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ORIGINAL ARTICLE Table of Contents  
Ahead of print publication
Predictors of posttraumatic growth in oncology patients in a tertiary care hospital in rural background

1 Assistant Professor, Department of Psychiatry, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
2 Associate Professor, Department of Psychiatry, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India
3 Consultant Oncologist, Incharge and HOD, Department of Oncology, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India

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Date of Submission04-Jun-2022
Date of Acceptance04-Aug-2022
Date of Web Publication27-Sep-2022


Background: Cancer, like other traumatic life events, can generate negative and positive changes in psychological well-being. Negative changes are defined as posttraumatic disorders and positive changes are called posttraumatic growth (PTG). Patients who experience PTG show positive and meaningful changes in their emotional and cognitive life, which has a positive impact on their behavior.
Aim: The current study aimed to examine the concept of PTG and its social and cultural aspects in cancer patients from rural background arena.
Settings and Design: This was a cross-sectional observational study.
Materials and Methods: One hundred and fifty-five cancer-diagnosed patients were included in the study from a tertiary care hospital, and PTG Inventory (PTGI) was administered to assess the posttrauma growth
Statistical analysis used: Data were analyzed using the SPSS statistics version 23. Descriptive statistics and inferential statistics were performed.
Results: Cancer patients showed posttrauma growth of 67.95 (standard deviation: 6.65). Of dimensions of PTGI, the highest score was for “relating to others.” Women had higher PTG of 70.46 (3.7) than men. Cervical and breast cancer patients showed higher scores of 71.9 (2.9) and 70.1 (3.5), respectively.
Conclusions: This study highlighted that women had more PTG and cervical and breast cancer patients had better scores.

Keywords: Cancer, female, posttraumatic growth

How to cite this URL:
SaiLahari KV, Abhinaya RV, Mutnuru V. Predictors of posttraumatic growth in oncology patients in a tertiary care hospital in rural background. Arch Ment Health [Epub ahead of print] [cited 2023 Mar 24]. Available from: https://www.amhonline.org/preprintarticle.asp?id=357205

  Introduction Top

Cancer, like other traumatic life events, can generate negative and positive changes in psychological well-being. Negative changes are defined as posttraumatic disorders and positive changes are called posttraumatic growth (PTG). PTG is the experience of positive change that occurs as a result of the struggle with highly challenging life crises.[1] PTG acts as a stress-buffering mechanism. Studies have shown that overcoming cancer and its treatment can be an opportunity for personal growth, as well as for enhanced mental and emotional well-being that could potentially be linked to better coping with disease-related demands.[2],[3] Patients who experience PTG show positive and meaningful changes in their emotional and cognitive life, which has a positive impact on their behavior.[4] The concept of PTG is related to the social and cultural context of the study population, and there are a limited number of studies conducted on cancer patients in rural background. Therefore, the aim of this study is to examine the concept of PTG and its aspects in cancer patients from this arena.

  Materials and Methods Top

It was a cross-sectional observational study conducted after getting ethical clearance from the institutional ethics committee EC04/IEC/2022. The study population consisted of 155 patients diagnosed with cancer. Patients who enrolled in the study were diagnosed with cancer by an oncology specialist and were aware of their diagnosis. Patients of age 18 years or older, no past history of Psychiatry illness and no report of suicidal ideation were included in the study. Patients' carcinoma diagnosis who were included in the study was proven by biopsy. Informed consent was taken from the patients. The tools used in this study included a demographic characteristic questionnaire and the PTG Inventory (PTGI). The demographic characteristic questionnaire included questions about age, gender, marital status, occupation, place of residence, type of cancer, the extent of cancer (metastatic and nonmetastatic), type of treatment, and duration of cancer diagnosis.

