Lung Cancer Trauma Leads to Emotional Growth



MIAMI – Well over a third of non–small cell lung cancer patients met clinically diagnostic criteria for distress, but many of the same patients also demonstrated positive mental health outcomes in the form of posttraumatic growth, a University of Kentucky study showed.

The seemingly paradoxical results may suggest that the most troubled cancer patients have the most to gain from the experience of learning how to cope, audience members suggested at the annual meeting of the American Psychosocial Cancer Society, where the findings were presented.

"We know from a theoretical standpoint that in order to grow, you have to have distress," agreed Michael Andrykowski, Ph.D., of the University of Kentucky, Lexington, primary investigator of the study of distress and posttraumatic growth in 189 survivors of non–small cell lung cancer (NSCLC).

Patients recruited from a statewide Surveillance, Epidemiology and End Results (SEER) registry completed a series of questionnaires a median 15.5 months following their diagnosis.

Younger patients and those diagnosed with metastatic disease were most likely to be among the 37% who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) threshold for traumatic stress.

"As we anticipated, these survivors had poorer outcomes on distress [measures], on average two-thirds of a standard deviation. I think we agree that’s a clinically important difference," said Dr. Andrykowski.

What was not expected was that the same distressed survivors also demonstrated more posttraumatic growth – a term used to describe positive psychological change arising from hardship – than less-troubled survivors, he noted.

The mean effect size of posttraumatic growth between groups – traumatized vs. less-traumatized survivors, was .42, with the most distressed survivors reporting more improvement in personal relationships, personal strength, and spirituality.

Dr. Andrykowski suggested that the results may indicate that distress and growth are two separate and independent dimensions of adjustment, rather than opposite extremes on a continuum. In other words, someone could simultaneously be quite distressed by the cancer experience, and also experiencing meaningful insight into life’s priorities, connection to others, and the power of resiliency.

Intriguingly, clinically distressed survivors enrolled also reported less connection to mental health resources that would be assumed to be helpful in nurturing posttraumatic growth, such as a supportive social environment, a sense of optimism, and belief in their own efficacy.

"That’s something that I’m wrestling with and puzzled by," said Dr. Andrykowski.

He noted that data are still being collected on potential mediators that might offer clues as to how the most traumatized patients were able to grow as a result of their experience.

In the future, a longitudinal study tracking distress and posttraumatic growth over time might be able to track the origins of positive adjustment arising from an otherwise traumatic and difficult experience, he said.

Funding for the study was through a variety of federal grants. Rachel Steffens, a teaching assistant at the University of Kentucky, was coauthor. Neither investigator reported any relevant financial conflicts of interest.

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