Original Article

Impact of Resilience on Psychological

Well-Being In Breast Cancer Patients
Undergoing Chemotherapy

Abd Gani Baeda* , Eka Nurwahyuni

Department of Medical Surgical Nursing, Faculty of Science and Technology,

Universitas Sembianbelas November Kolaka, Kolaka, Indonesia

Abstract
Background: The most commonly used therapy for breast cancer is
chemotherapy. Chemotherapy has physical and psychological side effects
that affect the psychological well-being of the patient. Resilience plays an
important role in changing psychological well-being. Cancer patients who
have low levels of resilience will show negative psychological well-being
and vice versa. However, the condition of cancer patients undergoing
chemotherapy is not yet known whether resilience can change psychological
OPEN ACCESS well-being so that they can adapt to the stressors of chemotherapy.
Purpose: This study aims to analyze the relationship between resilience and
Jurnal Keperawatan Padj- psychological well-being of breast cancer patients undergoing chemotherapy.
adjaran (JKP) Methods: This study was conducted using an observational analytic method
with a cross-sectional approach. The population in this study were breast
Volume 10(1), 37-44 cancer patients who underwent chemotherapy sessions 2-6 at one of the
© The Author(s) 2022 hospitals in Malang, Indonesia. A sample of 62 people was obtained by
https://doi.org/10.24198/jkp.
v10i1.1867 using a stratified random sampling technique based on the chemotherapy
sessions the patient underwent. Data Collection used the Connor-Davidson
Article Info Resilience Scale questionnaire. Data analysis procedures were carried out
Received : October 29, 2021 in univariate and bivariate ways (lambda correlation test).
Revised : February 08, 2022
Results: The Univariate analysis showed that the lowest resilience was
Accepted : February 21, 2022
Published : April 25, 2022 experienced by respondents who underwent the second chemotherapy
session and the bivariate analysis showed that there was a positive
Corresponding author correlation between resilience and psychological well-being with p=0.039
Abd Gani Baeda and r=0.267. This means that the higher a person’s resilience, the greater
Department of edical Surgical
Nursing, Faculty of Science and
the chance of having positive psychological well-being.
Technology, Universitas Sem- Conclusion: This study shows that the higher the resilience, the greater the
bilanbelas November Kolaka, probability of experiencing positive psychological well-being. While the higher
Kolaka District, Southeast Su- the resilience, the more likely it is to experience positive psychological well-
lawesi, Indonesia, 93511, Phone:
6282393276800, E-mail: abdgan- being. It is recommended that patients who will undergo chemotherapy are
[email protected] given education related to therapy so that low resilience is not experienced
at the beginning of chemotherapy.
Citation
Baeda, A.G., & Nurwahyuni, E
Keywords: breast cancer; chemotherapy; psychological well-being;
(2022). Impact of Resilience on
Psychological Well-Being In Breast resilience.
Cancer Patients Undergoing Che-
motherapy. Jurnal Keperawatan
Padjadjaran, 10(1), 37-44. https:// Introduction
doi.org/10.24198/jkp.v9i3.1867
Breast cancer cases in the world are ranked second after cervical cancer and
Website become one of the leading causes of mortality for women in the world. The
http://jkp.fkep.unpad.ac.id/index. North American Association of Central Cancer Registries in 2017 mentioned
php/jkp
that in Asia, the incidence of breast cancer is about 907 occurrences per
This is an Open Access article 100,000 people (De Santis et al, 2017). Breast cancer caused 8.8 million
distributed under the terms of deaths in 2015, while in the period 2011-2015 it was 11.3% of deaths and
the Creative Commons Attribu-
increased to 14% of deaths in 2016 (De Santis et al., 2017; Torre et al., 2016).
tion-NonCommercial 4.0 Interna-
tional License. Breast cancer is a type of cancer that is commonly found in Indonesia. The
estimated incidence of cancer cases in women in Indonesia is 12/100,000,
E-ISSN: 2442-7276 about 80% of cases are at an advanced stage, based on the identification of
P-ISSN: 2338-5324
the average cancer patient already in a very concerning condition (Ministry

