With the increased use of telehealth in oncology care (see Sidebar 29, p. 75), researchers are studying the effectiveness of bringing psycho-oncology practices like cognitive behavioral therapy and mindfulness stress reduction, as well as other interventions to survivors at their homes. In one clinical trial, researchers developed a smartphone app for breast cancer survivors to help reduce anxiety surrounding cancer recurrence. The group who had access to the smartphone app saw reduced recurrence-related anxiety after eight weeks compared to those who did not have access to the app (636). These types of technologies offer effective ways to help bring psycho-oncology care to patients, especially because currently there are a limited number of psychotherapists available for the growing number of cancer survivors. Researchers are also trying to understand how survivors of cancer experience posttraumatic growth, which describes positive life changes that can develop because of traumatic and stressful events, such as a diagnosis of cancer (see Sidebar 46, p. 140). Posttraumatic growth may lead to perceptions of new possibilities, closer relationships with family and friends, development of personal strength, spiritual development, and a greater appreciation for life (637). Although the concept of posttraumatic growth is not new, its potential is just beginning to be appreciated within the cancer care community. The most influential factors that affect posttraumatic growth include the level of social support and the use of various coping strategies among survivors of cancer. Coping with Posttraumatic Stress After a Cancer Diagnosis Both quantitative and qualitative data demonstrate that most cancer survivors experience posttraumatic growth, which is described as the personal growth that comes from experiencing a stressful, traumatic event (634,638,639). Posttraumatic growth is not necessarily a consequence of a traumatic event and to experience posttraumatic growth, survivors need to cultivate these feelings through personal development (640). Posttraumatic growth is being more appreciated as an approach to improving a survivor’s mental well-being and recovery. Components of posttraumatic growth include: RELATING TO OTHERS Survivors find that their cancer diagnosis helped them prioritize and improve relationships and build stronger connections with those who are important to them. These experiences are attributed to increased willingness to express feelings, understand complex emotions, and better empathize with those struggling with similar challenges. NEW POSSIBILITIES Often described as a completely new lifestyle after cancer diagnosis, survivors may reevaluate their career or life path and choose to spend more time with family and friends. Change of lifestyle can often lead to healthier behaviors such as smoking cessation, engaging in a healthy diet and exercising. PERSONAL STRENGTH Living with and beyond a cancer diagnosis presents survivors with an immense challenge. While enduring such a difficult time, survivors may experience a belief that if they are able to defeat cancer, they can possibly manage any future challenge. This can prompt positive attitudes during times of stress or anxiety. NEW APPRECIATION OF LIFE Reevaluation of what it means to be in good health leads many survivors to describe feelings of appreciation of good health, a second chance at life, appreciation of the beauty in the world, and gratitude for the small victories in life. Others report having the perspective of living in the moment. SPIRITUAL CHANGES Receiving a cancer diagnosis can lead to finding or strengthening of spiritual beliefs and a deepening of faith. Spiritual growth has also been shown to help survivors with their recovery and the ability to manage day-to-day challenges. Adapted from (641). SIDEBAR 46 AACR Cancer Progress Report 2023 Supporting Cancer Patients and Survivors 140
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