The role of communication and support in return to work following cancer‐related absence

Objective: Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post‐return period; and second, by drawing on a research sample working in the United Kingdom. Methods: In all, 26 cancer survivors took part in a semi‐structured telephone interview. Interviews were transcribed and analysed using thematic analysis. Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post‐return to work. Third, during the post‐return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow‐up and monitoring, and the wear‐off effect of empathy and support were highlighted as contributing to return‐to‐work difficulties. Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return‐to‐work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return‐to‐work process. Copyright © 2009 John Wiley & Sons, Ltd.     

Common‐sense beliefs about cancer and health practices among women completing treatment for breast cancer

Objective: Following the end of adjuvant treatment, breast cancer survivors must cope with uncertainty related to the possibility of recurrence and the loss of the ‘safety net’ treatment provides. This study examined breast cancer survivors' efforts to manage uncertainty by making lifestyle changes, such as improvement in diet and exercise. We further investigated the role of women's common‐sense beliefs about their cancer, as described by Leventhal's self‐regulation theory, in explaining post‐treatment changes. Method: At 3 weeks and 3 months post‐treatment, 79 women who received adjuvant chemotherapy and/or radiation therapy for stages 0–III breast cancer (mean age=55 years) completed assessments of changes in health practices and other behaviors. Participants also completed measures of beliefs about the causes, course, personal control, and consequences of their cancer. Results: Survivors reported behavior changes directed toward improving physical, emotional, and spiritual well‐being. Results further indicated that women who believed their cancer had more severe consequences and those who attributed the development of cancer or the prevention of recurrence to health behaviors or stress were most likely to report improvement in diet or physical activity and reduction in alcohol use or stress. Conclusions: Findings suggest that breast cancer survivors are poised to make lifestyle changes after treatment ends, creating an opportune time for health promotion interventions. Understanding women's cancer beliefs could help guide the development of tailored, proactive interventions to improve the health and well‐being of breast cancer survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Comparison of lasting life changes after cancer and BMT: perspectives of long‐term survivors and spouses

Objective: This qualitative follow up of long‐term (>5 years) cancer survivor and spouse participants from a large, previous study of quality of life after blood and marrow transplantation (BMT) was designed to gain a deeper understanding of lasting life changes they experienced. Methods: Thirty spouse–survivor pairs, an average of 13 years post‐BMT, were individually interviewed to identify lasting life changes. Participants were asked about their most significant long‐lasting change since cancer/BMT, most significant positive change and negative change, and whether the experience had affected them and their spouse differently. Results: Spouses and survivors spontaneously identified both positive and negative changes. Spouses reported a higher proportion of negative changes (24%) than did survivors (15%), and survivors a higher proportion of positive changes (85%) than spouses (76%). For both groups, the most frequent positive change was in ‘perspective/outlook on life’ and negative change was ‘lingering health effects,’ although survivors mentioned the latter twice as often as did spouses. Spouses were more likely to talk about changes in the first‐person plural (we, us) that were largely emotional or in relation to the survivor, whereas survivors spoke of changes in the first‐person singular (I, me) that occurred to them directly and were largely physical. Conclusions: Although both spouses and survivors described similar negative and positive long‐lasting changes that continued an average of 13 years post‐BMT, they reported differences in the ways they were impacted by the experience, which was reflected in the language they used. Implications for future studies, family education, and couples‐based interventions are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Objective: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at‐risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post‐traumatic stress symptoms (PTSS). Methods: Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self‐report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State‐trait anxiety, depression, and PTSS were assessed to all of the participants. Results: The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict (‘Supportive‐type’, n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict (‘Conflictive‐type’, n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict (‘Intermediate‐type’, n=113). Among the three types, an analysis of variance revealed that ‘Conflictive‐type’ members had the highest levels of PTSS, depression, and state–trait anxiety. Conclusions: These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family‐focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a ‘Conflictive‐type’ family member. Copyright © 2009 John Wiley & Sons, Ltd.     

