Effects of dynamic resilience on quality of life among cancer patients: Coping strategies as intervention targets

Abstract

In this editorial, we comment on the article by Qin et al. Although their article focused on the correlations of resilience with coping styles and quality of life (QoL) among patients with malignancies, we further discuss the effect of resilience on QoL, the moderating role of the three dimensions of coping styles, and the longitudinal role of dynamic resilience throughout the cancer trajectory.

Key Words: Malignant tumor; Resilience; Coping style; Quality of life; Dynamic process

Core Tip: Cancer diagnosis impacts patients' physical and mental health. This editorial comments on resilience’s role in cancer patients' quality of life (QoL). We clarify the interrelationships among resilience, coping styles, and QoL, emphasize the moderating role of three coping style dimensions on QoL, and reveal the longitudinal impact of dynamic resilience across the cancer trajectory. We propose interventions targeting coping flexibility and emphasize integrating coping assessments into care plans to enhance patients' resilience and QoL.

INTRODUCTION

Cancer remains a formidable challenge to global public health, as this disease profoundly impacts not only patients' physical well-being but also their psychological states[1]. Following diagnosis, the emotional distress and mental health trajectories of patients are altered. For example, the uncertainty of disease progression and the potential for life-threatening outcomes raise concerns. Such concerns often lead to increased anxiety, as patients struggle to come to terms with potential disruptions to their daily lives and potential long-term consequences with respect to their health and social life[1,2]. The field of psychological services and efforts to support cancer patients represent an emerging area of research that highlights the importance of mitigating the adverse psychological impacts of this disease and improving patients’ overall well-being.

Qin et al[3] published a significant paper that aimed to explore the correlations among resilience, coping styles, and quality of life (QoL) among patients with malignancies. Data from 175 patients with malignancies who visited Fuyang Hospital Affiliated with Anhui Medical University from March 2022 to March 2024 were collected via the “Connor–Davidson Resilience Scale”, “Medical Coping Modes Questionnaire”, “Social Support Rating Scale”, and “European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30”. The results revealed that resilience is positively correlated with positive coping styles and negatively correlated with negative coping styles, indicating that positive coping styles are conducive to physical and mental health. This study also revealed that resilience was positively correlated with subjective support, objective support, and support utilization. Moreover, the total resilience and tenacity dimension scores were positively correlated with the functional domains of QoL (including physical, role, cognitive, emotional, and social functions) and overall health status and can be enhanced through health education and relaxation training to improve patients' resilience and QoL. Clinicians should focus on how coping styles and social support affect resilience in cancer patients to improve their QoL.

These findings provide critical pathways for intervention, particularly in the context of perceiving resilience not only as an innate mental trait but also as a dynamic process to provide a long-term protective factor that exerts a profound influence throughout the cancer journey[4]. A recent meta-analysis indicated that 62% of cancer patients experience significant declines in resilience within two years postdiagnosis, thus underscoring the need for dynamic interventions[5]. However, most existing studies, including that of Qin et al[3], rely on cross-sectional designs, thus limiting insights into how resilience evolves with disease progression. The present editorial bridges this gap by expanding on several key points to consider how resilience, coping styles, and QoL interact with each other, the specific resilience dimensions that can serve as potential intervention targets, and the longitudinal role of resilience in cancer patients throughout their disease trajectory.

INTERRELATIONSHIPS AMONG RESILIENCE, COPING STYLES, AND QOL

While the study by Qin et al[3] has elucidated the significant correlations among resilience, coping styles, and QoL in cancer patients, a deeper investigation into the interplay among these variables specifically in patients with malignancies would provide more precise and actionable insights for targeted interventions.

Resilience is defined as the ability to adapt positively and maintain one’s mental health in response to adversity, trauma, threats, or significant stressful events[5]. Resilience is a core capability that enables patients with malignant tumors to maintain psychological homeostasis in response to disease-related stress, and individuals who exhibit high levels of resilience can effectively mobilize cognitive and emotional resources to mitigate negative emotions such as anxiety and depression[6]. A previous study reported that among breast cancer patients, higher levels of resilience are closely associated with better QoL. Among patients in the intervention group, resilience was positively correlated with QoL, thus indicating that higher levels of resilience can help reduce anxiety and depression among cancer patients, thereby enhancing their overall psychological well-being[7]. This adaptive trait could directly enhance patients’ adherence to treatment, social functioning, and overall life satisfaction[8]. Moreover, the Managing Cancer and Living Meaningfully (CALM) intervention not only significantly improves patients’ resilience but also further enhances their QoL[7]. Additionally, among breast cancer patients undergoing chemotherapy, higher levels of resilience increase the likelihood of positive psychological well-being, which may further improve QoL. These findings indicate that resilience is an important factor in efforts to improve the QoL of cancer patients.

