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Background:Because of medical advances, metastatic breast cancer (MBC) is now viewed as a chronic disease, rather than an imminent death sentence. Helping women live with this disease requires more than a medical approach to symptoms. Thus, a mentor-based and supportive-expressive program ‘Be Resilient to Breast Cancer’ (BRBC) was designed to help Chinese women with MBC enhance their resilience levels, biopsychosocial functions, and potentially extend their life span.Methods:A total of 226 women with MBC were randomly assigned, in a 1 : 1 ratio, to an intervention group (IG) that participated in BRBC or to a control group (CG) that received no intervention. Be Resilient to Breast Cancer was conducted for 120 min once a week. Primary outcomes were cancer-specific survival and secondary outcomes were resilience, Allostatic Load Index (ALI), anxiety, depression, and quality of life (QoL). The Cox proportional-hazards model was used for survival analysis and growth mixture models were performed for secondary outcomes.Results:Be Resilient to Breast Cancer did not significantly prolong 3- or 5-year survival (median survival, 36.7 months in IG and 31.5 months in CG). The hazard ratio for death was 0.736 (95% CI, 0.525–1.133, P=0.076; univariate Cox model) and 0.837 (95% CI, 0.578–1.211, P=0.345; multivariate Cox analysis). The IG improved in anxiety (ES=0.85, P<0.001), depression (ES=0.95, P<0.001), QoL (ES=0.55, P<0.001), resilience (ES=0.67, P<0.001), and ALI (ES=0.90, P<0.001) compared to CG.Conclusions:BRBC does not improve survival of women with MBC in this study, though longer follow up is warranted. It positively impacts resilience, QoL, ALI, and emotional distress.

The present study suggests that psychological resilience is positively associated with QOL and may comprise a robust buffer between depression and QOL in Chinese patients with cancer.

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To reduce the risk of adjustment problems for breast cancer patients in mainland China, we examined the efficacy of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), delivered after breast surgery to (a) increase protective factors of social support, hope for the future, etc.; (b) decrease risk factors of Physical and Emotional Distress; and (c) increase outcomes of Resilience, Transcendence and Quality of Life (QOL). A multisite randomized controlled trial was conducted at 6 specialist cancer hospitals. 101 and 103 breast cancer patients were allocated to intervention group (IG) and control group (CG), respectively, and 112 general females (without breast cancer) were allocated to the norm group (NG). Participants completed measures that were related to latent variables derived from the Resilience Model for Breast Cancer (RM-BC) at baseline (T1), 2 months (T2), 6 months (T3), and 12 months (T4) after intervention. At T2, the IG reported significantly lower Depression (ES = 0.65,P = 0.0019) and Illness Uncertainty (ES = 0.57, P = 0.004), better Hope (ES = 0.81, P < 0.001) and QOL (ES = 0.60, P = 0.002) than did the CG. At T3, the IG reported significantly lower Anxiety (ES = 0.74, P < 0.001), better Social Support (ES = 0.51,P = 0.009), Transcendence (ES = 0.87, P < 0.001), and Resilience (ES = 0.83, P < 0.001) compared with the CG. At T4, the IG reported better Resilience though not significant (P = 0.085) and better Transcendence (P = 0.0243) than did the NG. The BRBC intervention improves the positive health outcomes and decreases the risk factors of illness-related distress of breast cancer patients during the high-risk cancer treatment.

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The RS-SC is a brief and specific self-report resilience instrument for Chinese patients with cancer and shows sound psychometric properties in this study. The RS-SC has potential applications in both clinical practice and research with strength-based resiliency interventions.

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