The nature and timing of distress among post‐treatment haematological cancer survivors

Many people with haematological cancers will not meet the diagnostic criteria for a psychological disorder, but will still suffer distress during treatment and beyond. The current study aimed to explore the nature and timing of psychosocial distress experienced by haematological cancer survivors. Twenty‐three post‐treatment haematological cancer survivors participated in a semi‐structured interview. Data were analysed using thematic analysis which involved identifying, analysing and reporting themes. Four themes were identified: Apprehension about leaving the safety of the health care system comprises the struggles encountered when transitioning from patient to survivor, Uncertainty and life transitions in the post‐treatment period encompasses the changes survivors face when attempting to re‐enter their “normal” lives, Distress associated with ongoing physical problems or impairment describes issues associated with the ongoing physical sequelae, and Fear of recurrence encapsulates how the continuing threat of cancer recurrence impacted survivors. This study has found that distress is ongoing for many haematological cancer survivors in the post‐treatment period . It is imperative that distress is identified and support offered to those in need to prevent further psychosocial issues. It is especially important to consider the psychosocial needs of survivors in the post‐treatment stage who are discharged from the health system may be unsure where to seek help.     

Onset and relapse of psychiatric disorders following early breast cancer: a case–control study

Objective: Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM‐IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. Methods: A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post‐Traumatic Stress Disorder Inventory) over three successive periods, ‘before cancer’ (from childhood to 3 years before the interview), ‘around the cancer event’ (the last 3 years including the time of diagnosis and treatment), and ‘currently’ (the last 2 weeks). Results: Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two‐year prevalent cases) and PTSD (7/7) and the re‐emergence of MDD (n=21 relapses/28 three‐year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2–4 times greater in breast cancer survivors than in controls. Conclusion: Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Experiences and concerns about ‘returning to work’ for women breast cancer survivors: a literature review

Objective: To explore how female breast cancer patients experience work incapacity during the treatment and return‐to‐work phases and how interactions between patients and stakeholders affect this experience. Method: Database search for full text articles published between January 1995 and January 2008 that focused on employed female breast cancer patients, factors related to work incapacity, and returning to work. Only results based on self‐report data were included. Studies focusing on treatment, financial factors, rate of return, or absence were excluded. Results: Six articles met the inclusion criteria. Women with breast cancer receive varied reactions but little advice about returning to work. Women were primarily concerned with disclosing the diagnosis to their employer and to relatives. Uncertainties about physical appearance, ability to work, and possible job loss affected the women's decisions about working during the treatment phase. After treatment, most women wanted to regain their ‘normal life’, but concentration and arm or fatigue problems potentially interfered. Although supportive work environments were helpful, the individual needs of women differed. Employers and employees need to find a balance in defining accommodating work. Many women received favourable support, but some reported feeling discriminated against. Many women re‐evaluated the role of work in their lives after being confronted with breast cancer. Conclusion: Work adjustments could help women to keep their jobs during illness and recovery. To resolve women's concerns about returning to work, employers, physicians, and insurance institutions should consider increasing and improving communication with breast cancer patients and playing a more active and supportive role. Copyright © 2009 John Wiley & Sons, Ltd.     

Feasibility of a self‐help treatment for insomnia comorbid with cancer

Objective: Professionally administered cognitive‐behavioral therapy (CBT) is efficacious for treating insomnia in breast cancer survivors. However, given the limited accessibility to CBT for insomnia in cancer clinics, there is a need to develop other delivery formats for this intervention. This feasibility study examined patients' satisfaction with a self‐help CBT for insomnia comorbid with cancer and gathered some preliminary data on its effect on sleep and associated features. Methods: Eleven breast cancer patients reporting insomnia symptoms received a 6‐week intervention composed of a 60‐min video using an animated cartoon format and 6 short booklets developed in French. Patients completed a semi‐structured interview at post‐treatment, a battery of self‐report scales and a daily sleep diary (14 days) at pre‐ and post‐treatment and at a 3‐month follow‐up. Results: At post‐treatment interview, comments about the treatment material were uniformly positive. On a questionnaire, patients also reported to be satisfied with the treatment overall, with the video and the booklets' content, as well as with their sleep improvement at post‐treatment (scores from 2.7 to 3.1; scale from 0 to 4). From pre‐ to post‐treatment, moderate‐to‐large effect sizes and statistically and clinically significant differences were found on most sleep variables, as well as overall quality of life. These therapeutic gains were well sustained at a 3‐month follow‐up. Conclusions: Patients were satisfied with the treatment received. Although it is too early to draw any firm conclusion, treatment outcomes suggest a potential for integration into routine cancer care as a first‐line sleep management intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

