M. (2019). Resilience and coping in cancer survivors: The unique effects of optimism and mastery. Cognitive Therapy and Research, 43, 32-44. https://doi.org/10.1007/s10608-018-9975-9

Gao, Y., Yuan, L., Pan, B., & Wang, L. (2019). Resilience and associated factors among Chinese patients diagnosed with oral cancer. BMC Cancer, 19, 1-9. https://doi.org/10.1186/s12885-019-5679-0

Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and grove's the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, Missouri: Elsevier Health Sciences.

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2014). Pearson new international edition: Multivariate data analysis (7th ed.). Essex: Pearson.

Hanucharurnkul, S. (1988). Social support, self-care, and quality of life in cancer patients receiving radiotherapy in Thailand. Ann Arbor: Wayne State University.

Herth, K. (1992). Abbreviated instrument to measure hope: Development and psychometric evaluation. Journal of Advanced Nursing, 17(10), 1251-1259. https://doi.org/10.1111/j.1365-2648.1992.tb01843.x

Hu, T., Xiao, J., Peng, J., Kuang, X., & He, B. (2018). Relationship between resilience, social support as well as anxiety/depression of lung cancer patients: A cross-sectional observation study. Journal of Cancer Research and Therapeutics, 14(1), 72-77. https://doi.org/10.4103/jcrt.JCRT_849_17

Kavak, F., Özdemir, A., & Dural, G. (2021). The relation between spiritual wellbeing and psychological resilience among patients diagnosed with advanced gastrointestinal cancer. Current Psychology, 40(4), 1788-1794. https://doi.org/10.1007/s12144-018-0116-0

Kolsteren, E. E. M., Deuning-Smit, E., Chu, A. K., van der Hoeven, Y. C. W., Prins, J. B., van der Graaf, W. T. A., van Herpen, C. M. L., van Oort, I. M., Lebel, S., & Thewes, B. (2022). Psychosocial aspects of living long term with advanced cancer and ongoing systemic treatment: A scoping review. Cancers, 14(16), 3889. https://doi.org/10.3390/cancers14163889

Kumpfer, K. L. (1999). Factors and processes contributing to resilience: The resilience framework. In M. D. Glantz & J. L. Johnson (Eds.), Resilience and development: Positive life adaptations (pp. 179-224). Kluwer Academic Publishers.

Li, C., Lu, H., Qin, W., Li, X., Yu, J., & Fang, F. (2019). Resilience and its predictors among Chinese liver cancer patients undergoing transarterial chemoembolization. Cancer Nursing, 42(5), E1-E9. https://doi.org/10.1097/NCC.0000000000000640

Limwattanathawornkul, I., Jullamate, P., & Piphatvanitcha, N. (2019). Factors related to resilience among elderly cancer patients receiving chemotherapy. Journal of Nursing, Siam University, 20(38), 24-36.

Luo, D., Eicher, M., & White, K. (2020). Individual resilience in adult cancer care: A concept analysis. International Journal of Nursing Studies, 102, 103467. https://doi.org/10.1016/j.ijnurstu.2019.103467

Mihic-Gongora, L., Jiménez-Fonseca, P., Hernandez, R., Gil-Raga, M., Pacheco-Barcia, V., Manzano-Fernández, A., Hernando-Polo, S., Antoñanzas-Basa, M., Corral, M. J., & Valero-Arbizu, M. (2022). Psychological distress and resilience in patients with advanced cancer during the Covid-19 pandemic: The mediating role of spirituality. BMC Palliative Care, 21(1), 146. https://doi.org/10.1186/s12904-022-01034-y

Miller, K. D., Nogueira, L., Devasia, T., Mariotto, A. B., Yabroff, K. R., Jemal, A., Kramer, J., & Siegel, R. L. (2022). Cancer treatment and survivorship statistics, 2022. CA: A Cancer Journal for Clinicians, 72(5), 409-436. https://doi.org/10.3322/caac.21731

Mungase, M., Chaudhury, S., Patil, A. A., Jagtap, B., & Jain, V. (2021). Stress, anxiety, depression, and resilience in cancer patients on radiotherapy. Industrial Psychiatry Journal, 30(2), 346-352. https://doi.org/10.4103%2Fipj.ipj_78_20

Nahm, S. H., Stockler, M. R., Martin, A. J., Grimison, P., Fox, P., Zielinski, R., Hawson, G. A. T., Tattersall, M. H. N., & Kiely, B. E. (2022). Using three scenarios to explain life expectancy in advanced cancer: Attitudes of patients, family members, and other healthcare professionals. Supportive Care in Cancer, 30(9), 7763-7772. https://doi.org/10.1007/s00520-022-07167-3

Nilchaikovit, T., Sookying, J., & Silapakit, C. (1996). Determinants related with mental disorders of residents in Nongjok. Journal of Psychiatrist Association in Thailand, 41(3), 191-202.

