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Simple Summary Psychological resilience is an important psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Despite improved prognosis, breast cancer is associated with emotional distress across the trajectory of the disease. This study aimed to investigate psychological resilience and health-related quality of life in Swedish women with breast cancer at diagnosis and one year later. The resilience score declined in the cohort and was associated with health-related quality of life at both time points. Assessment of psychological resilience in breast cancer care might enable the identification of patients in need of intensified rehabilitation to improve their health-related quality of life. Abstract Psychological resilience is considered a major protective psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Higher levels of resilience have been associated with higher levels of health-related quality of life (HRQoL) in breast cancer (BC) patients, but research examining the longitudinal process of resilience is limited. The aim of this population-based longitudinal study was to investigate resilience and HRQoL from diagnosis to one year later in 418 Swedish women with primary BC. Resilience was measured with the Connor–Davidson Resilience Scale 25, and HRQoL was measured with the Short Form Health Survey. The participants responded to questions regarding demographic and study-specific variables. Clinicopathological variables were collected from the Swedish National Quality Register for Breast Cancer. The mean score for resilience was 70.6 (standard deviation, SD = 13.0) at diagnosis and 68.9 (SD = 14.0) one year later, p < 0.001. The level of trust in the treatment and financial situation demonstrated the greatest association with the change in resilience levels. No oncological treatment modality was associated with a change in resilience levels. HRQoL decreased over time in the cohort. Resilience was positively associated with HRQoL at one year post diagnosis, which demonstrates that resilience is an important factor in maintaining HRQoL.

Åsa Mohlin,1,2 Ulrika Axelsson,3 Pär-Ola Bendahl,4 Carl Borrebaeck,3 Cecilia Hegardt,4 Per Johnsson,5 Ingalill Rahm Hallberg,6 Lisa Rydén7,8 1Department of Clinical Sciences Lund, Division of Medical History, Lund University, Lund 221 84, Sweden; 2Healthcare Center Laröd, Helsingborg 252 86, Sweden; 3Department of Immunotechnology and CREATE Health Translational Cancer Center, Lunds University, Lund 223 81, Sweden; 4Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund 223 81, Sweden; 5Department of Psychology, Lund University, Lund 221 00, Sweden; 6Department of Health Sciences, Lund University, Lund 221 00, Sweden; 7Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund 223 81, Sweden; 8Department of Surgery, Skåne University Hospital, Malmö, 214 28, SwedenCorrespondence: Åsa MohlinHealthcare Center Laröd, Travvägen 27, Helsingborg 252 86, SwedenTel +46 42-406 08 50Email asa.mohlin@med.lu.sePurpose: Psychological resilience appears to be an important influencing factor in various aspects of health-related quality of life (HRQoL) in a context of adversity, eg, being informed of a cancer diagnosis. The purpose was to investigate psychological resilience and HRQoL in Swedish women with newly diagnosed breast cancer in relation to demographic and clinicopathological characteristics.Methods: A population-based cross-sectional study was conducted including 517 women with breast cancer in the South Swedish Health Care Region. Participants were enrolled at the time of consultation for the diagnosis. Psychological resilience was assessed with the Connor-Davidson Resilience Scale 25 (CD-RISC25), and HRQoL was assessed with the Short Form Health Survey. The participants responded to questions regarding demographic variables. Clinicopathological data were collected from the Swedish National Quality Register for Breast Cancer.Results: The mean score for psychological resilience was 70.6, identifying 15% of included patients with a score lower than 58 (− 1 standard deviation). The study cohort had significantly lower mean scores for several aspects of HRQoL compared with Swedish normative data. Regression analyses demonstrated that psychological resilience was significantly associated with all domains of HRQoL after adjustment for demographic and clinicopathological factors.Conclusion: Higher levels of psychological resilience were significantly related to higher levels of HRQoL in Swedish women with newly diagnosed breast cancer and no modifying factor was identified. The assessment of psychological resilience at the time of breast cancer diagnosis might allow for early identification of women in need of more intense psychosocial support. Future studies are needed to identify a clinically relevant threshold of the CD-RISC25.Keywords: breast cancer, psychological resilience, health-related quality of life, Connor-Davidson Resilience Scale 25, CD-RISC25, Short Form Health Survey, SF-36

Figure S1. Boxplot summarising sequencing statistics including total purity-filtered reads, uniquely aligned reads, multimapping reads, unaligned reads and reads that were removed due to a very short insert size (

Representative cytograms of cell surface markers CD44 and CD24 obtained using flow cytometry. JIMT-1 cells were treated with 50 nM salinomycin or salinomycin analogs for 72 h. SA: salinomycin, 2a: carbamate, 2b: acetate, 2c: carbonate and 3: C1-methyl ester. (DOCX 1340 kb)

Representative cytograms of cell surface markers CD44 and CD24 obtained using flow cytometry. JIMT-1 cells were treated with salinomycin or salinomycin analogs at IC50 for 72 h. SA: salinomycin, 2a: carbamate, 2b: acetate, 2c: carbonate and 3: C1-methyl ester. (DOCX 1331 kb)

Representative cytograms of ALDH assay obtained using flow cytometry. JIMT-1 cells were treated with salinomycin or salinomycin analogs at IC50 for 72 h. SA: salinomycin, 2a: carbamate, 2b: acetate, 2c: carbonate and 3: C1-methyl ester. (DOCX 1597 kb)

Representative cytograms of ALDH assay obtained using flow cytometry. JIMT-1 cells were treated with 50 nM salinomycin or salinomycin analogs for 72 h. SA: salinomycin, 2a: carbamate, 2b: acetate, 2c: carbonate and 3: C1-methyl ester. (DOCX 1678 kb)

Salinomycin treatment decreases the proportion of ALDH+ in a dose dependent manner. JIMT-1 cells were treated with salinomycin for 72 h at the indicated concentrations. The effect on the ALDH+ population was determined using flow cytometry. Data are represented as mean ± SEM for n = 3. (DOCX 38 kb)

U-shaped dose response curve found for the CD44+ /CD24− population in N–ethyl carbamate 2a-treated JIMT-1 cells. JIMT-1 cells were treated with 2a for 72 h at the indicated concentrations. The effect on the CD44+/CD24− population was determined using flow cytometry. Data are represented as mean ± SEM for n = 4. (DOCX 41 kb)