Posttraumatic Growth Inventory

It was developed by Tedeschi and Calhoun to assess the concept of PTG. This tool has 21 items, which determines 5 domains of psychological growth after encountering a traumatic stressor, including Factor I: relating to others, Factor II: new possibilities, Factor III: personal strength, Factor IV: spiritual change, and Factor V: appreciation of life. This tool is based on the six-point Likert scale, of which the first item is assigned zero points (not in general); items 2–6 receive 1–5 points (very little, to some extent, moderate, to a large extent, and very much). The PTGI is scored by adding all the responses. Individual factors are scored by adding responses to items on each factor. Scores range from 0 to 105. Higher scores indicate greater PTG. The PTGI has a good internal consistency for the entire instrument (α = 0.90) and an acceptable internal consistency for the five subscales (α = 0.67–0.85).[5]

Statistical analysis

The data obtained from 155 patients were populated into Microsoft Excel sheet and analyzed using IBM SPSS Statistics version 23 (IBM Company, Chicago city, Illinois state, United States of America country). Descriptive statistics were performed to get frequencies, means, and percentages with 95% confidence interval. Inferential statistics was performed using t-test and analysis of variance and Pearson correlation, and a P value of 0.05 was considered statistically significant.

  Results Top

In this study, data from 155 patients were analyzed. The mean age of the participants was 57.95 years, with a range from 29 to 86 years. There were 42 (27.1%) male patients and 113 (72.9%) female patients. Metastatic cancer was present in 94 (60.6%) of patients. The results indicated that all cancer patients who participated in this study showed some degree of growth. The mean PTG was 67.95 (standard deviation [SD]: 6.65). The results of the descriptive data showed that the mean score for the total score of PTGI was 67.95 (SD: 6.65). Of dimensions of PTGI, the highest score was related to others (mean: 22.9, SD: 2.5) followed by new possibilities (mean: 16.1, SD: 2.07), personal growth (mean: 12.9, SD: 1.4), spiritual change (mean: 7.1, SD: 1.1), and appreciation of life (mean: 8.8, SD: 1.06).

  Discussion Top

The aim of this study was to examine PTG in patients with cancer from rural background and to evaluate its relationship with demographic characteristics of these patients. The results of this study supported the results from previous studies which showed that experiencing a stressful event such as diagnosis of cancer could have positive psychological effects.[6]. These findings support the theory of posttraumatic proposed by Tedeschi and Calhoun.[1]

There was a negative significant relationship between age and PTG (r = −0.91, P = 0.01) [Table 1]; the score of PTG in younger age group was higher than in older patients. It seemed that younger people found new paths in life and attempted to live better. These findings were supported by Bellizzi and Blank study.[7] Age, in general, had an inverse relationship with PTG according to Liu et al.[8] Stanko and colleagues.[9] suggested that the older age (>65 years) lost hope in having positive changes occurring after a trauma. Furthermore [Table 1], longer time since the diagnosis of illness may be associated with a higher level of PTG, supported by Cordova et al. study.[10]
Table 1: Correlation between age, duration, and posttraumatic growth

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The present study showed that women had higher PTG than men; evident from [Table 2], this growth was significant regarding the aspect of “relating to others,” “new possibilities,” “personal strength,” “spiritual change,” and “appreciation of life.” In the study by Zwahlen et al.,[11] women had higher scores than men in dimensions of “relating to others,” “appreciation of life,” and “personal strength.” The study by Morris et al. revealed that the highest PTG in patients with cancer was related to appreciation of life, becoming personally stronger, new possibilities, and spirituality.[6],[12] The gender difference of higher scores in females than males is because of life cycle events and physical changes. Developmental maturity associated with aging also differed by gender leading to better positive view of the trauma. Females experience more stressful life events with physical changes, such as pregnancy, giving birth, or (peri) menopause. They may also be more sensitive to perceive a situation as threatening and stressful, and experience more psychological and biological responses to trauma.[13]
Table 2: The scores of posttraumatic growth and its dimensions in cancer patients

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The findings of this study were also consistent with previous research, indicating a positive association between traumatic events and personal growth. These studies have documented that some patients with cancer reported a greater appreciation of life, better relationships with others, and spiritual change as a result of their experience with their illness.[10]

