Impact of Posttraumatic stress disorder (PTSD) on Health-related quality of life of cancer patients: Role of experiential avoidance and psychological resilience

Chinenye Joseph Aliche, Erhabor Sunday Idemudia

Abstract


Background: Cancer is a serious chronic health condition known to potentially trigger negative psychological consequences including posttraumatic stress disorders symptoms and poor health-related quality of life. This study aims to examine the impact of posttraumatic stress disorder symptoms on health-related quality of life; and to explore the role of experiential avoidance and resilience as potential mechanisms of the association among cancer patients.


Methods: Data were obtained from 251 cancer patients (153 (61%) females, M age = 43.22; SD = 10.93) conveniently selected from University of Nigeria Teaching Hospital, Ituku-Ozala, Enugu State, Nigeria. Participants were diagnosed with either colon cancer 19 (7.6%), prostate cancer 50 (19.9%), liver cancer 20 (7.9%), gastric cancer 21 (8.4%), breast cancer 61 (24.3%), or other kinds of cancer 80 (31.9%). They completed relevant self-report measures such as the PTSD Checklist for DSM 5 (PCL), Acceptance and Action Questionnaire 11 (AAQ), Resilience Scale (RS) and Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive statistics, Pearsons’s correlation and Hayes PROCESS macro for SPSS were used for analysis.


Results: Results showed that posttraumatic stress disorders symptom was negatively associated with health-related quality of life, and this link was moderated by experiential avoidance such that high posttraumatic stress disorders symptom was associated with poor health-related quality of life among cancer patients with average and high, but not among those with low levels of experiential avoidance. Moreover, the association between posttraumatic stress disorder symptoms and health-related quality of life was mediated by psychological resilience.


Conclusion: These findings have revealed that experiential avoidance is a pathway through which posttraumatic stress disorder symptoms lead to poor health-related quality of life among cancer patients; and that psychological resilience may protect patients from the negative impact of posttraumatic stress disorder symptoms on health-related quality of life. Therefore, interventions such as acceptance-based behavioral approach might be very useful in reducing experiential avoidance and posttraumatic stress disorder symptoms severity.  In addition, resilience enhancement therapies could be very critical in reducing distress and promoting psychological resilience and quality of life of cancer patients.

Keywords


Avoidance behaviour; Cancerous disease; Clinical psychology; Quality of life; Resilience; Trauma symptoms.

Full Text:

PDF

References


Abbey, G., Thompson, S. B., Hickish, T., & Heathcote, D. (2015). A meta‐analysis of prevalence rates and moderating factors for cancer‐related post‐traumatic stress disorder. Psych-oncology, 24(4), 371-381. https://doi.org/10.1002/pon.3654

Akıncı, İ., Akyüz-Yılmaz, C., & Bozo, Ö. (2021). Dispositional Optimism and Well-being in Cancer Patients: The Role of Cancer-Related Self-Efficacy. Mediterranean Journal of Clinical Psychology, 9(3). https://doi.org/10.13129/2282-1619/mjcp-3229

Aliche, C. J., & Idemudia, E. S. (2024). Role of distress tolerance, meaning in life and social support in the relationship between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among Nigerian cancer patients. Journal of Psychology in Africa, 34(4), 367–372. https://doi.org/10.1080/14330237.2024.2371718

Aliche, C. J., Ifeagwazi, C. M., & Ezaka, E. S. (2023). Moderating role of meaning in life in the relationship of death anxiety, experiential avoidance and health-related quality of life among type 2 diabetes patients. South African Journal of Psychology, 53(4), 533–547. https://doi.org/10.1177/00812463231186328

Aliche, C. J., Ifeagwazi, C. M., Mefoh, P. C., Eze, J. E., & Chukwuorji, J. C. (2021). Experiential avoidance mediates the relations between mindfulness and PTSD symptoms severity in terrorist attack survivors. Nordic Psychology, 73(2), 191–207. https://doi.org/10.1080/19012276.2020.1852953

Aliche, J. C., Ifeagwazi, C. M., Onyishi, I. E., & Mefoh, P. C. (2019). Presence of meaning in life mediates the relations between social support, posttraumatic growth, and resilience in young adult survivors of a terror attack. Journal of Loss and Trauma, 24(8), 736–749. https://doi.org/10.1080/15325024.2019.1624416

