Contributors and Inhibitors of Resilience Among Adolescents and Young Adults with Cancer
Open accessAbstract
Purpose: Self-perceived resilience may enable coping and mitigate poor psychosocial outcomes among adolescent and young adult (AYA) patients with cancer. In order to inform the development of resilience-promoting interventions, we aimed to: (1) describe AYA patient-reported resilience and (2) identify AYA patient-reported contributors and inhibitors of resilience. Methods: The “Resilience in Adolescents and Young Adults with Cancer” study was a prospective longitudinal mixed-methods study. Consecutive Caucasian patients aged 14–25 years old enrolled 14–60 days following their diagnosis of cancer and completed one-on-one semi-structured interviews both at the time of enrollment and 3–6 months later. Constant comparative analyses identified salient themes describing modifiable contributors and inhibitors to patient-perceived resilience. Results: Seventeen patients (85% of those approached) enrolled in the study. The mean age was 17 years (SD=2.6) and 53% were female. All patient definitions of resilience inferred an ability to handle adversity. Five themes emerged as predominant contributors or inhibitors of resilience: (1) stress and coping; (2) goals, purpose, and planning; (3) optimism; (4) gratitude and meaning; and (5) connection and belonging. Merged analyses suggested that AYA resilience was a balance that may be enabled by promoting certain skills. Conclusion: AYA patients with cancer perceive resilience as a balance. Learned skills in stress management, goal-setting, and benefit-finding may empower AYAs during their cancer experience, in turn improving long-term psychosocial outcomes.
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PRISM is a novel, developmentally appropriate, brief, skills-based psychosocial intervention targeting resilience resources.
“we developed and demonstrated the feasibility and acceptability of a novel, developmentally appropriate, brief, skills-based psychosocial intervention targeting resilience resources: Promoting Resilience in Stress Management (PRISM).24,25”
From Promoting resilience in adolescents and young adults with cancer: Results from the PRISM randomized controlled trial (2018) · cites this paper as [24]
PRISM's feasibility and acceptability have been demonstrated.
“we developed and demonstrated the feasibility and acceptability of a novel, developmentally appropriate, brief, skills-based psychosocial intervention targeting resilience resources: Promoting Resilience in Stress Management (PRISM).24,25”
From Promoting resilience in adolescents and young adults with cancer: Results from the PRISM randomized controlled trial (2018) · cites this paper as [24]
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BackgroundRosenberg, A. R., Steiner, J. M., Lau, N., Fladeboe, K., Toprak, D., Gmuca, S., O’Donnell, M. B., Smith, K., Brown, C. E., & Yi‐Frazier, J. P. (2021) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2021.02.036 · Cited by 20 · see citing works
Self-citationThe Impact of an Integrated Gratitude Intervention on Positive Affect and Coping Resources
Klibert, J., Rochani, H. D., Samawi, H. M., LeLeux-LaBarge, K., & Ryan, R. G. (2019) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-019-00015-6 · Cited by 20 · see citing works
Head, K. J., & Iannarino, N. T. (2018) · Qualitative Health Research · doi:10.1177/1049732318800674 · Cited by 20 · see citing works
Relationships Between Adolescents with Cancer and Healthy Peers: A Qualitative Study
Fladeboe, K., Walker, A. J., Rosenberg, A. R., & Katz, L. F. (2020) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2020.0133 · Cited by 17 · see citing works
Self-citationJóhannsdóttir, I. M., Loge, J. H., Kiserud, C. E., Karlstad, Ø., & Skurtveit, S. O. (2017) · Pediatric Blood & Cancer · doi:10.1002/pbc.26860 · Cited by 16 · see citing works
Scott, S., O'Daffer, A., Bradford, M., Fladeboe, K. M., Lau, N., Steineck, A., Taylor, M. R., Yi-Frazier, J. P., & Rosenberg, A. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05888-x · Cited by 14 · see citing works