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

37
 Original Article

Baeda, A.G., et al. (2022)

of Health of the Republic of Indonesia, 2017). The fulfillment of individual positive psychological function
data above shows that the morbidity and mortality of criteria (Karyono, Dewi and Lela, 2008). Breast
breast cancer has increased every year. cancer patients who have positive psychological
Most symptomatic patients who do not undergo well-being will show self-acceptance, self-reliance,
immediate medical treatment are generally ability to interact with the environment, a purpose in
diagnosed with cancer at an advanced stage. This life, ability to show personal development and ability
is due to the delay of patients coming to health to build positive relationships with others. Negative
services after the appearance of early symptoms psychological well-being will have an impact on an
of breast cancer (Fathania, Rahayuwati, & Yani, individual’s self-acceptance of his or her physical
2019). Advanced breast cancer will affect the quality changes, feeling lost, changing roles, difficulty
of life and prognosis of the sufferer can be disturbed. achieving life goals, as well as awareness of family
(Moatter, T., Aban, M., Iqbal, W., & Pervez, S., 2015). suffering (Zimmermann, Burrell and Jordan, 2018).
Breast cancer patients lead a life of forming patterns In addition, individuals with negative psychological
that become reference throughout their lives. This well-being will feel burdensome to others or families
pattern is an effort to learn, understand and apply because of reduced independence. This is what
a treatment and treatment behavior to support their makes breast cancer patients who have negative
quality of life, one of the efforts made is to undergo psychological well-being problems find it difficult to
therapy (Witdiawati, Rahayuwati, & Sari, 2017). undergo chemotherapy (Lai et al., 2018).
Breast cancer therapy is given based on Negative psychological well-being causes
the stage. Therapy given in stages I and II is a individuals to not have good stress management
combination of breast surgery and radiotherapy, strategies (Mawarpury, 2013). Stress management
a combination of breast surgery, radiotherapy and strategies play a role in maintaining the stability of
chemotherapy. The combination of mastectomy and the psychological condition of breast cancer patients
chemotherapy is mostly done at this stage. While undergoing therapy. The balance of the patient’s
in stage IV, the most widely chosen treatment is a psychological condition plays an important role in
combination of radiotherapy and chemotherapy or the treatment process. Breast cancer patients who
one of them. Of the above therapies, chemotherapy have a good stress management strategy will have
is the most effective and most widely used therapy. improved health, high enthusiasm for life, good social
The choice of therapy also depends largely on socio- function, decreased anxiety about the therapeutic
demographic factors and the patient’s knowledge. process (Karyono, Dewi and Lela, 2008) For breast
The more they know, the better decisions they cancer patients undergoing chemotherapy, it is very
make to treat the disease. Although in the end in important to reduce the occurrence of negative
general breast cancer patients decide to undergo psychological effects due to chemotherapy.
chemotherapy (Rahayuwati, Ibrahim, Nurhidayah, Number of visits to breast cancer chemotherapy
& Hendrawati, 2020). at the RST chemotherapy unit. TK II dr. Soepraoen
In stage I, patients have a 70% chance of Malang is ± 95 people every month and 20 of
recovery so that the quality of life is not too disturbed. them are new patients. A preliminary study using a
In stage II, the possibility of recovery by 30-40% questionnaire with guided questions on 10 patients
which causes the quality of life at this stage begins undergoing chemotherapy showed 8 patients (80%)
to be disrupted (Moatter, T., Aban, M., Iqbal, W., & had negative psychological well-being, including
Pervez, S., 2015). Many physical and psychological patients who said that during chemotherapy they
conditions undergo changes due to the side effects experienced limited activity, the patients also said
of chemotherapy. The impact that chemotherapy that they were no longer able to do what they wanted
has on the physical is very diverse. Most patients because they felt limited and dependent on others.
experience gastrointestinal disorders such as Five patients (50%) said they could not accept their
diarrhea, constipation, nausea, vomiting, (Escalante current condition and had limitations in building
et al., 2017) hair loss (Chon et al., 2012), decreased relationships. 9 patients (90%) stated that they had
weight, malnutrition, general weakness (Bicakli et a desire to discontinue chemotherapy because of
al., 2018), and sensory neuropathy (Kuchuk et al., the difficulties experienced during chemotherapy.
2013). Resilience is a factor related to psychological
Psychic impacts caused by chemotherapy such well-being. Patients who have low levels of resilience
as anxiety and depression due to physical changes will show negative psychological well-being. High
(Baati et al., 2010) fear if the disease recurs, anger resilience will make patients able to adapt to
and feel guilty (Costa et al., 2016), self-esteem, stressors (De Couto et al, 2011). Souri & Hasanirad
impaired body image due to the occurrence of (2011) research on medical students as a sample,
alopecia (Baati et al., 2010; Chon et al., 2012) The shows that individuals who have high resilience can
impact of chemotherapy above will have an effect adapt to change so those individuals have positive
on the psychological well-being of patients (Costa psychological well-being. This is influenced by the
et al., 2016). characteristics of individuals who consider religious
Psychological well-being is an overview of an values to play an important role so that a person is
individual’s psychological health based on the optimistic. However, Wang and Tian (2010) research

