Resilience in Symptom Response to Cancer Treatment: A New Lens for Examining Variable Symptom Trajectories in Older Adults with Advanced Cancer

Background Symptom trajectories vary among patients during cancer treatment. The National Institutes of Health resilience model, which defines resilience as the ability to resist, recover, or grow from stressors, may be useful in understanding these variations. This study examined variations in symptom trajectories through the lens of resilience among older adults with advanced cancer. Methods This longitudinal quantitative study included patients aged 70 and older with advanced cancer who were receiving treatment regimens associated with a high risk of treatment-related toxicities, using data from the GAP70+ study (NCT02054741). A summary severity score of 24 symptoms from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events and functional status (measured by instrumental activities of daily living) were assessed prior to the treatment regimen initiation, at 4-6 weeks, 3 months, and 6 months later. Symptom trajectories were estimated using growth mixture models. Resilience was indicated by trajectories of resisting, recovering, or growing (i.e., improving from moderate/severe to none/mild severity). Its association with functional status was examined using longitudinal linear mixed models. Results The study included 710 patients (average age 77.2, 43.2% female, 88.0% receiving chemotherapy). Overall, 17.7% of patients showed resilience in symptom response, which was associated with higher baseline functional status (13.2 vs 12.0, p < 0.001) and stable functioning over six months. In contrast, non-resilience in symptom response was associated with a functional decline of 0.7–0.9 points without recovery by six months (p < 0.001). Conclusion Resilience in symptom response provides a novel perspective on symptom trajectory variations. Future research should explore underlying contributing factors to inform interventions that promote resilient symptom responses.