Palacio, C., & Arias, M. (2018). The role of resilience and coping strategies of fighting spirit in the adaptation of patients with advanced cancer disease attending an oncological institution of medellín-colombia. Journal of Pain and Symptom Management, 56(6), e134. https://doi.org/10.1016/j.jpainsymman.2018.10.427

Pollock, S. E., & Duffy, M. E. (1990). The health-related hardiness scale: Development and psychometric analysis. Nursing Research, 39(4), 218-222. https://doi.org/10.1097/00006199-199007000-00008

Promkaewngam, S., Pothiban, L., Srisuphan, W., & Sucamvang, K. (2014). Development of the spiritual well-being scale for Thai Buddhist adults with chronic illness. Pacific Rim International Journal of Nursing Research, 18(4), 320-332.

Schaefer, C., Coyne, J. C., & Lazarus, R. S. (1981). The health-related functions of social support. Journal of Behavioral Medicine, 4(4), 381-406. https://doi.org/10.1007/BF00846149

Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063-1078. https://doi.org/10.1037/0022-3514.67.6.1063

Seesopon, S., Pothiban, L., & Suwankruhasn, N. (2017). Buddhist beliefs and caregiving burden among caregivers of older persons with congestive heart failure. Journal of Nursing and Education, 10(3), 56-70.

Seiler, A., & Jenewein, J. (2019). Resilience in cancer patients. Frontiers in Psychiatry, 10, 208. https://doi.org/10.3389/fpsyt.2019.00208

Somaratne, G. A. (2018). Birth, aging and death: Three existential sufferings in early Buddhism. International Journal of Buddhist Thought and Culture, 28(2), 115-145. https://doi.org/10.16893/IJBTC.2018.

Suara, E., Mardiyono, M., & Anggorowati, A. (2017). Relationship between demographic characteristics and spiritual wellbeing among cancer survivors. Belitung Nursing Journal, 3(4), 405-411. https://doi.org/10.33546/bnj.74

Tamura, S. (2021). Factors related to resilience, anxiety/depression, and quality of life in patients with colorectal cancer undergoing chemotherapy in Japan. Asia-Pacific Journal of Oncology Nursing, 8(4), 393-402. https://doi.org/10.4103/apjon.apjon-2099

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18. https://doi.org/10.1207/s15327965pli1501_01

Thai Ministry of Public Health. (2020). Public health statistics A.D. 2020. http://dmsic.moph.go.th/index/detail/8900

Thai Ministry of Public Health. (2023). National Cancer Institute strategic plan 2019-2022. https://nci.go.th/th/

Thai National Cancer Institute. (2020). Hospital-based cancer registry 2019. https://www.nci.go.th/th/File_download/Nci%20Cancer%20Registry/Hospital-Based%202019%20NCI.pdf

Thai National Cancer Institute. (2021). Hospital-based cancer registry 2021. https://www.nci.go.th/e_book/hosbased_2564/index.html

World Cancer Research Fund International. (2022). Worldwide cancer data. https://www.wcrf.org/cancer-trends/worldwide-cancer-data/

World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

Zahid, N., Khalid, W., Ahmad, K., Bhamani, S. S., Azam, I., Asad, N., Jabbar, A. A., Khan, M., & Enam, A. (2019). Resilience and quality of life (QoL) of head and neck cancer and brain tumour survivors in Pakistan: An analytical cross-sectional study protocol. BMJ Open, 9(9), e029084. http://dx.doi.org/10.1136/bmjopen-2019-029084

Zhao, X., Sun, M., & Yang, Y. (2021). Effects of social support, hope and resilience on depressive symptoms within 18 months after diagnosis of prostate cancer. Health and Quality of Life Outcomes, 19, 1-10. https://doi.org/10.1186/s12955-020-01660-1

Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x