Document Type : Review Article
Authors
1 Nursing Research Center, Counselling in Midwifery Department, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
2 Geriatric Research Center, Department of Medical Surgical Nursing, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 Department of Epidemiology, Shahroud University of Medical Sciences, Shahroud, Iran
4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: This meta-analysis study aimed to evaluate post-traumatic growth (PTG) in cancer patients.
Methods: We systematically searched for studies that reported PTG in cancer patients. Then, irrelevant studies were removed after the abstracts of articles were studied, and articles completely related to the research purpose were selected by examining the full texts of the articles. Finally, the articles that met the inclusion criteria were selected for analysis based on the criteria of critical evaluation.
Results: Of 21 articles, nine studies were performed on women, one study on men, and 11 studies on both sexes, and all of them used post-traumatic growth inventory (PTGI). The studies showed that the mean PTGI score was 60.72 and heterogeneity was not statistically significant (I2 = 0.0, heterogeneity = 0.998). The subgroups classified according to continents showed that the mean PTGI scores in Asia, Europe, and the United States were 61.40, 59.12, and 60.42, respectively.
Conclusion: Recognition of the psychological responses in cancer patients requires much more attention from health care professionals, and they should consider programs to enhance PTG in cancer survivors.
Keywords
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Isfahani H, Shojaei MR, Masoumeh YM, et al. Quality of life,
religious attitude and cancer coping in a sample of Iranian
patients with cancer. J Res Med Sci. 2011;16(7):928-37.
2. Freire ME, Sawada NO, de França IS, da Costa SF, Oliveira
CD. [Health-related quality of life among patients
with advanced cancer: an integrative review]. Rev Esc
Enferm USP. 2014;48(2):357-67. doi: 10.1590/s0080-
6234201400002000022.
3. Lee IJ. The effects of stress on quality of life in cancer patients:
focusing on the moderating effects of post-traumatic growth.
Health and Social Welfare Review. 2012;32(3):522-57.
4. 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(1):12-20. doi:
10.1002/pon.1486.
5. Atefeh Ahmadi AH, Dehghan M, Safarizadeh MH, Azizzadeh
Forouzi M. Spiritual coping strategies: Relationship with
physical, anxiety, and depression symptoms of patients with
cancer. Indian Journal of Cancer. 2021.
6. Behnam-Talab E, Amin-Shokravi F, Hashemian M, Moshki M,
Jafaei N. The effect of stress management group counseling
on stress in women with a family history of breast cancer. J
Kerman Univ Med Sci. 2016;22(1):68-80. [Persian].
7. Mirmahmoodi M, Mangalian P, Ahmadi A, Dehghan
M. The effect of mindfulness-based stress reduction
group counseling on psychological and inflammatory
responses of the women with breast cancer. Integr
Cancer Ther. 2020;19:1534735420946819. doi:
10.1177/1534735420946819.
8. Azizzadeh Forouzi M, Tirgari B, Safarizadeh MH, Jahani Y.
Spiritual needs and quality of life of patients with cancer.
Indian J Palliat Care. 2017;23(4):437-44. doi: 10.4103/ijpc.
ijpc_53_17.
9. Hosseini M, Tirgari B, Azizzadeh Forouzi M, Jahani Y. Guided
imagery effects on chemotherapy induced nausea and
vomiting in Iranian breast cancer patients. Complement Ther
Clin Pract. 2016;25:8-12. doi: 10.1016/j.ctcp.2016.07.002.
10. Hatam N, Bastani P, Ahmadlo N, Ahmadkia-Daliri AA. Health
related quality of life in breast cancer patients undergoing
current chemotherapy protocols. J Kerman Univ Med Sci.
2012;19(1):49-58. [Persian].
11. Tedeschi RG, Calhoun LG. The Posttraumatic Growth
Inventory: measuring the positive legacy of trauma. J Trauma
Stress. 1996;9(3):455-71. doi: 10.1007/bf02103658.