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

38
 Original Article

Impact of Resilience on Psychological Well-Being

Table 1. Respondent Demographic Data

Characteristics of respondents n %
Recent education
Elementary school or equivalent 29 46.8
Junior high school or equivalent 18 29.0
High school or equivalent 10 16.1
College 5 8.1
Marital status
Married 55 88.7
Unmarried 2 3.2
Ever married 5 8.1
Domicile
Malang City 26 41.9
Out of Malang 36 58.1
Have you ever received information about breast cancer from health workers?
Yes 44 71.0
No 16 29.0
Have you ever received information about chemotherapy from health workers?
Yes 51 82.3
No 11 17.7
Have had breast removal surgery
Yes 40 64.5
No 22 35.5

Table 2. Distribution of Respondents by Age and Length of Illness

Characteristics of respondents n Mean±SD Min- Max
Age 62 48.90±8.11 30-62
Duration of illness 62 12.29±8.67 2-37

Table 3. Distribution of Respondents by Level of Resilience and Distribution of Respondents Based on

The Level of Psychological Well-Being
Resilience Session 2 Session 3 Session 4 Session 5 Session 6 Total
n % n % n % n % n % n %
Low (22-29) 7 41.2 3 23.1 3 25.0 3 27.3 1 11.1 17 27.4
Medium (20-36) 6 35.3 6 46.2 6 50.0 5 45.5 6 66.7 29 46.8
High (37-42) 4 23.5 4 30.8 3 25.0 3 27.3 2 22.2 16 25.8
Psychological well-being
Negative < cut off point 6 35.3 8 61.5 7 58.3 7 63.6 4 44.4 32 51.6
Positive > cut off point 11 64.7 5 38.5 5 41.7 4 36.4 5 55.6 30 48.4

Table 4. The Results of The Analysis of The Relationship between Resilience and Psychological Well-Be-
ing
psychological well-being Total r P
Positive Negative
Resilience Low 5 12 17 0.267 0.039
Medium 13 16 29
High 12 4 16

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

39
 Original Article

Baeda, A.G., et al. (2022)

conducted on gastrointestinal cancer patients who Resilience Scale (CD-RISC) questionnaire is