Self-citationDay-to-Day Decision Making by Adolescents and Young Adults with Cancer
Pyke‐Grimm, K. A., Franck, L. S., Halpern‐Felsher, B. L., Goldsby, R. E., & Rehm, R. S. (2022) · Journal of Pediatric Hematology/Oncology Nursing · doi:10.1177/27527530211068718 · Cited by 14 · see citing works
“…cancer and its treatment negatively affect AYAs’ peer relationships (Bellizzi et al., 2012; Fladeboe et al., 2020; Larouche & Chin-Peuckert, 2006; Rosenberg et al., 2014; Zebrack et al., 2014) and life experiences, causing isolation and alienation (Belpame et al., 2017; Hokkanen et al., 2004;…”
BackgroundAtay, S., Sarvan, S., Akcan, A., Güler, E., & Birsen, S. A. Y. (2022) · Current Psychology · doi:10.1007/s12144-022-03649-z · Cited by 14 · see citing works
Journey towards resiliency: A systematic review and meta-synthesis of cancer patients’ experiences
Khok, X. W., Ng, W. H. D., Lee, A. Y., Yoon, H. J., Devi, M. K., Johnston, B. M., & Ang, W. H. D. (2024) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2024.102640 · Cited by 13 · see citing works
Ghazal, L. V., Cole, S. W., Salsman, J. M., Wagner, L. I., Duan, F., Gareen, I. F., Lux, L., Parsons, S. K., Cheung, C. K., Loeb, D. M., et al. (2022) · JCO Precision Oncology · doi:10.1200/po.21.00462 · Cited by 11 · see citing works
Rosenberg, A. R., Taylor, M. R., Fladeboe, K., Zhou, C., Levine, D. R., Johnston, E. E., Freyer, D. R., Comiskey, L., Junkins, C. C., Bradford, M. C., et al. (2024) · Cancer · doi:10.1002/cncr.35440 · Cited by 10 · see citing works
Self-citationWilharm, C., Pralong, A., Weiß, M., Hallek, M. J., Voltz, R., Tuchscherer, A., & Simon, S. T. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08370-0 · Cited by 10 · see citing works
“Comparing our results and those of other AYA studies [27, 28] with studies of older cancer patients, the coping strategies of AYAs appear to differ little from those of older patients.”
ResultLife is precious: Sarcoma/giant-cell tumors survivors' perspectives on their psychological journey
Taylor, M. F., & Pooley, J. A. (2018) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2018.1498425 · Cited by 9 · see citing works
“Psychological interventions, such as the journaling one used in this study, work by providing patients with a practical means of coping with and rebounding from their traumatic sarcoma experiences.(39,40) Key to the success of using psychological interventions with cancer patients is their ability to foster resilience…”
MethodLau, N., Palermo, T. M., Zhou, C., Badillo, I., Hong, S., Aalfs, H., Yi-Frazier, J. P., McCauley, E., Chow, E. J., Weiner, B. J., et al. (2024) · JMIR Research Protocols · doi:10.2196/57950 · Cited by 9 · see citing works
“PRISM was developed based on iterative research within the AYA and pediatric oncology population, stress and coping theory, resilience theory, and evidence-based cognitive-behavioral and mindfulness interventions [7-13].”
MethodSelf-citationRosenberg, A. R., Fladeboe, K., Zhou, C., Bradford, M. C., Kang, T. I., Maurer, S. H., Freyer, D. R., Baker, K. S., Comiskey, L., Junkins, C. C., et al. (2025) · JCO Oncology Practice · doi:10.1200/op-25-00161 · Cited by 10 · see citing works
Self-citationArruda, M. A., Arruda, R., Landeira-Fernández, J., Anunciação, L., & BIGAL, M. E. (2021) · Headache The Journal of Head and Face Pain · doi:10.1111/head.14078 · Cited by 8 · see citing works
Barrios, P., Enesco, I., & Varea, E. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.834312 · Cited by 10 · see citing works
Care at the End of Life for Children with Cancer
Bergstraesser, E., & Flury, M. (2018) · Pediatric Oncology · doi:10.1007/978-3-319-61391-8_11 · Cited by 7 · see citing works
Rodríguez, D. J. S., Ortigosa-Quiles, J., Marin, A., & Martínez, R. S. (2024) · European Journal of Investigation in Health, Psychology and Education · doi:10.3390/ejihpe14050074 · Cited by 7 · see citing works
“Throughout the course of their illnesses, adolescents acquire valuable skills in stress management, goal setting, and seeking benefits, all of which empower them throughout their experiences with cancer, leading to improved long-term psychosocial outcomes [26].”
