Expert Explains How Resilience Supports Survivors After Cancer Treatment

Survivors often face emotional and physical challenges once treatment ends, including fear of recurrence, lingering side effects and adjusting to changes in work and daily life. Resilience is a key focus during recovery because patients bring strengths from their life experiences into survivorship, according to Frank Penedo, professor of psychology and medicine and associate director for population sciences at the Sylvester Comprehensive Cancer Center.

Penedo said resilience can be learned through mindfulness, cognitive behavioral strategies and healthy behavioral habits that help patients manage stress, balance fear with medical evidence and find meaning while adjusting to a “new normal” after treatment.

CURE: What are some of the most common challenges survivors face once treatment ends, and why is resilience such an important focus during the stage of recovery?

Penedo: Resilience is critically important for a variety of reasons. Once treatment ends for our cancer patients, including lymphoma survivors, it’s important to remember everything they have already gone through. Patients experience the diagnosis, the treatment planning, the coordination of care and the uncertainty and anxiety of wondering whether treatment is going to work and whether they are going to survive.

Treatment-related side effects are also a major issue. Some physical side effects can persist well beyond treatment, sometimes even five to 10 years later. Emotional concerns often continue as well. Even for patients who respond well to treatment, there is often fear of recurrence and ongoing anxiety. Many patients also experience changes in their physical functioning and their social roles. Work roles may shift and daily life may look different. For many people, survivorship involves adjusting to what they often describe as a “new normal.”

For a long time, most of the attention in cancer care focused on diagnosis, treatment planning and treatment itself. After treatment ended, patients often received a follow-up plan and surveillance schedule, but there was less focus on helping them adjust to survivorship. Over the past several decades, however, we’ve made progress in understanding tools that can help survivors cope better. These include stress management approaches, lifestyle and behavioral strategies and a greater focus on resilience.

Patients bring their life experiences, strengths and challenges into the cancer experience. For many individuals, resilience is already a strength that helps them navigate difficult situations. It’s also connected to the concept of benefit finding. Research with cancer survivors has shown that even though cancer is a very stressful and difficult experience, some patients are able to reframe aspects of it. They may develop a greater appreciation for life, stronger relationships or new perspectives. That process of adjusting and finding meaning is one aspect of resilience.

The study approaches resilience as a skill that can be learned. For patients with lymphoma who may feel overwhelmed after treatment, what does learning resilience actually look like in everyday life?

It’s actually a simple idea, although we don’t always think about it directly. When people go through difficult experiences in life, they often get through them by drawing on different sources of strength, even if they don’t consciously call that resilience.

For some individuals, that strength may come from spirituality or faith. For others, it may come from social support, such as friends, family members or loved ones who provide encouragement. People also bring skills they have developed through their life experiences, such as problem solving, planning or organization.

What we try to do in this program is help patients become more aware of those strengths and how they can use them when they face challenges. We also provide tools to help them manage stress more effectively.

For example, if you ask a patient what is stressing them out, they might say, “I’m afraid my cancer is going to come back.” That’s a very real concern, but it’s also broad. We try to break it down further by asking what information they have from their care team. Often patients have been told that their response to treatment looks good or that their risk of recurrence is relatively low. Focusing on the evidence they have can help balance some of the fear they are feeling.

Part of the process also involves examining thinking patterns. When someone views the entire cancer experience as one overwhelming problem, it can feel impossible to manage. But when we break it down into specific concerns and look at the information available, it can help people feel more grounded and better able to cope.

At the same time, resilience doesn’t mean everything will turn out positively for every patient. Some people face very difficult outcomes. In those situations, resilience may involve focusing on meaningful relationships, addressing important life issues or finding ways to make the most of the present moment.

The SMART-3RP lymphoma program combines mindfulness, cognitive behavioral strategies and behavioral approaches. How do these approaches work together to help survivors manage stress and improve quality of life?

Each component plays a different role. Mindfulness focuses on awareness and being present in the moment. Patients learn to recognize what they are experiencing right now rather than immediately reacting to stress.

Cognitive behavioral strategies focus on thinking patterns. For example, someone might assume that a phone call from their doctor means something is wrong. Cognitive strategies help patients slow down and consider other explanations rather than jumping to the worst conclusion.

Behavioral strategies focus on actions and habits. This can include improving communication with health care providers, maintaining healthy routines such as exercise and sleep and staying engaged in daily activities. Even simple steps, like helping someone feel more comfortable discussing concerns with their doctor or with family members, can have a meaningful impact on quality of life.

The program is delivered virtually and offered in both English and Spanish. Why was it important to design the intervention in a way that could reach a broader and more diverse group of survivors?

Many cancer survivors today are living longer and leading busy lives. Traveling to in-person sessions can be difficult. Virtual programs make it easier for patients to participate because they can join from home or during a break at work.

This approach also helps us reach more people. Using web-based platforms allows programs like this to scale and support a larger number of survivors who could benefit from these tools.

The study will also measure biological markers of stress, such as cortisol. What can those measurements tell us about how stress affects survivorship and recovery for patients with lymphoma?

This part of the research looks at how stress affects the body. Chronic stress can lead to increased levels of hormones such as cortisol. Over time, elevated stress hormones can contribute to inflammation in the body.

Inflammation has been linked to symptoms that many survivors experience, including fatigue, pain, cognitive difficulties and mood changes. The idea behind this research is that if we can reduce chronic stress and help normalize those stress responses, we may also be able to reduce these symptoms.

In other words, addressing stress is not only about emotional well-being. It may also influence physical symptoms and overall quality of life during survivorship.

Transcript has been edited for clarity and conciseness.

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