Background: Approximately half of advanced cancer patients with a long-term response to immuno- or targeted therapy (IT/TT) (ie, long-term responders (LTRs)) experience heightened distress due to persistent uncertainty.
Purpose: We aimed to study to what extent supportive factors (ie, illness acceptance, tolerance of uncertainty, mindfulness, social support, optimism, emotion regulation variability, and positive affect in general and prior to a stressor) predict micro-level resilience in response to unpleasant daily life events.
Methods: We conducted an observational cohort study with a baseline assessment of supportive factors, followed by Ecological Momentary Assessment with 8 assessments a day for 14 consecutive days. Resilience was operationalized as maintenance of low negative affect (NA) or a smaller increase in NA to an unpleasant event, as this suggests that partial recovery has already taken place. We used Dynamic Structural Equation Models to study supportive factors of resilience.
Results: We included data from 61 patients with advanced melanoma or lung cancer with confirmed response to or long-term stable disease while on IT/TT. More unpleasant daily life events were associated with increases in NA. The multivariate model did not identify any supportive factors. Exploratory analysis using separate models tentatively indicated that LTRs with higher levels of illness acceptance, mindfulness, optimism, and general positive affect showed a smaller increase in NA in response to an unpleasant event (ie, more resilient response).
Conclusions: Preliminary findings suggest that illness acceptance, mindfulness, optimism, and general positive affect are supportive factors of resilience in LTRs. Future research should include these factors at momentary level to enhance insight into the resilience process.
Keywords: ecological momentary assessment; immunotherapy; lung cancer; melanoma; resilience; targeted therapy.
New treatment options, such as immunotherapy and targeted therapy, have drastically improved the life expectancy of many patients with advanced cancer. While this is obviously good news, approximately 50% of these so-called long-term responders report heightened levels of distress. With treatment side effects, recurring control scans, and an uncertain life perspective, patients face stressor after stressor. Daily life resilience refers to the extent to which people recover from daily life stressors. This study explored what factors support long-term responders’ daily life resilience. In a diary study, unpleasant daily life events and negative emotions were assessed 8 times a day for 14 days among 61 long-term responders. Our findings suggested that illness acceptance, mindfulness, optimism, and positive affect support long-term responders’ daily life resilience. While these results suggest that promoting resilience may be achievable through cultivating these positive psychological factors, further diary studies are needed to explore how these factors aid the resilience process from one moment to the next.
© The Author(s) 2025. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.