BackgroundO’Daffer, A., Comiskey, L., Scott, S., Zhou, C., Bradford, M. C., Yi‐Frazier, J. P., & Rosenberg, A. R. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01179-4 · Cited by 7 · see citing works
“A potential barrier to improving the experiences of AYAs with advanced cancer is their limited opportunities to develop “resilience resources” such as stressmanagement, goal-setting, positive reframing, and meaning-making skills [16].”
BackgroundSelf-citationResilience in adolescent and young adult oncology: Problems and prospects
Rosenberg, A. R., & Salsman, J. M. (2023) · Cancer · doi:10.1002/cncr.35180 · Cited by 5 · see citing works
Self-citationHirschmann, J., Kozato, A., Sharma, V., Villagra, C., Wetmore, J. B., Jandorf, L. H., Pang, J. H., Reynolds, M., Dodge, L., Mejía, S., et al. (2020) · Transgender Health · doi:10.1089/trgh.2020.0030 · Cited by 5 · see citing works
“57 Patients’ expressions of gratitude may increase providers’ feelings of wellbeing at work and may be protective against burnout.”
Simon, P. J., Pyke‐Grimm, K. A., & Nasr, A. S. (2022) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2021.0195 · Cited by 4 · see citing works
Murphy, K. M., Chen, E., Ip, E. H., Rosenberg, A. R., Snyder, M. A., & Salsman, J. M. (2022) · Quality of Life Research · doi:10.1007/s11136-022-03219-7 · Cited by 4 · see citing works
Self-citationSupporting the Well-Being of Children and Youth With Special Health Care Needs: NASEM Proceedings
Rosenberg, A. R., Pickles, D. M., Harris, D. S., Lannon, C., Houtrow, A. J., Boat, T. F., & Ramsey, B. W. (2024) · PEDIATRICS · doi:10.1542/peds.2024-067032 · Cited by 4 · see citing works
Self-citationTincture of Time: The Evolution of Goals in Adolescents and Young Adults with Cancer
Steineck, A., Barton, K. S., Bradford, M. C., Yi‐Frazier, J. P., & Rosenberg, A. R. (2021) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2020.0223 · Cited by 3 · see citing works
Self-citationStress Among Immigrants in the United States
Rai, A., Held, M. L., Osborne, E., & Kapur, I. (2024) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2024.2320345 · Cited by 3 · see citing works
Sun, B. J., Pang, E. M., Yue, T. M., & Lee, B. (2025) · Annals of Surgical Oncology · doi:10.1245/s10434-025-17768-x · Cited by 3 · see citing works
“48,49 As articulated by a 21-year-old, “You can’t just wait until everything is all better.””
Bernier, P. (2024) · Canadian Oncology Nursing Journal · doi:10.5737/23688076342173 · Cited by 3 · see citing works
Wise, A. F., Upham, E. J., & DeCourcey, D. D. (2025) · Children · doi:10.3390/children12030318 · Cited by 2 · see citing works
Scott, S., Peterson, R. L., North, S. J., Merrick, J., Petranovich, C. L., Wilson, P. E., Lantagne, A., & Simpson, T. S. (2024) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsae102 · Cited by 2 · see citing works
Sáez-Rodríguez, D.-J., Ortigosa-Quiles, J., Riquelme-Marín, A., Suriá-Martínez, R., & Chico-Sánchez, P. (2024) · Healthcare · doi:10.3390/healthcare12232476 · Cited by 2 · see citing works
Fladeboe, K., O’Daffer, A., Engelberg, R. A., Salsman, J. M., Merluzzi, T. V., Baker, K. S., Yi‐Frazier, J. P., & Rosenberg, A. R. (2025) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaf012 · Cited by 1 · see citing works
Self-citationResilience and Pediatric Cancer Survivorship in Cultural Context
Yi, J., Kim, M. A., & Akter, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-32223-0_8 · Cited by 2 · see citing works
Walker, A. (2018) · Cited by 1 · see citing works
Resilience among racially diverse adolescent patients with chronic orthopedic conditions
