This cross-sectional study examined the posttraumatic growth of a large sample of long-term and disease-free cancer survivors, and to the best of our knowledge, it is one of the few research efforts so far to have focused on cancer-related growth over three decades after diagnosis.
The first interesting finding of our study is the total score of posttraumatic growth, which was significantly lower than that of Italian adults who had experienced a range of adverse life events.
Associations between posttraumatic growth dimensions and study variables
Among the study variables that correlate more closely with PTG were perceived social support, as provided by three different sources, age, education, and employment.
In our sample, all the PTG dimensions correlated with
perceived social support provided by family, friends, and significant others. Consistent with these findings, there is a previous longitudinal research exploring which kind of support is more related to PTG, finding that emotional support actually received from others is related to PTG also many years after diagnosis [
35]. The support of close people and the possibility to talk with them can arouse new cognitive processes and booster coping responses that may in turn promote positive changes. Mechanisms implicated may be both cognitive and emotional: emotional support and talking with others may offer new perspectives on the traumatic event. On the other hand, other people may give encouragement and positive reinforcement with respect to how the patient is addressing the difficulty contributing to his/her self-esteem and sense of mastery [
36,
37].
Younger
age was associated with four dimension of posttraumatic growth, except for Spiritual change, confirming previous literature findings [
11,
32]. This could be due to the fact that younger people have expectation of longer life and planning skills that may help them to better enjoy the present and prepare for the future life. It has also been suggested by Tedeschi and Calhoun themselves [
4] that the more is the traumatic event shocking for the individual previous functioning and the more it is disrupting his/her previous identity (e.g., sense of immortality, expectations on the future, which are more present in younger people), the more the person may develop internal sense of growth after the trauma. Moreover, often the elderly are more involved in the management of other stressful life events, such as other comorbidities and bereavement than younger people. On this note, in our sample, participants not reporting other health issues showed a higher level of PTG. This consideration was also supported by the findings of a study conducted by Bellizzi [
38] that showed that elderly survivors of breast cancer were less worried by their diagnosis due to the presence of other painful life events (death of a spouse, visual or hearing impairment etc.).
All PTG dimensions showed correlation to
employment, except Spiritual change. This result is in line with those reported by Bellizzi and Blank, namely, that the survivors employed full- or part-time showed higher levels of PTG [
39]. Work could be a protective factor against stress [
40] helping people to focus on various life goals and to find meaning deriving also from their professional life.
To what concerns the correlation between PTG and
education, we have found that the two dimensions that are more implicated are New possibilities and Appreciation for life. We can speculate that having a high level of education is a positive resource with respect to the ability to overcome the psychosocial difficulties related to oncological disease. In fact, Ross et al. reported that people with a higher level of education have more ease in the construction of social relations, which are characterized by greater stability. From this, it arises the possibility of a better social support. [
41].
In our sample, Spiritual change behaved differently from other dimensions: unlike the others, it did not correlate with age and employment, but it was the only PTG dimension positively correlated with gender (women showed higher results than men) and with anxiety and depression. Survivors who are more depressed and have a higher level of trait anxiety reported more change in this dimension, as if they try and find support in spirituality more than others with less psychological symptoms. This seems like a kind of outsourcing.
We were also interested in evaluating the relationship between psychological distress, i.e., a cancer-specific psychological effect and PTG.
In our sample, PTG as a general construct was not correlated to depression or to anxiety, as underlined in previous research [
10,
13], but a negative correlation was found with depression and the dimensions “new possibilities” and “personal strength”: if other research has found a correlation between PTG and depression, this can be linked to the fact that in the short term, people still feel confusion related to the disruption of previous certainties [
18,
19], which may be overcome in the long-term period, which is the case of the present study population.
The findings of the present study provide interesting insights for therapeutic work with cancer patients and cancer survivors: the absence of a correlation between posttraumatic growth and psychological distress (depression and anxiety) and the same datum of low levels of posttraumatic growth in this population of long-term cancer survivors let us question the importance of talking about posttraumatic growth when working as psychotherapists with persons that have lived the cancer experience many years before. It may be suggested that for LCS, the construct of PTG has been overcome by other experiences or worries happened in the years after the end of treatments, and they did not focus anymore so much on positive changes occurred after the trauma. Probably the PTG may better work as a sort of coping strategy, as one way to make sense of a traumatic experience right or short after the cancer experience has occurred, in order to help the individual to find a meaning and a positive interpretation of the illness experience.
On the other hand, when treating patients
still in treatment or in the short period of survival, the concept of PTG may bring an interesting clinical perspective in the clinical setting that allows the psychotherapist and the oncologist to see distress, disbelief, and the patient’s pain not only as a maladaptive response but also as possible growth factors [
42].
The important information obtained regarding the relevance of work, for example, stress the need not to marginalize cancer survivors due to their cancer experience but rather to protect their relationship with work.
Furthermore, the strong relationship between perceived social support and PTG suggests that clinicians should look carefully at the social context of the survivors and promote and sustain the creation of a social network that can help them to experience sharing and closeness to others, rather than loneliness. This could be particularly adapt for the cultural context where the study has been carried out: people in Italy are used to rely on partners and extended family members as important source of support. This kind of support, also in the present work, has been shown important to help the individual to cognitively and emotionally find meaning out of the cancer experience and developing new perspectives of growth.
Limitations of the present study regard the cross-sectional design that did not allow us to draw conclusion of the causal relationship between the variables under study. Furthermore, the present study did not investigate any further crucial life events of cancer survivors (positive or negative) that could have affected the results and the development of posttraumatic growth, in relation to the event cancer. Then, in future research, it would be useful to evaluate this aspect in order to understand whether survivors who have been exposed to significant life events after the cancer may have reduced the significance of the cancer experience in their personal life. Moreover, for future research, it would be useful to consider whether the Italian culture has some specificities in the dimensions of the PTG that the PTGI does not completely capture.