Resilience in older adults with cancer: A scoping literature review

Abstract

Introduction: Resilience, the ability to respond to stressors by maintaining or rapidly returning to normal homeostasis, serves as a new paradigm to improve the care of older adults. However, resilience research in oncology is nascent. We aimed to describe the current research landscape on physical, cognitive, and psychosocial resilience in older cancer patients.

Materials and methods: We searched PubMed/MEDLINE from inception to January 28, 2022 for records with the terms "resilient OR resilience OR resiliency." We included studies that focused on persons over age 65 with cancer and assessed physical, cognitive, or psychological resilience. We excluded studies that did not report original data; did not have the full text available; assessed resilience on fewer than three time points; and published in non-English languages. Definitions and measures of resilience were extracted and categorized using qualitative analysis.

Results: Of 473 articles screened, we found 29 articles that met criteria for inclusion in our review. There was a high degree of heterogeneity in the definitions and measures of resilience. Resilience was defined as robustness/resistance to decline (n = 11), recovery from trauma/stressor (n = 7), and adaptive and proactive coping behaviors (n = 6). Ten papers did not define resilience. 21 studies utilized longitudinal analysis, five studies used randomized and nonrandomized control trials, and four studies assessed pre-post analysis. Stressors included cancer diagnosis (n = 18), chemotherapy (n = 3), radiation (n = 3), acute illness (n = 3), surgery (n = 2), and hematopoietic cell transplant (n = 1).

Discussion: Evidence for predictors and determinants of resilience in older adults with cancer is limited by the absence of standardized definitions and measurements. There is a fundamental need for a more precise definition, measures, and understanding of the physiologic mechanisms underlying the response to the physical, cognitive, and psychosocial stressors of cancer and its treatments.

Keywords: Cancer; Cancer treatment; Cognitive function; Healthy aging; Older adults; Physical function; Psychological function; Resilience.

Figure 1:. Flow diagram of articles included in scoping review

Figure 2:. Distribution of papers based on type of resilience

Figure 3:. Conceptual framework for resilience in geriatric oncology.

Resilience is defined as the response to a stressor over time. Unlike most older adults, older adults with cancer face stressors such as chemotherapy and radiation. Responses to such stressors can be measured using physical, psychosocial, and/or cognitive measures. By isolating stressors and utilizing accurate response measures, specific resiliencies unique to both the stressor and outcome measure can be found. Such resiliencies may be driven in part by an individual’s baseline physical, psychosocial, and cognitive reserve. Furthermore, moderators (e.g., social support) and the magnitude/duration of a stressor can influence an individual’s response. Favorable responses to a stressor (i.e., resilience) may be predictive of future health outcomes (e.g., survival). Understanding and measuring resilience in older adults with cancer may improve clinical management of patients (e.g., inform choice of treatment) and identify early preventative interventions that enhance the outcomes of older adults with cancer.