Measuring social activities and social function in long‐term cancer survivors who received hematopoietic stem cell transplantation

Objective: Cancer survivors report deficits in social functioning even years after completing treatment. Commonly used measures of social functioning provide incomplete understanding of survivors' social behavior. This study describes social activities of survivors and evaluates the psychometric properties of the Social Activity Log (SAL) in a cohort of long‐term survivors of hematopoietic stem cell transplantation (HSCT) for cancer. Methods: One hundred and two (5–20 year) survivors completed the SAL, Short‐Form‐36 Health Survey (SF‐36), and other patient‐reported outcomes. Principal components analysis determined the factor structure of the SAL along with correlations and regressions to establish validity. Results: Principal component analysis yielded three factors in the SAL: ‘non‐contact events’ (e.g. telephone calls), ‘regular events’ (e.g. played cards), and ‘special events’ (e.g. concerts), which explained 59% of the total variance. The SAL possessed good internal consistency (Cronbach's α=0.82). SF‐36 social function and SAL were moderately correlated (r=0.31). In linear regressions, physical function and depression explained 16% of the variance in the SAL (P<0.001), while physical function, depression, and fatigue predicted 55% of the variance in SF‐36 social function (P<0.001). Conclusions: Results support the use of the SAL as a measure of social activity in cancer survivors who received HSCT. Although the SAL is designed to measure social behaviors, SF‐36 social function assesses subjective experience and is more strongly associated with depression and fatigue. The SAL appears to be a promising tool to understand the behavioral social deficits reported by long‐term survivors of cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Long‐term cancer survivors experience work changes after diagnosis: results of a population‐based study

Background: Although cancer survivorship is increasing with improved diagnosis and treatments, few studies have explored employment changes and the factors related to this change among cancer survivors. Therefore, we aim to explore the prevalence of employment problems in long‐term cancer survivors. In addition, we explored what patient or tumour characteristics predicted employment changes. Methods: All 1893 long‐term survivors of prostate cancer, endometrial cancer, non‐Hodgkin's lymphoma, and Hodgkin's lymphoma diagnosed between 1989 and 1998 in the area of the Comprehensive Cancer Centre South, The Netherlands were included in a population‐based cross‐sectional survey. Results: Response rate was 80% (n=1511). After excluding survivors without a job before diagnosis, 403 survivors remained; 197 (49%) experienced no changes in their work situation following cancer diagnosis, 69 (17%) were working fewer hours, and 137 (34%) stopped working or retired. A medium educational level was significant in reducing the risk of work changes. Being older, having more than one comorbid condition, being treated with chemotherapy, and disease progression were significant independent predictors of work changes after cancer. Experiencing work changes was associated with lower physical functioning but positively associated with social well‐being. Discussion: Long‐term cancer survivors experience work changes after diagnosis and treatment, and clinical factors significantly predicted work change after cancer. As such, our study underscores the importance of rehabilitation programs in improving the return to work after cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial

BACKGROUND:

Cancer‐related fatigue afflicts up to 33% of breast cancer survivors, yet there are no empirically validated treatments for this symptom.

METHODS:

The authors conducted a 2‐group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post‐treatment fatigue. Participants were breast cancer survivors who had completed cancer treatments (other than endocrine therapy) at least 6 months before enrollment, reported significant cancer‐related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12‐week, Iyengar‐based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post‐treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent‐to‐treat analyses were conducted with all randomized participants using linear mixed models.

RESULTS:

Thirty‐one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post‐treatment and over a 3‐month follow‐up in the yoga group relative to controls (P = .032). In addition, the yoga group had significant increases in vigor relative to controls (P = .011). Both groups had positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed.

