title: Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer?
abstract: While knowledge about late psychosocial effects in pediatric cancer survivors is growing, investigation of positive changes, notably posttraumatic growth (PTG), is still lacking. Recent studies have not established any stable relationship between PTG and posttraumatic stress symptoms (PTSS), and it is still unclear which factors are associated with PTG in survivors of childhood cancer. The aims of this study were to give a quantitative description of PTG in long-term survivors of adolescent cancer and to investigate its association with psychological variables, especially the recalled amount of fear of death during treatment, as well as other cancer-related and demographic issues.
  
  
  
  A cohort of 784 long-term survivors of adolescent cancer (age M = 30.4 ± 6.1, time since diagnosis M = 13.7 ± 6.0 years) completed a set of questionnaires measuring PTG, PTSS, depression, anxiety, fear of death and psychosocial support during treatment, and sociodemographic and medical variables.
  
  
  
  More than 5 years after cancer diagnosis, 94.3 % of participants reported having "very strongly" experienced at least one positive consequence in the aftermath of the stressful experience. There were positive correlations between PTG and fear of death and psychosocial support during treatment, as well as for current symptoms of depression. No association with the amount of PTSS was found.
  
  
  
  Findings suggest that experiencing fear of death during cancer experience as well as utilizing psychosocial support catalyzes posttraumatic growth in the aftermath. Further studies should investigate how interventions could be designed to promote and stimulate PTG in young cancer patients.
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstraße 5, 89075, Ulm, Germany. gunst@verhaltenstherapie-aalen.de.
authors.forename: Diana Christine Maria
authors.initials: DC
authors.lastname: Gunst
authors.affiliation: German Childhood Cancer Registry at the Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kaatsch
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstraße 5, 89075, Ulm, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Goldbeck
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Adolescence; Cancer; Posttraumatic growth; Survivor