Amedu, A. N. (2024). Addressing trauma, post-traumatic stress disorder, and post-traumatic growth in breast cancer patients. World Journal of Experimental Medicine, 14(3), 95565. https://doi.org/10.5493/wjem.v14.i3.95565

Arnaboldi, P., Riva, S., Crico, C., & Pravettoni, G. (2017). A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory. Breast Cancer (Dove Med Press), 9, 473–485. https://doi:10.2147/BCTT.S111101

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the acceptance and action questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007

Bordieri, M. J., Tull, M. T., McDermott, M. J., & Gratz, K. L. (2014). The moderating role of experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and cannabis dependence. Journal of Contextual Behavioral Science, 3(4), 273-278. https://doi:10.1016/j.jcbs.2014.08.005

Brown, L. C., Murphy, A. R., Lalonde, C. S., Subhedar, P. D., Miller, A. H., & Stevens, J. S. (2020). Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function. Cancer, 126(14), 3181–3191. https://doi.org/10.1002/cncr.32934

Caldiroli, C. L., Sarandacchi, S., Tomasuolo, M., Diso, D., Castiglioni, M., & Procaccia, R. (2025). Resilience as a mediator of quality of life in cancer patients in healthcare services. Scientific Report, 15(1), 8599. https://doi.org/10.1038/s41598-025-93008-2

Capaldi, J. M., Shabanian, J., Finster, L. B., Asher, A., Wertheimer, J. C., Zebrack, B. J., Shirazipour, C. H. (2024). Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions. Health Psychol Review, 18(1), 41-74. https://doi.org/10.1080/17437199.2022.2162947

Castiglioni, M., Caldiroli, C. L., Manzoni, G. M., & Procaccia, R. (2023). Does resilience mediate the association between mental health symptoms and linguistic markers of trauma processing? Analyzing the narratives of women survivors of intimate partner violence. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2023.1211022

Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., Silberman, M., Yellen, S. B., Wincout, P., & Bonomi, P. (1993). The functional assessment of cancer therapy scale: development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570-579. https://doi.org/101200/JCO1993113570

Chen, C., Sun, X., Liu, Z., Jiao, M., Wei, W., & Hu, Y. (2023). The relationship between resilience and quality of life in advanced cancer survivors: multiple mediating effects of social support and spirituality. Frontiers in Public Health, 11, 1207097. https://doi:10.3389/fpubh.2023.1207097

Cherifi, F., Gernier, F., Jardin, F., Lefevre-Arbogast, S., Bastien, E., Lequesne, J., Rigal, O., Quilan, F., Clarisse, B., Grellard, J-M., Binarelli, G., Fernette, M., Lange, M., Richard, D., Morel, A., Griffon, B., Pepin, L-F., Leconte, A., Faveyrial, A. … & Joly, F. (2023). Post-traumatic stress disorder symptoms and quality of life among older patients with cancer during the COVID-19 pandemic. Journal of Geriatric Oncology, 14(8), 101634. https://doi:10.1016/j.jgo.2023.101634

Cordova, M. J., Riba, M. B., & Spiegel, D. (2017). Post-traumatic stress disorder and cancer. Lancet Psychiatry, 4(4), 330-338. https://doi.org/10.1016/S2215-0366(17)30014-7

Coutinho, M., Trindade, I. A., & Ferreira, C. (2021). Experiential avoidance committed action and quality of life: Differences between college students with and without chronic illness. Journal of Health Psychology, 26(7), 1035-1045. https://doi:10.1177/1359105319860167

Davis, S., Serfaty, M., Low, J., Armstrong, M., Kupeli, N., & Lanceley, A. (2023). Experiential avoidance in advanced cancer: a mixed-methods systematic review. International Journal of Behavioral Medicine, 30(5), 585-604. https://doi:10.1007/s12529-022-10131-4

De Vincenzo, F., Cosentino, C., Quinto, R. M., Di Leo, S., Contardi, A., Guidotti, S., Iani, L., Pruneti, C. (2022). Psychological adjustment and heart rate variability in ovarian cancer survivors. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3318

Dhungana, S., Koirala, R., Ojha, S. P., & Thapa, S. B. (2022). Resilience and its association with post-traumatic stress disorder, anxiety, and depression symptoms in the aftermath of trauma: a cross-sectional study from Nepal. SSM-Mental Health, 2, 100135. https://doi.org/10.1016/j.ssmmh.2022.100135