CONCLUSIONS:

A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms. Cancer 2012. © 2011 American Cancer Society.     

Evaluation of a psycho‐educational group intervention for children treated for cancer: a descriptive pilot study

Objective: The present paper reports about the content and evaluation of a psycho‐educational group intervention for children growing up with a history of cancer, Op Koers Oncologie (OK Onco). OK Onco is aimed at empowerment of survivors of childhood cancer by teaching disease‐related skills. The purpose of this pilot study is to evaluate whether OK Onco was appropriate for use among paediatric survivors of childhood cancer. Methods: Eleven participating children and their parents completed questionnaires about the disease‐related skills that were taught in the intervention, before the intervention and 0–4 weeks after the intervention. In addition, parents were interviewed in focus groups. Results: Positive outcomes were found on most items concerning disease‐related skills. Remarkable improvements were found with respect to the intervention goals ‘social competence’ and ‘positive thinking’. The parents reported that sharing emotions and experiences with other survivors of childhood cancer was an important element of the OK Onco program, which underscores the benefit of a disease‐specific program for cancer survivors. Conclusions: In conclusion, the results of the pilot study indicate that OK Onco is appropriate for paediatric survivors of childhood cancer. Implementation of the intervention is the next challenge. Copyright © 2008 John Wiley & Sons, Ltd.     

Transitioning childhood cancer survivors to adult‐centered healthcare: insights from parents,adolescent, and young adult survivors

Objective: To determine Latino adolescent and young adults (AYA) cancer survivors' perceived barriers or facilitators to transition from pediatric to adult‐centered survivorship care and to also assess the parents' perspective of care. Methods: Partnering with a community‐based organization that serves Latino survivors, we conducted a qualitative, constant comparative analytic approach exploring in‐depth themes that have salience for Latino pediatric cancer survivors seeking care in the adult healthcare setting. Twenty‐seven Latino AYA survivors (?15 years of age) completed key informant interviews and 21 Latino parents participated in focus groups. Results: Both AYA survivors and parents identified two major facilitative factors for survivorship care: Involvement of the nuclear family in the AYA's survivorship care in the adult healthcare setting and including symptom communication in late effects discussions. Barriers to care included: perceived stigma of a cancer history and continued emotional trauma related to discussions about the childhood cancer experience. Conclusions: Barriers to survivorship care include cancer stigma for both patient and nuclear family, which can impact on seeking survivorship care due to constraints placed on discussions because it remains difficult to discuss ‘cancer’ years later. Future research can evaluate if these findings are unique to Latino childhood cancer survivors or are found in other populations of AYA cancer survivors transitioning to adult‐centered healthcare. This community‐based participatory research collaboration also highlights the opportunity to learn about the needs of childhood cancer survivors from the lens of community leaders serving culturally diverse populations. Copyright © 2010 John Wiley & Sons, Ltd.     

Impact of physical appearance changes reported by adolescent and young adult cancer survivors: A qualitative analysis

Poor body image may be one driver of distress for adolescent and young adults (AYAs) after cancer. We explored physical appearance changes reported by AYA cancer survivors to understand impacts on body image, distress, lifestyle and health behaviours. We recruited AYAs (15–25 years) who had completed cancer treatment. Using semi‐structured interviews, we asked participants about appearance changes resulting from their cancer. We used iterative thematic analyses to explain experiences. Forty‐three participants (51% male, mean age = 21 years) completed an interview. Two key themes emerged. Participants discussed physical appearance changes and psychosocial impacts including appraisal of their changed appearance. Thirty‐eight participants (n = 38/43) reported that their cancer and/or treatment changed their appearance (most commonly: alopecia [n = 15/43], scarring [n = 14/43] and weight gain [n = 11/43]). Ten participants (n = 10/43) acknowledged body dissatisfaction. Other impacts included feeling a loss of identity, not being recognised by peers and feeling helpless to change. Our results have translational significance for AYA care. Body image concerns should be considered a potential barrier to successful reintegration post‐treatment. AYAs may benefit from familial and peer support, healthy lifestyle interventions and clinical environments catering to appearance‐related sensitivities.     