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breast cancer survivors. Health Psychol. 2006;25(1):47-56.
doi: 10.1037/0278-6133.25.1.47.
13. Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road
and the emerald city: benefit finding, positive reappraisal
coping and posttraumatic growth in women with earlystage
breast cancer. Health Psychol. 2003;22(5):487-97. doi:
10.1037/0278-6133.22.5.487.
14. Kroemeke A, Bargiel-Matusiewicz K, Kalamarz M. Mixed
psychological changes following mastectomy: unique
predictors and heterogeneity of post-traumatic growth and
post-traumatic depreciation. Front Psychol. 2017;8:1245. doi:
10.3389/fpsyg.2017.01245.
15. Bostock L, Sheikh AI, Barton S. Posttraumatic growth and
optimism in health-related trauma: a systematic review. J
Clin Psychol Med Settings. 2009;16(4):281-96. doi: 10.1007/
s10880-009-9175-6.
16. Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic
review of benefit finding and growth. J Consult Clin Psychol.
Ahmadi et al
500 Journal of Kerman University of Medical Sciences. Volume 29, Number 5, 2022
2006;74(5):797-816. doi: 10.1037/0022-006x.74.5.797.
17. Prati G, Pietrantoni L. Optimism, social support, and coping
strategies as factors contributing to posttraumatic growth:
a meta-analysis. J Loss Trauma. 2009;14(5):364-88. doi:
10.1080/15325020902724271.
18. Svetina M, Nastran K. Family relationships and posttraumatic
growth in breast cancer patients. Psychiatr Danub.
2012;24(3):298-306.
19. Merecz D, Waszkowska M, Wezyk A. Psychological
consequences of trauma in MVA perpetrators – relationship
between post-traumatic growth, PTSD symptoms and
individual characteristics. Transp Res Part F Traffic Psychol
Behav. 2012;15(5):565-74. doi: 10.1016/j.trf.2012.05.008.
20. Akbar Z, Witruk E. Coping mediates the relationship between
gender and posttraumatic growth. Procedia Soc Behav Sci.
2016;217:1036-43. doi: 10.1016/j.sbspro.2016.02.102.
21. Sawyer A, Ayers S, Field AP. Posttraumatic growth and
adjustment among individuals with cancer or HIV/AIDS: a
meta-analysis. Clin Psychol Rev. 2010;30(4):436-47. doi:
10.1016/j.cpr.2010.02.004.
22. Baglama B, Atak IE. Posttraumatic growth and related
factors among postoperative breast cancer patients.
Procedia Soc Behav Sci. 2015;190:448-54. doi: 10.1016/j.
sbspro.2015.05.024.
23. Tedeschi RG, Calhoun LG. “Posttraumatic growth: conceptual
foundations and empirical evidence”. Psychol Inq.
2004;15(1):1-18. doi: 10.1207/s15327965pli1501_01.
24. Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA.
Post-traumatic growth among an ethnically diverse sample of
adolescent and young adult cancer survivors. Psychooncology.
2013;22(10):2235-44. doi: 10.1002/pon.3286.
25. Azizzadeh Forouzi M, Roudi Rashtabadi OS, Heidarzadeh A,
Malkyan L, Ghazanfarabadi M. Studying the relationship of
posttraumatic growth with religious coping and social support
among earthquake victims of Bam. Health in Emergencies
and Disasters Quarterly. 2018;4(1):55-61. doi: 10.32598/
hdq.4.1.55.
26. Cummings J, Swickert R. Relationship between locus
of control and posttraumatic growth. Individ Differ Res.
2010;8(3):198-204.
27. Joseph S, Linley PA. Positive adjustment to threatening events:
an organismic valuing theory of growth through adversity.
Rev Gen Psychol. 2005;9(3):262-80. doi: 10.1037/1089-
2680.9.3.262.