Miyamoto, R. H., Ono, C. M., Faustina, K., Miyamoto, K. D. S., Nakamatsu, P., & Lew, D. (2023) · Current Psychology · doi:10.1007/s12144-023-04543-y · Cited by 1 · see citing works
“…have examined the resilience of pediatric patients with chronic conditions such as asthma (Koinis-Mitchell et al., 2012; Vinson, 2002), cancer (Rosenberg et al., 2014; Tillery et al., 2017), type 1 diabetes (Lord et al., 2015; Rohan et al., 2015), orthopedic conditions (Fee & Hinton, 2011;…”
Lau, N., Bona, K. O., Steineck, A., & Rosenberg, A. R. (2018) · Pediatric Blood & Cancer · doi:10.1002/pbc.27411 · Cited by 1 · see citing works
Self-citationMack, J. W., & Frederick, N. N. (2018) · Pediatric Blood & Cancer · doi:10.1002/pbc.27049
Simard, C. (2023) · Enfances Familles Générations · doi:10.7202/1108408ar
Bernier, P. (2024) · Canadian Oncology Nursing Journal · doi:10.5737/23688076342166
“Les attitudes positives, l’optimisme et la gratitude sont aussi fortement associés à la résilience (Rosenberg et al., 2014).”
InfluentialResilience-Enhancing Factors among Youth with Cancer: A Systematic ReviewPreprint
Sumrall, S., Ghriwati, N. A., & Winter, M. A. (2024) · doi:10.22541/au.171651705.57108723/v1
Endurance and Evolution: Exploring Levels of Resilience Among Indian Breast Cancer Survivors
Alexander, A., Kuruveettissery, S., Ramesh, R. S., Srinath, B. S., Appachu, S., & Thippeswamy, R. (2024) · Illness Crisis & Loss · doi:10.1177/10541373241260157
“Prior research emphasizes the signi fi cance of promoting positive coping and adjustment for fostering long-term psychosocial outcomes and resilience (Rosenberg et al., 2014).”
Adaptive Psychosocial Outcomes in Cancer Predisposition Syndromes: A Scoping Review
Hanania, J. W., Tsang, K. K., & Rotman, C. (2025) · Journal of Adolescent and Young Adult Oncology · doi:10.1177/21565333251366387
Psychosocial dimensions of mental fatigue
Simon, M., & Al-Ghailani, A. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-24080-5.00040-0
Fladeboe, K., Fredman, G., Maurer, S. H., Zhou, C., Bradford, M. C., Yi‐Frazier, J. P., Salsman, J. M., Baker, K. S., Mack, M. C., Taylor, M., et al. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-026-01775-0
“Informed by stress and coping and resilience theories [29–32], Cognitive-Behavioral Therapy, and positive psychology interventions [33–39], PRISM is a lay coach-led inter - vention delivered in a brief, 1:1 format, teaching action-able behavioral skills associated with wellbeing [28, 40].”
Self-citation
- Authors
- Rosenberg, A. R., Yi-Frazier, J. P., Wharton, C., Gordon, K., & Jones, B.
- Affiliations
- Seattle Children's Hospital (US)
- University of Washington
- The University of Texas at Austin (US)
- Corresponding author
- Rosenberg, Abby R.
- Venue
- Journal of Adolescent and Young Adult Oncology
- Publisher
- SAGE Publications
- Published
- 2014-12-01
- Volume
- 3
- Issue
- 4
- Pages
- 185-193
- ISSN
- 2156-5333 (ISSN-L)
- 2156-535X
- PMC
- PMC4418509
- OpenAlex
- W2332960234
- Cited by
- 78
- References
- 50
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 14 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 13 · 2017: 10 · 2016: 2 · 2015: 4
- Type
- paratext
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Adolescent and Young Adult Oncology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- CureSearch for Children's Cancer
- Seattle Children's Research Institute
- Center for Clinical and Translational Research
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- resilience, adolescent and young adult cancer, stress coping, goal setting, optimism, gratitude, meaning-making, benefit finding, psychosocial outcomes
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