Importantly, resilience also exerts indirect influence on QoL through its modulation of coping style selection. Coping styles are defined as cognitive and behavioral strategies employed to manage stressors[9]. When facing the challenges of cancer, patients with high resilience are more likely to adopt positive coping styles[4]. Moreover, they are more likely to actively seek medical information and understand conditions and treatment plans. This enables them to better cooperate with medical treatments and improve therapeutic outcomes[10]. For instance, a study on coping styles in cancer patients found that individuals with higher resilience tend to adopt proactive coping styles, inclining to proactively confront challenges posed by illness[11]. They actively engage in social interactions as means to mitigate stress, thereby improving both physical symptoms and psychological well-being[12]. Conversely, patients with lower resilience may be trapped in a vicious cycle due to inabilities to cope with negative emotions, exacerbating pain perception and social withdrawal. Research indicates that avoidant coping behaviors are significantly correlated with more severe fatigue symptoms during chemotherapy[1].

Additionally, coping styles do not merely function as unidirectional mediators but rather form a regulatory loop with resilience: Positive coping styles strengthen resilience in a reciprocal manner (e.g., by boosting self-efficacy through successful problem-solving), whereas persistent reliance on negative coping strategies depletes psychological reserves, potentially diminishing resilience over time[13]. This bidirectional interplay highlights multiple intervention opportunities: Fostering coping flexibility through tailored psychological support could simultaneously enhance resilience and QoL, offering synergistic benefits across the cancer trajectory.

COPING STYLE DIMENSIONS AND POTENTIAL INTERVENTION TARGETS

While resilience serves as a psychological scaffold enabling individuals to endure adversity, the dimensions of coping styles-confrontation, avoidance, and resignation-function as critical moderators determining whether resilience translates into improved QoL. These three coping dimensions exhibit significant buffering effects on subsequent QoL following the context of resilience, offering actionable targets for personalized clinical interventions.

Confrontation involves directly addressing the stressor or problem. People who use confrontation as a coping style actively seek solutions and take steps to overcome the difficulties they face[14]. Confrontation serves as a positive moderator to enhance resilience’s protective effects. Patients with high resilience who adopt confrontation coping report better QoL through improved symptom management and perceived control[12]. For example, resilient cancer patients using confrontation strategies (e.g., discussing treatment options assertively) report 30% lower pain interference, a benefit mediated by heightened self-efficacy[15]. Such findings underscore the importance of interventions targeting health literacy and communication skills, such as implementing "question prompt lists” during clinician interactions to translate resilience into actionable advocacy[16].

Avoidance coping style is characterized by attempts to avoid or escape from stressors. Distancing from stressors (e.g., denial, distraction) initially buffers distress but erodes resilience’s long-term benefits[4]. While short-term avoidance (e.g., avoiding cancer-related media during chemotherapy) may reduce acute anxiety, longitudinal studies demonstrate that persistent avoidance correlates with delayed help-seeking behaviors, exacerbated symptom burden, and diminished QoL[15]. This pattern highlights the need for interventions that balance acute distress relief with strategies to transition patients toward adaptive coping mechanisms.

Resignation refers to a state of accepting stressors without attempting to change them. Individuals adopting resignation as a coping style may feel powerless or hopeless in the face of the problem and believe that there is nothing they can do to improve the situation[17]. This coping style directly counteracts resilience: High-resilience individuals who lapse into resignation exhibit QoL scores comparable to low-resilience peers, indicating that resignation significantly and negatively moderates the association between positive affect of resilience and QoL[6]. For instance, cancer patients with high resilience but predominant resignation coping display elevated distress levels and reduced treatment engagement[18]. These observations emphasize the urgency of identifying and addressing resignation early in the care trajectory.

Patients with high resilience predominantly adopt confrontation strategies (e.g., problem-focused coping, social support-seeking). For instance, Gallagher et al[11] has found that breast cancer patients with high resilience were more likely to enhance treatment adherence by participating in clinical trials or joining support groups, with higher social functioning scores compared to the control group. In contrast, those with low resilience are more likely to rely on avoidance or resignation. In the study of gastric cancer patients, Wu et al[15] demonstrated that individuals with low resilience predominantly adopted avoidance strategies during the initial stages of chemotherapy (e.g., refusing to discuss prognosis), which subsequently led to a significant exacerbation of fatigue symptoms at the 6-month follow-up.