Dixit, J., Gupta, N., Kataki, A., Roy, P., Mehra, N., Kumar, L., Singh, A., Malhotra, P., Gupta, D., Goyal, A., Rajsekar, K., Krishnamurthy, M. N., Gupta, S., & Prinja, S. (2024). Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health and Quality of Life Outcomes, 22(1), 26. https://doi.org/10.1186/s12955-024-02227-0

Ezenkwa, U. S., Lawan, A. I., Garbati, M. A., Suleiman, D. E., Katagum, D. A., Kabir, A., Adamu, A. I., Modu, A. K., Olanrewaju, O. D., Dachi, R. A., Abdullahi, Y. M., Alkali, M., Bojude, D. A., Usman, H. A., Omotoso, A., Schlumbrecht, M., George, S. H. L & Audu, B. M. (2024). Emerging cancer disease burden in a rural sub-Saharan African population: northeast Nigeria in focus. Frontiers in Oncology, 14, 1380615. https://doi.org/10.3389/fonc.2024.1380615

Fergerson, A. K., & Brausch, A.M. (2022). Resilience mediates the relationship between PTSD symptoms and disordered eating in college women who have experienced sexual victimization. Journal of Interpersonal Violence, 37(1-2), NP1013-NP1030. https://doi:10.1177/0886260520918581

González-Fernández, S., & Fernández-Rodríguez, C. (2019). Acceptance and commitment therapy in cancer: review of applications and findings. Behavioral Medicine, 45(3), 255-69. https://doi.org/10.1080/08964289.2018.1452713

Gori, A., Topino, E., Musetti, A., Tulli, G., Craparo, G., Cacioppo, M., & Janiri, L. (2023). Investigating the association between post-traumatic stress symptoms and satisfaction with life: Avoidance is significantly related to life satisfaction with the moderation of Mature defense mechanisms. Mediterranean Journal of Clinical Psychology, 11(2). https://doi.org/10.13129/2282-1619/mjcp-3689

Guerra, F., Cilli, E., Cogodi, E., & Ranieri, J. (2024). Emotional traits, self-care and emotional regulation in young early-stage breast cancer women: an observational study on survivorship psychological adaptation. Mediterranean Journal of Clinical Psychology, 12(2). https://doi.org/10.13129/2282-1619/mjcp-4225

Hayes, A. F. (2018). Partial, conditional, and moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4–40. https://doi.org/10.1080/03637751.2017.1352100

Horn, S. R., & Feder, A. (2018). Understanding Resilience and Preventing and Treating PTSD. Harvard Review of Psychiatry, 26, 158–174. https://doi.org/10.1097/HRP.0000000000000194

Johnson, P. O., & Neyman, J. (1936). Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs, 1, 57–93.

Kashdan, T. B., & Kane, J. Q. (2011). Post-traumatic distress and the presence of post-traumatic growth and meaning in life: experiential avoidance as a moderator. Personality and Individual Differences, 50(1), 84-89. https://doi.org/10.1016/j.paid.2010.08.028

Lee, D., Yu, E. S., & Kim, N. H. (2020). Resilience as a mediator in the relationship between posttraumatic stress and posttraumatic growth among adult accident or crime victims: the moderated mediating effect of childhood trauma. European Journal of Psychotraumatology, 11(1), 1704563. https://doi:10.1080/20008198.2019.1704563

Li, G., Wang, L., Cao, C., Fang, R., Liu, P., Luo, S., Zhang, J., Hall, B. J., & Elhai, J. D. (2018). DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors. European Journal of Psychotraumatology, 9(1), 1468710. https://doi:10.1080/20008198.2018.1468710

Meneghini, A. M., Poletti, S., Morandini, S., Muss, D. (2023). The Effectiveness of the Rewind Technique in Treating PTSD Symptoms of Intrusiveness and Avoidance in Violence Survivors. Mediterranean Journal of Clinical Psychology 11(3). https://doi.org/10.13129/2282-1619/mjcp-3809

Mikutta, C., Schmid, J. J., & Ehlert, U. (2022). Resilience and post-traumatic stress disorder in the Swiss alpine rescue association. Frontiers in Psychiatry, 13, 780498. https://doi.org/10.3389/fpsyt.2022.780498