In this study, patients with cervical cancer, breast cancer, and thyroid cancer [Table 3] had higher PTG scores compared to patients with other types of cancer. A study conducted by Ruini et al.[3] and Cordova et al.[10] showed higher PTG score in breast cancer patients. The present study showed new light into cervical, thyroid, and stomach cancers. Patients underwent positive cognitive, emotional, and behavioral changes after experiencing a traumatic life, such as cancer, and coping with the difficulties that come with such a life.[14] These changes affected a positive change in self-awareness (an increase in self-understanding, empathy, maturity, self-confidence, and self-sufficiency), a positive change in interpersonal relationships (more tolerant, social support networks, establishing positive relationships with friends and family, and perceiving the environment more positively), and a change in their philosophy of life (cherishing the moment, understanding the value of life, giving their life a new direction, and paying more attention to spiritual matters).
Table 3: The relationship between demographic characteristics and posttraumatic growth in cancer patients

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The present study showed that patients went through spiritual change to deal with the trauma. Pargament et al.[15] pointed out that a strengthening of religious beliefs may lead to an increased sense of control, intimacy, and finding meaning. Recognizing meaning in the midst of trauma and its aftermath may allow a person to experience emotional relief and lead to a new philosophy of life that alters basic assumptions people hold about life and what meaning it may have.

The better scores attained in “relating to others” and “appreciation of life” in the current study, were supported by Pinquart et al.[16] study which showed high levels of social support led to better perceiving of positive changes. Evidence from the literature suggests that those who perceive growth shortly after a stressful life event experience better mental health and fewer posttraumatic symptoms later. Furthermore, a study conducted by Husson et al.[17] showed that PTG has been linked to positive affect and improved life satisfaction.

The present study did not show a significant relationship between PTG and type of treatment received, supported by Tempelaar et al.[18] study. However, due to the heterogeneity of the sample characteristics and different cutoff values used in previous studies, it is difficult to directly compare the studies using samples from other cultures.

Cohen and Numa[19] stated that social support, family dynamics in particular, should be kept alive during long-term treatment; health-care workers play an important role regarding the said subject. Accordingly, the social environment of the patient should be informed about the importance of social support and how it helps the patient; they should be made aware of necessity of social support in both acute and chronic periods.

PTG appears to play a protective role when present, while having a negative impact on patient quality of life when absent.

More recently, interest has increased in promoting resilience in palliative cancer patients: in particular, interventions to foster resilience in patients with advanced or terminal cancer who have given up hope could benefit from resilience-fostering interventions. PTG as an indirect path of resilience is an important phenomenon during adjustments to cancer, and is linked to less distress, better mental health, and improved quality of life.[17] Cancer recurrence/metastasis is also a challenging or traumatic event. It is also possible that personality traits (e.g., optimism and positive reframing) could play a role. However, this study did not include personality traits. Further studies could investigate the associations between perceived illness severity and personality traits on PTG after disease recurrence in long-term cancer survivors.

The present study highlighted the importance of social support and life meaning to experience personal growth. The results of this research have some clinical implications for health professionals, who work with individuals with chronic illnesses, encourage clinicians to pay more attention to positive experience, and not merely focus on illness-related deficits. Furthermore, clinicians might be able to assist patients to live more meaningfully.

The present study had limitations. The results should be considered preliminary as the sample size is small. This study found no association between PTG and clinical outcomes, although additional patient follow-up data and more detailed medical, psychological, and family history data could reveal an association similar to other reports. Furthermore, we cannot conclude a cause–effect relation based on this cross-sectional study. Further longitudinal studies on PTG in cancer survivors are warranted to address heterogeneity in survivors' experience after cancer diagnosis. Future research should include more diverse patient populations, collect longitudinal data, and focus on pathways toward positive changes

