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INTRODUCTION

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Whenever one is confronted with an inescapable, unavoidable situation, whenever one has to face a fate that cannot be changed … such as an incurable or chronic disease … just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the meaning of suffering. For what matters above all is the attitude we take toward suffering, the attitude in which we take our suffering upon ourselves.

Viktor Frankl1

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RESILIENCE AND CANCER: WHAT IS IT?

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A cancer diagnosis challenges patients and their caregivers from every conceivable angle: physical, cognitive, emotional, social, spiritual, and financial. To cope with this onslaught and effect the optimal strategy for reestablishing quality and quantity of life, cancer patients are tested for their ability to absorb the impact of this challenge, and then rebound with resilience.

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Resilience refers to the ability to successfully adapt to stressors, bounce back from setbacks, and maintain psychological well-being in the face of adversity.2 The everyday meaning of the word "resilience" extends to anything that bounces back. In psychology it is the word for springing back from serious adversity, such as abuse, war, illness, or natural disasters. In the dictionary, it is explained as an ability to recover from or adjust easily to misfortune or change (from the Latin verb "resilire," which means to "jump back" or "recoil").3 This interactive concept, resilience, refers to a relative resistance to environmental risk experiences, or involves the overcoming of stress or adversity. As such, it differs from both social competence and positive mental health. Resilience also differs from traditional concepts of risk and protection in its focus on individual variations in response to comparable experiences. For the sake of this discussion, we will focus on psychological resilience and the factors that affect it in a cancer patient, although there are many different areas that can be referenced as pertaining to resilience—ranging from biology to the environment, the economy, or sociology.

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For the cancer patients resilience is not the result of a fixed attribute, but may come about as the result of either the patient adapting to living with a life-threatening illness, using specific physiologic or psychological coping mechanisms, or having specific traits that allow an advantage for coping. "Bouncing back" may not necessarily involve recovery from cancer, but rather may tap into an opportunity for healing. Through a combination of cognitive, emotional, relational, instrumental, and/or spiritual strategies, the patient may be motivated to explore and act in such a way that the meaning and purpose of life transform suffering, and the individual's perception is that life's harmony and integrity are restored. Medical research over the past 20 years has identified over 30 psychosocial and neurophysiologic components that may contribute to the degree to which a cancer patient is able to be resilient to a life-threatening illness. It would be impossible to discuss each of these ...

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