28. Rosenbach C, Renneberg B. Positive change after severe burn
injuries. J Burn Care Res. 2008;29(4):638-43. doi: 10.1097/
BCR.0b013e31817de275.
29. Milam JE, Ritt-Olson A, Unger JB. Posttraumatic growth
among adolescents. J Adolesc Res. 2004;19(2):192-204. doi:
10.1177/0743558403258273.
30. Milam JE. Posttraumatic growth among HIV/AIDS patients.
J Appl Soc Psychol. 2004;34(11):2353-76. doi: 10.1111/
j.1559-1816.2004.tb01981.x.
31. Collins RL, Taylor SE, Skokan LA. A better world or a shattered
vision? Changes in life perspectives following victimization.
Soc Cogn. 1990;8(3):263-85.
32. Fromm K, Andrykowski MA, Hunt J. Positive and negative
psychosocial sequelae of bone marrow transplantation:
implications for quality of life assessment. J Behav Med.
1996;19(3):221-40. doi: 10.1007/bf01857767.
33. Wagner AC, Torbit L, Jenzer T, Landy MS, Pukay-Martin ND,
Macdonald A, et al. The role of posttraumatic growth in a
randomized controlled trial of cognitive-behavioral conjoint
therapy for PTSD. J Trauma Stress. 2016;29(4):379-83. doi:
10.1002/jts.22122.
34. Ferro MA, Speechley KN. Depressive symptoms among mothers
of children with epilepsy: a review of prevalence, associated
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54. doi: 10.1111/j.1528-1167.2009.02276.x.
35. DerSimonian R, Laird N. Meta-analysis in clinical trials.
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2456(86)90046-2.
36. Higgins JP, Thompson SG. Quantifying heterogeneity in a
meta-analysis. Stat Med. 2002;21(11):1539-58. doi: 10.1002/
sim.1186.
37. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page
MJ, et al. Cochrane Handbook for Systematic Reviews of
Interventions. John Wiley & Sons; 2011.
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conclusions when study results vary. Methods Mol Biol.
2010;594:427-34. doi: 10.1007/978-1-60761-411-1_30.
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Isfahani H, Shojaei MR, Masoumeh YM, et al. Quality of life,
religious attitude and cancer coping in a sample of Iranian
patients with cancer. J Res Med Sci. 2011;16(7):928-37.
2. Freire ME, Sawada NO, de França IS, da Costa SF, Oliveira
CD. [Health-related quality of life among patients
with advanced cancer: an integrative review]. Rev Esc
Enferm USP. 2014;48(2):357-67. doi: 10.1590/s0080-
6234201400002000022.
3. Lee IJ. The effects of stress on quality of life in cancer patients:
focusing on the moderating effects of post-traumatic growth.
Health and Social Welfare Review. 2012;32(3):522-57.
4. 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(1):12-20. doi:
10.1002/pon.1486.
5. Atefeh Ahmadi AH, Dehghan M, Safarizadeh MH, Azizzadeh
Forouzi M. Spiritual coping strategies: Relationship with
physical, anxiety, and depression symptoms of patients with
cancer. Indian Journal of Cancer. 2021.
6. Behnam-Talab E, Amin-Shokravi F, Hashemian M, Moshki M,
Jafaei N. The effect of stress management group counseling
on stress in women with a family history of breast cancer. J
Kerman Univ Med Sci. 2016;22(1):68-80. [Persian].
7. Mirmahmoodi M, Mangalian P, Ahmadi A, Dehghan
M. The effect of mindfulness-based stress reduction
group counseling on psychological and inflammatory
responses of the women with breast cancer. Integr
Cancer Ther. 2020;19:1534735420946819. doi:
10.1177/1534735420946819.
8. Azizzadeh Forouzi M, Tirgari B, Safarizadeh MH, Jahani Y.
Spiritual needs and quality of life of patients with cancer.