  Conclusions Top

The present study indicated that all the participating cancer patients had experienced PTG. Further studies to be conducted on other influencing factors on PTG like personality traits etc., which would help to adjust and improve the patients' health. That could improve their further quality of life. Promoting PTG should be a critical component of cancer care.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Tedeschi RG, Calhoun LG. Posttraumatic growth: Conceptual foundations and empirical evidence. Psychol Inq 2004;15:1-18.  Back to cited text no. 1
Farooqui U, Pushkarna M. A study exploring post traumatic growth (PTG) in individuals who have undergone traumatic life events. Int J Indian Psychol 2021;9.  Back to cited text no. 2
Ruini C, Vescovelli F, Albieri E. Post-traumatic growth in breast cancer survivors: new insights into its relationships with well-being and distress. J Clin Psychol Med Settings 2013;20:383-91.  Back to cited text no. 3
Tedeschi RG, Park CL, Calhoun LG. Posttraumatic Growth: Positive Change in the Aftermath of Crisis. New Jersey: Lawrence Erlbaum Associates; 1998. p. 1-23.  Back to cited text no. 4
Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. J Trauma Stress 1996;9:455-71.  Back to cited text no. 5
Morris BA, Shakespeare-Finch J, Scott JL. Posttraumatic growth after cancer: The importance of health-related benefits and newfound compassion for others. Support Care Cancer 2012;20:749-56.  Back to cited text no. 6
Bellizzi KM, Blank TO. Predicting posttraumatic growth in breast cancer survivors. Health Psychol 2006;25:47-56.  Back to cited text no. 7
Liu Z, Thong MS, Doege D, Koch-Gallenkamp L, Bertram H, Eberle A, et al. Prevalence of benefit finding and posttraumatic growth in long-term cancer survivors: Results from a multi-regional population-based survey in Germany. Br J Cancer 2021;125:877-83.  Back to cited text no. 8
Stanko, Park CL. Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. PsycholBull. 2010;136:257-301.  Back to cited text no. 9
Cordova MJ, Cunningham LL, Carlson CR, Andrykowski MA. Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychol 2001;20:176-85.  Back to cited text no. 10
Zwahlen D, Hagenbuch N, Carley MI, Jenewein J, Buchi S. Posttraumatic growth in cancer patients and partners-effects of role, gender and the dyad on couples' posttraumatic growth experience. Psychooncology 2010;19:12-20.  Back to cited text no. 11
Curbow B, Legro MW, Baker F, Wingard JR, Somerfield MR. Loss and recovery themes of lng-term survivors of bone marrow transplants. J Psychosoc Oncol 1993;10:1-20.  Back to cited text no. 12
Steiner M, Dunn E, Born L. Hormones and mood: From menarche to menopause and beyond. J Affect Disord 2003;74:67-83.  Back to cited text no. 13
Thombre A, Sherman AC, Simonton S. Posttraumatic growth among cancer patients in India. J Behav Med 2010;33:15-23.  Back to cited text no. 14
Pargament ICI, Royster BJT, Albert M, Crowe P, Cullman EP, Holley et al. A Qualitative Approach to the Study of Religion and Coping: Four Tentative Conclusions. Paper Presented at the Annual Convention of the American Psychological Association, Boston, MA; August, 1990.  Back to cited text no. 15
Pinquart M, Fröhlich C, Silbereisen RK. Cancer patients' perceptions of positive and negative illness-related changes. J Health Psychol 2007;12:907-21.  Back to cited text no. 16
Husson O, Zebrack B, Block R, Embry L, Aguilar C, Hayes-Lattin B, et al. Posttraumatic growth and well-being among adolescents and young adults (AYAs) with cancer: A longitudinal study. Support Care Cancer 2017;25:2881-90.  Back to cited text no. 17
Tempelaar R, De Haes JC, De Ruiter JH, Bakker D, Van Den Heuvel WJ, Van Nieuwenhuijzen MG. The social experiences of cancer patients under treatment: A comparative study. Soc Sci Med 1989;29:635-42.  Back to cited text no. 18
Pehlivan S, Ovayolu O, Ovayolu N, Sevinc A, Camci C. Relationship between hopelessness, loneliness, and perceived social support from family in Turkish patients with cancer. Support Care Cancer 2012;20:733-9.  Back to cited text no. 19

Correspondence Address:
Kakarla V. M. SaiLahari,
D/o K.S.Prasada Rao, LIG- A-130, Sagar Nagar, Visakhapatnam - 530 045, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amh.amh_90_22


  [Table 1], [Table 2], [Table 3]


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