I must admit that, having been on the opposite side of the bed as a cancer survivor, as well as a caregiver to a husband and a father who died from cancer, I initially found the statement about flourishing after cancer a bit of an anomaly.
Yes, I knew people who learned from and flourished after the diagnosis of the dreaded Big C. I also remembered how I re-evaluated my own life, learned to let go of the trivial, and embraced what was truly important to me after my melanoma diagnosis decades ago. Yet I didn't see this as growth. It seemed more like reframing -- looking at a picture with a new set of glasses. The more contemporary nomenclature of post-traumatic growth (PTG) has made me reconsider the possibility of thriving after cancer.
Nenova and colleagues recently addressed this concept in bone marrow transplant survivors and its relationship to social support.1 The investigators used the definition of PTG coined by Tedeschi: "Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life crises."2
The relationship of this construct with social support was the primary theme of the research with an interesting twist -- the differentiation of two distinct subtypes. Emotional support was operationally defined as the provision of love, comfort, caring, affection, and an "empathic ear." Instrumental support consisted of tangible services and goods, such as help with household chores, transportation, and financial matters. The investigators postulated that emotional support would be most indicative of PTG, but instrumental support proved to be the unique predictor of this construct.
A notable finding from this investigation is the unique corollaries for the transplant experience. The physical, social, emotional, and existential compromise induced by this therapy can overwhelm even those with a highly functional support system. Due to the extensive demands imposed on the patient, it makes sense that the provision of instrumental support would be most helpful in living through and living on in a positive trajectory after a transplant. However, the researchers clarified that these findings should not be interpreted to minimize the more affective aspects of social support. Rather, they postulated that perhaps the nature of support should match the degree of imposition that a traumatic event causes on the patient and/or family unit.
We as healthcare providers often fail to highlight practical help (as depicted by the term "instrumental support") when we discuss home care. However, informal caregivers -- friends, extended family, and colleagues -- are often quick to ask how they can help in this regard.
Perhaps those of us who work with bone marrow transplant patients should include these measures in our teaching as an effective intervention to augment not just living through, but also living on and thriving after cancer.
- Nenova M, DuHamel K, Zemon V, Rini C, Redd WH (2013). Post-traumatic growth, social support, and social constraint in hematopoietic stem cell transplant survivors. Psycho-Oncology, 22: 195-202.
- Tedeschi RG (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychol Inq, 15: 1-18.