Indian J Palliat Care. 2017;23(4):437-44. doi: 10.4103/ijpc.
ijpc_53_17.
9. Hosseini M, Tirgari B, Azizzadeh Forouzi M, Jahani Y. Guided
imagery effects on chemotherapy induced nausea and
vomiting in Iranian breast cancer patients. Complement Ther
Clin Pract. 2016;25:8-12. doi: 10.1016/j.ctcp.2016.07.002.
10. Hatam N, Bastani P, Ahmadlo N, Ahmadkia-Daliri AA. Health
related quality of life in breast cancer patients undergoing
current chemotherapy protocols. J Kerman Univ Med Sci.
2012;19(1):49-58. [Persian].
11. Tedeschi RG, Calhoun LG. The Posttraumatic Growth
Inventory: measuring the positive legacy of trauma. J Trauma
Stress. 1996;9(3):455-71. doi: 10.1007/bf02103658.
12. Bellizzi KM, Blank TO. Predicting posttraumatic growth in
breast cancer survivors. Health Psychol. 2006;25(1):47-56.
doi: 10.1037/0278-6133.25.1.47.
13. Sears SR, Stanton AL, Danoff-Burg S. The yellow brick road
and the emerald city: benefit finding, positive reappraisal
coping and posttraumatic growth in women with earlystage
breast cancer. Health Psychol. 2003;22(5):487-97. doi:
10.1037/0278-6133.22.5.487.
14. Kroemeke A, Bargiel-Matusiewicz K, Kalamarz M. Mixed
psychological changes following mastectomy: unique
predictors and heterogeneity of post-traumatic growth and
post-traumatic depreciation. Front Psychol. 2017;8:1245. doi:
10.3389/fpsyg.2017.01245.
15. Bostock L, Sheikh AI, Barton S. Posttraumatic growth and
optimism in health-related trauma: a systematic review. J
Clin Psychol Med Settings. 2009;16(4):281-96. doi: 10.1007/
s10880-009-9175-6.
16. Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic
review of benefit finding and growth. J Consult Clin Psychol.
Ahmadi et al
500 Journal of Kerman University of Medical Sciences. Volume 29, Number 5, 2022
2006;74(5):797-816. doi: 10.1037/0022-006x.74.5.797.
17. Prati G, Pietrantoni L. Optimism, social support, and coping
strategies as factors contributing to posttraumatic growth:
a meta-analysis. J Loss Trauma. 2009;14(5):364-88. doi:
10.1080/15325020902724271.
18. Svetina M, Nastran K. Family relationships and posttraumatic
growth in breast cancer patients. Psychiatr Danub.
2012;24(3):298-306.
19. Merecz D, Waszkowska M, Wezyk A. Psychological
consequences of trauma in MVA perpetrators – relationship
between post-traumatic growth, PTSD symptoms and
individual characteristics. Transp Res Part F Traffic Psychol
Behav. 2012;15(5):565-74. doi: 10.1016/j.trf.2012.05.008.
20. Akbar Z, Witruk E. Coping mediates the relationship between
gender and posttraumatic growth. Procedia Soc Behav Sci.
2016;217:1036-43. doi: 10.1016/j.sbspro.2016.02.102.
21. Sawyer A, Ayers S, Field AP. Posttraumatic growth and
adjustment among individuals with cancer or HIV/AIDS: a
meta-analysis. Clin Psychol Rev. 2010;30(4):436-47. doi:
10.1016/j.cpr.2010.02.004.
22. Baglama B, Atak IE. Posttraumatic growth and related
factors among postoperative breast cancer patients.
Procedia Soc Behav Sci. 2015;190:448-54. doi: 10.1016/j.
sbspro.2015.05.024.
23. Tedeschi RG, Calhoun LG. “Posttraumatic growth: conceptual
foundations and empirical evidence”. Psychol Inq.
2004;15(1):1-18. doi: 10.1207/s15327965pli1501_01.
24. Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA.
Post-traumatic growth among an ethnically diverse sample of
adolescent and young adult cancer survivors. Psychooncology.
2013;22(10):2235-44. doi: 10.1002/pon.3286.
25. Azizzadeh Forouzi M, Roudi Rashtabadi OS, Heidarzadeh A,
Malkyan L, Ghazanfarabadi M. Studying the relationship of
posttraumatic growth with religious coping and social support
among earthquake victims of Bam. Health in Emergencies
and Disasters Quarterly. 2018;4(1):55-61. doi: 10.32598/
hdq.4.1.55.
26. Cummings J, Swickert R. Relationship between locus
of control and posttraumatic growth. Individ Differ Res.
2010;8(3):198-204.
27. Joseph S, Linley PA. Positive adjustment to threatening events:
an organismic valuing theory of growth through adversity.
Rev Gen Psychol. 2005;9(3):262-80. doi: 10.1037/1089-
2680.9.3.262.
28. Rosenbach C, Renneberg B. Positive change after severe burn
injuries. J Burn Care Res. 2008;29(4):638-43. doi: 10.1097/
BCR.0b013e31817de275.
29. Milam JE, Ritt-Olson A, Unger JB. Posttraumatic growth
among adolescents. J Adolesc Res. 2004;19(2):192-204. doi:
10.1177/0743558403258273.
30. Milam JE. Posttraumatic growth among HIV/AIDS patients.
J Appl Soc Psychol. 2004;34(11):2353-76. doi: 10.1111/
j.1559-1816.2004.tb01981.x.
31. Collins RL, Taylor SE, Skokan LA. A better world or a shattered
vision? Changes in life perspectives following victimization.
Soc Cogn. 1990;8(3):263-85.
32. Fromm K, Andrykowski MA, Hunt J. Positive and negative
psychosocial sequelae of bone marrow transplantation:
implications for quality of life assessment. J Behav Med.
1996;19(3):221-40. doi: 10.1007/bf01857767.
33. Wagner AC, Torbit L, Jenzer T, Landy MS, Pukay-Martin ND,
Macdonald A, et al. The role of posttraumatic growth in a
randomized controlled trial of cognitive-behavioral conjoint
therapy for PTSD. J Trauma Stress. 2016;29(4):379-83. doi:
10.1002/jts.22122.
34. Ferro MA, Speechley KN. Depressive symptoms among mothers
of children with epilepsy: a review of prevalence, associated
factors, and impact on children. Epilepsia. 2009;50(11):2344-
54. doi: 10.1111/j.1528-1167.2009.02276.x.
35. DerSimonian R, Laird N. Meta-analysis in clinical trials.
Control Clin Trials. 1986;7(3):177-88. doi: 10.1016/0197-
2456(86)90046-2.
36. Higgins JP, Thompson SG. Quantifying heterogeneity in a
meta-analysis. Stat Med. 2002;21(11):1539-58. doi: 10.1002/
sim.1186.
37. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page
MJ, et al. Cochrane Handbook for Systematic Reviews of
Interventions. John Wiley & Sons; 2011.
38. Rosenthal L, Schisterman E. Meta-analysis: drawing
conclusions when study results vary. Methods Mol Biol.
2010;594:427-34. doi: 10.1007/978-1-60761-411-1_30.
39. Stafford L, Foley E, Judd F, Gibson P, Kiropoulos L, Couper
J. Mindfulness-based cognitive group therapy for women
with breast and gynecologic cancer: a pilot study to
determine effectiveness and feasibility. Support Care Cancer.
2013;21(11):3009-19. doi: 10.1007/s00520-013-1880-x.
40. Dong X, Li G, Liu C, Kong L, Fang Y, Kang X, et al. The
mediating role of resilience in the relationship between social
support and posttraumatic growth among colorectal cancer
survivors with permanent intestinal ostomies: a structural
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