Resilience in advanced cancer patients who obtain a long-term response to immunotherapy or targeted therapy: an Ecological Momentary Assessment study

BACKGROUND: Approximately half of advanced cancer patients with a long-term response to immuno- or targeted therapy (IT/TT) (ie, long-term responders (LTRs)) experience heightened distress due to persistent uncertainty.

PURPOSE: We aimed to study to what extent supportive factors (ie, illness acceptance, tolerance of uncertainty, mindfulness, social support, optimism, emotion regulation variability, and positive affect in general and prior to a stressor) predict micro-level resilience in response to unpleasant daily life events.

METHODS: We conducted an observational cohort study with a baseline assessment of supportive factors, followed by Ecological Momentary Assessment with 8 assessments a day for 14 consecutive days. Resilience was operationalized as maintenance of low negative affect (NA) or a smaller increase in NA to an unpleasant event, as this suggests that partial recovery has already taken place. We used Dynamic Structural Equation Models to study supportive factors of resilience.

RESULTS: We included data from 61 patients with advanced melanoma or lung cancer with confirmed response to or long-term stable disease while on IT/TT. More unpleasant daily life events were associated with increases in NA. The multivariate model did not identify any supportive factors. Exploratory analysis using separate models tentatively indicated that LTRs with higher levels of illness acceptance, mindfulness, optimism, and general positive affect showed a smaller increase in NA in response to an unpleasant event (ie, more resilient response).

CONCLUSIONS: Preliminary findings suggest that illness acceptance, mindfulness, optimism, and general positive affect are supportive factors of resilience in LTRs. Future research should include these factors at momentary level to enhance insight into the resilience process.