Mohlin, Å., Axelsson, U., Bendahl, P. O., Borrebaeck, C., Hegardt, C., Johnsson, P., Halberg, I. R., & Rydén, L. (2020). Psychological resilience and health-related quality of life in Swedish women with newly diagnosed breast cancer. Cancer Management and Research, 12041-12051. https://doi:10.2147/CMAR.S268774

Muhamed, A. N., Bogale, S. K., & Netere, H. B. (2023). Quality of life and associated factors among adult cancer patients undergoing chemotherapy treatment at Amhara National, Regional State, Ethiopia, 2021. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231174866

Ofei, S. D., Teye-Kwadjo, E., Amankwah-Poku, M., Gyasi-Gyamerah, A. A., Akotia, C. S., Osafo, J., Roomaney, R., & Kagee, A. (2023). Determinants of Post-Traumatic Growth and Quality of Life in Ghanaian Breast Cancer Survivors. Cancer Investigation, 41(4), 379-393. https://doi.org/10.1080/07357907.2023.2181636

Papadopoulou, A., Govina, O., Tsatsou, I., Mantzorou, M., Mantoudi, A., Tsiou, C., & Adamakidou, T. (2022). Quality of life, distress, anxiety and depression of ambulatory cancer patients receiving chemotherapy. Medical Pharmacy Report, 95(4), 418-429. https://doi.org/10.15386/mpr-2458

Patel, T. A., Blakey, S. M., Halverson, T. F., Mann, A. J., Calhoun, P. S., Beckham, J. C., Pugh, M. J., & Kimbrel, N. A. (2023). Experiential avoidance, posttraumatic stress disorder, and self-injurious thoughts and behaviors: A moderation analysis in a national veteran sample. International Journal of Cognitive Therapy, 16(3), 340-355. https://doi.org/10.1007/s41811-023-00164-2

Rahnea-Nita, R. A., Paunica, S., Motofei, C., & Rahnea-Nita, G. (2019). Assessment of anxiety and depression in patients with advanced gynaecological cancer. Mediterranean Journal of Clinical Psychology, 7(2). https://doi.org/10.6092/2282-1619/2019.7.2214

Ranieri, J., Guerra, F., Cilli, E., Brancati, F., & Di Giacomo, D. (2023). BRCA genetic result disclosure for women with Breast Cancer: influence of +/- predisposition genetic mutation. Mediterranean Journal of Clinical Psychology 11(2). https://doi.org/10.13129/2282-1619/mjcp-3805

Schnyder, U., & Cloitre, M. (2015). Evidence based treatments for trauma-related psychological disorders: A practical guide for clinicians. Switzerland: Springer International Publishing.

Shalev, A., Liberzon, I., & Marmar, C. (2017). Posttraumatic stress disorder. The New England Journal of Medicine, 376, 2459–2469. https://doi:10.1056/NEJMra1612499

Springer, F., Kuba, K., Ernst, J., Friedrich, M., Glaesmer, H., Platzbecker, U., Vucinic, V., Heyne, S., Mehnert-Theuerkauf, A., & Esser, P. (2023). Symptoms of posttraumatic stress disorder and adjustment disorder in hematological cancer patients with different treatment regimes. Acta Oncology, 62(9), 1110-1117. https://doi:10.1080/0284186X.2023.2239477

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249. https://doi:10.3322/caac.21660

Sylla, B. S., & Wild, C. P. (2012). A million Africans a year dying from cancer by 2030: What can cancer research and control offer to the continent? International Journal of Cancer, 130, 245–50. https://doi.org/10.1002/ijc.26333

Tu, P. C. (2022). The effects of trait resilience and rumination on psychological adaptation to breast cancer. Health Psychology Open, 9(2). https://doi:10.1177/20551029221140765

Unseld, M., Krammer, K., Lubowitzki, S., Jachs, M., Baumann, L., Vyssoki, B., Riedel, J., Puhr, H., Zehentgruber, S., Prager, G., Masel, E. K., Preusser, M., Jaeger, U., & Gaiger, A. (2019). Screening for post-traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress. Psychooncology, 28(12), 2382-2388. https://doi:10.1002/pon.5239

Wagnild, G., & Young, H. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1(2), 165-178.

Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov

World Health Organization (2020). Cancer country profle. https://www.who.int/cancer/countryprofles




DOI: https://doi.org/10.13129/2282-1619/mjcp-4859

Refbacks

  • There are currently no refbacks.