Socioeconomic conditions among long‐term gynaecological cancer survivors—a population‐based case–control study

Background: The population of gynaecological cancer survivors is growing, yet little is known about the effects of cancer and treatment on socioeconomic conditions well beyond the completion of therapy. The aim of this study was to investigate the socioeconomic conditions in long‐term survivors of gynaecological cancer compared with a representative group of women from the general population. Material and methods: The study comprises women aged 32–75 residing in central part of Norway and who were treated as primary cases of gynaecological cancer at the University Hospital in Trondheim, Norway (n=160), and a control group from the general population (n=493). All analyses were done by χ² test and logistic regression. Results: Gynaecological cancer survivors scored lower on a Socioeconomic Condition Index than the control group. They had on the average a complete remission period of 12 years. Compared with the control group, they were more often disabled (p<0.01) and had lower annual household income (p<0.01). No difference was detected between the groups in ability to pay bills. More cases than controls had experienced problems assigning personal insurance (p<0.03). Conclusion: Long‐term gynaecological cancer survivors lived under poorer socioeconomic conditions, were more often disabled and had lower annual household income than the women in the control group, whereas no difference in ability to pay bills were found between the groups. In spite of poorer socioeconomic conditions, the gynaecological cancer survivors seem to adapt well to their financial situation. Copyright © 2009 John Wiley & Sons, Ltd.     

Fear of recurrence in long-term testicular cancer survivors

Objective: To explore fear of recurrence (FoR) in long‐term testicular cancer survivors (TCSs) since FoR hardly has been examined in TCSs. Methods: In a cross‐sectional questionnaire study, 1336 TCSs at a mean of 11.4 years (SD 4.2) after diagnosis gave information about their medical and social situation, and completed measures on mental distress, fatigue, quality of life, coping, self‐esteem and neuroticism. FoR during the last week was explored with one question, with the response categories rated on a 4‐point Likert scale. Nine percent of the TCSs had a structured psychiatric interview. Results: Twenty‐four percent of the TCSs reported ‘quite a bit’ FoR and 7% reported ‘very much’ FoR during the last week. The FoR question showed moderate correlations (0.22–0.51) with established psychological measures. The level of FoR was significantly positively correlated with mental distress, fatigue and neuroticism and significantly negatively correlated with quality of life, self‐esteem and coping. In univariate analyses, neurotoxic side effects and somatic symptoms, but not treatment modality, were significantly associated with level of FoR. In a multivariate analysis, a medium educational level, increasing levels of traumatic cancer‐related stress symptoms and of neuroticism were significantly associated with rising FoR. Among those who had a psychiatric interview, the presence of at least one current mental disorder was significantly associated with FoR. Conclusions: High levels of FoR in long‐term TCSs are not uncommon. Levels of mental and somatic problems are associated with the levels of FoR. Clinical consequences of these findings for TCSs are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Post‐traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults

Objective: We examined whether post‐traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well‐being in a sample of younger adult survivors of various types of cancer. Methods: 167 participants completed questionnaires regarding intrusive thoughts, post‐traumatic growth, mental and physical health‐related quality of life, positive and negative affect, life satisfaction, and spiritual well‐being. Multiple regression analyses controlling for relevant background and cancer‐related variables tested the interaction effects of post‐traumatic growth and intrusive thoughts. Results: Intrusive thoughts were related to poorer adjustment on all indices except physical health‐related quality of life. However, post‐traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well‐being in a protective fashion. That is, for those higher in post‐traumatic growth, higher levels of intrusive thoughts were related to better adjustment. Conclusions: The positive meaning that individuals assign to their cancer experience as reflected in their reports of post‐traumatic growth appears to be important in determining the impact of intrusive thoughts on post‐cancer adjustment. Copyright © 2009 John Wiley & Sons, Ltd.     

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing

Introduction: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. Methods: Fifty‐five post‐treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post‐diagnosis, were recruited from a state cancer registry and completed baseline and 3‐month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). Results: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3‐month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3‐month PTG. Conclusions: Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. Copyright © 2008 John Wiley & Sons, Ltd.