Examining the Role of Resilience, Posttraumatic Growth, and Quality of Life in Women with Breast Cancer: A Serial Multiple Mediator Model Approach.

The study measured resilience only at the moment of recruitment, so it cannot show that resilience causes better quality of life or that symptom distress causes lower quality of life. Only 91 of 400 mailed surveys were returned, so the sample may represent survivors with less distress or more resources. Participants were selected because they had received financial assistance from a foundation, which may limit generalisability to women with breast cancer of higher socioeconomic status. The sample was small, so age, time since diagnosis, and treatment type could not be included in the model. Most participants had early-stage breast cancer, had completed treatment, and were about 2 years after diagnosis, with relatively low symptom distress, so findings may not apply to newly treated or advanced disease. A post hoc power analysis showed the sample was adequate only for the indirect effect through resilience, not for the other pathways.

Do not conclude that resilience training will improve quality of life or reduce symptom distress. This was a survey of associations at a moment, and no resilience intervention was tested.