For patients relying on avoidance or resignation, the following tiered interventions can be implemented. Cognitive behavioral therapy (CBT) effectively enhances coping flexibility through the systematic restructuring of maladaptive thought patterns. For example, Greer et al[16] developed an AI-driven CBT app that significantly reduced anxiety in advanced cancer patients. This digital therapeutic approach utilizes real-time behavioral tracking and machine-learning algorithms to adaptively challenge catastrophic thinking, thereby fostering psychological resilience during palliative care. Moreover, optimizing social support systems through structured peer-led initiatives and family-integrated interventions can disrupt the maladaptive feedback loop of social disengagement. A randomized clinical trial by Liu et al[7] revealed that the CALM protocol produced clinically meaningful reductions in avoidant behaviors by enhancing social support mobilization capacity. Additionally, ecological momentary assessment (EMA) applications enable real-time detection of maladaptive coping attempts through multimodal data integration (e.g., physiological sensor streams, self-report diaries, and geolocation tracking)[15]. The dynamic monitoring system, when coupled with machine learning-driven anomaly detection algorithms, can activate just-in-time interventions.

THE LONGITUDINAL ROLE OF RESILIENCE IN CANCER PATIENTS

Cancer is part of a trajectory that includes the fear of diagnosis, anxious treatments, and the uncertainty of survival. While cross-sectional studies have explored the short-term adaptation of patients, longitudinal research has revealed that resilient patients exhibit better emotional regulation and problem-solving skills over time[19]. This finding indicates that resilience is not a static trait but rather a dynamic process that interacts with evolving coping strategies to shape QoL over time.

At diagnosis, high levels of baseline resilience (particularly optimism) protect patients from existential distress and facilitate the rapid mobilization of coping styles. For example, newly diagnosed patients who exhibit higher levels of optimism tend to adopt problem-focused coping (e.g., by seeking second opinions) more rapidly, thus leading to reduced anxiety at the 6-month follow-up[18]. However, resilience alone is insufficient; longitudinal data reveal that patients who exhibit rigid avoidant coping (e.g., by refusing to discuss their prognosis) experience steeper decreases in QoL, even if they are initially resilient[5]. During active treatment, the buffering role of resilience in this context may become weaker as a result of continuous treatments (e.g., chemotherapy-induced fatigue). Longitudinal studies have reported that tenacity predicts treatment adherence at 3 months but that this effect became weaker by 6 months unless it is reinforced by adaptive coping (e.g., goal-setting apps). Patients who combine tenacity with emotional approach coping (e.g., by journaling their fears) maintain higher functional QoL scores[20]. Conversely, reliance on passive coping (e.g., resignation) accelerates resilience depletion, which is correlated with prolonged depression[21].

Furthermore, coping styles act as time-sensitive moderators, determining whether resilience resources grow or deplete. A 3-month cohort of patients with breast cancer revealed that coping flexibility mediated the protective effect of resilience[22]. In contrast, cancer patients with high baseline resilience but stagnant coping skills experience negative changes[23].

To ensure constant adaptability, coping checkpoints should be integrated into the care plan. Longitudinal coping assessments can reveal changes in coping styles over time. Regular assessment of coping styles is a core component of dynamic care planning. Standardized tools such as the Brief COPE Questionnaire[12] can be administered at key intervals (e.g., diagnosis, every 3-month follow-up, treatment milestones) to systematically capture these shifts. Additionally, EMA technology, which uses mobile applications to collect real-time coping behaviors (e.g., “How did you manage stress today?”) alongside physiological sensor data (e.g., heart rate variability), provides high temporal resolution for dynamic feedback[16]. This approach not only identifies maladaptive patterns but also contextual triggers, thereby optimizing intervention timing.

For patients stuck in negative patterns, “coping resets” should be taken. These may include motivational interviewing (MI) to explore new strategies and enhance coping flexibility. MI is central to this process, using open-ended questions, empathetic feedback, and goal-setting to help patients recognize coping impasses and explore alternatives[24]. Moreover, developing AI-driven platforms (e.g., chatbots) to adapt coping training modules could identify and respond to patients’ changing resilience profiles[16] by dynamically adjusting intervention intensity based on real-time emotional states and triggering predictive alerts to preempt coping breakdowns (e.g., avoidance peaks 5 days post-chemotherapy) through historical data-driven insights[8].

CONCLUSION

This editorial has examined the interactions between resilience, coping styles, and QoL among cancer patients and highlighted the importance of resilience as a dynamic factor influencing both coping styles and QoL. Positive coping styles enhance resilience and improve QoL, whereas negative coping styles can deplete resilience and exacerbate declines. Longitudinal research indicates that resilience not only directly impacts psychological well-being but also indirectly affects QoL through the mediation of coping styles. Positive coping styles, such as confrontation and active problem solving, enhance resilience and contribute to better QoL, whereas negative coping styles, such as avoidance and resignation, can deplete resilience and exacerbate declines in QoL. Moreover, the longitudinal role of resilience throughout the cancer journey emphasizes the need for timely and targeted interventions.

Clinicians should integrate coping assessments into care plans to identify maladaptive patterns and deliver tailored interventions aimed at enhancing coping flexibility. By fostering resilience and adaptive coping, healthcare providers can empower cancer patients to effectively navigate illness, reduce psychological distress, and enhance QoL. Future research should focus on developing personalized interventions that support resilience across the cancer journey.