did not undergo chemotherapy, explained that developed by Kathryn M. Connor and Jonathan
resilience is not directly related to psychological R.T Davidson in 2003. Before the instrument is
well-being, this is because the study depends on the used, it must first be translated into Indonesian
individual’s quality of life. Meanwhile, in this study, using the services of a professional translator.
the researcher wanted to analyze the relationship The questionnaire contains 22 statements, the
between resilience and psychological well-being of independent variables (resilience) are measured
breast cancer patients undergoing chemotherapy using the Guttman scale, namely yes and no choices.
at a hospital unit in Malang, Indonesia. Resilience For the favorable statement, the choice of ‘yes’ is
research is needed to provide nursing care that given a value of 2 and the choice of ‘not’ is given a
focuses on the psyche of patients undergoing value of 1. While the statement that is not favored,
chemotherapy treatment. the choice is given a value of 1 and the choice is
not given a value of 2. The score obtained is in the
Methods form of an interval scale, to interpret in 3 categories,
namely high, medium and low. Psychological well-
being was measured using a Ryff’s Psychological
Study design well-being scale (PWB) questionnaire. The Guttman
This study used an observational analytic survey scale, namely “yes” and “no”, is used to measure the
design with a cross sectional approach. psychological well-being of respondents with a total
of 38 statement items. Favorable statements with
Setting and sample the “yes” option are given a value of 2 and the “no”
The population in this study were breast cancer choice is given a value of 1, while statements that
patients who underwent chemotherapy in one of are unfavorable with the choice of “yes” are given a
the units of Malang Hospital, Indonesia. The total value of 1 and the choice of “no” is given a value of
population of 74 people consisted of 20 people in 2. Determination of the category in the dependent
session 2, 16 people in session 3, 15 people in variable uses with a cut off value. mean. Data
session 4, 13 people in session 5, and 11 people in were analyzed by univariate analysis and bivariate
session 6. The number of samples was determined analysis (lambda correlation test).
using Issacs Michael formula with an error rate of 5% Validity testing is carried out to determine
so that the number of samples obtained is 62 people. whether or not the statement on each variable is
The sample was selected using a stratified random valid. The instrument is valid if the calculated r value
sampling technique based on the chemotherapy > r table. The value of r table in this study is 0.576.
sessions carried out, namely sessions 2-6. The The reliability test was carried out on statements
sample size for each session is determined based that had a value of r>0.576 (valid). Reliability testing
on the stratum size by using the formula for the is done only once by testing the instrument. After
number of samples multiplied by the total population that, the analysis was carried out using KR-20. The
for each session divided by the total population, so results of the reliability of the questionnaire are
that the minimum sample size for each session is as based on Kuder Richardson-20, the questionnaire
follows; session 2 with 17 people, session 3 with 13 is declared reliable if the KR-20 value is > 0.90. The
people, session 4 with 12 people, session 5 with 11 validity test for the resilience variable was carried
people, and session 6 with 9 people. Respondents out on 25 statements. From these 25 statements,
have different levels of resilience, meaning that for 22 valid statements and 3 invalid statements
each chemotherapy session, there are respondents were obtained. Valid statements are statements
with high to low resilience. The inclusion criteria numbered 1, 2, 3,4, 5, 6, 8, 10,11, 12, 13, 14, 15,
in this study were breast cancer patients who had 16, 17, 19, 21, 22, 23, 24, 25 while the invalid is
undergone the first session of chemotherapy, aged statement number 7,9,20. All invalid statements are
18-65 years, were willing to become respondents removed (drop). Because based on the reliability
by signing an informed consent form, and were test using the Kuder Richardson-20, a value above
able to read and write. Exclusion criteria in this 0.90 means that the deleted statements are not
study were patients undergoing radiotherapy, taking reliable. Even if the statement is deleted, it will not
antihistamines, anti-anxiety and antidepressants. affect the results because each resilience indicator
Variable still has a representative statement.
There are two variables in the study, namely
the independent and dependent variables. The Data analysis
independent variable is the factor that affects Data is processed using SPSS 16 for windows.
psychological well-being, namely resilience, and the The data analysis procedure was carried out
dependent variable is psychological well-being. with univariate and bivariate analysis. Univariate
analysis is used to describe the characteristics
Instruments of respondents. Bivariate analysis is done by
Collecting data using the Connor-Davidson connecting the independent variable with the

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

40
 Original Article

Impact of Resilience on Psychological Well-Being

dependent variable that is thought to have a next session.

correlation. The two variables connected are Table 4 shows that the value of p = 0.039, if
categorical data (ordinal and nominal). p <0.05. It can be concluded that H0 is rejected,
meaning that there is a relationship between
Ethical clearance resilience and psychological well-being. The value
This research has obtained ethical permission of r=0.267 indicates a positive correlation with weak
number 352/EC/KEPK-S2/12/2018 from the Ethics strength, meaning that the higher the resilience
Committee of the Faculty of Medicine, Universitas of patients undergoing chemotherapy, the more
Brawijaya. The ethical aspect of research in this positive the psychological well-being of patients.
study is to respect the dignity of the respondent,
namely the respondent is given the freedom to Discussion
follow or refuse to be a respondent, patients agree to
participate in the research, respect the privacy of the Resilience is a process of adaptation when facing
respondents by not disclosing personal information problems, pressures, threats, or more severe
about the respondents, and ensure that the research stressors. Resilience is needed in dealing with
does not harm the respondents. In this study, the anxiety and depression to be able to adapt positively
possibility of the ethical principle being violated is and be able to improve abilities in bad situations
related to the respondent’s autonomy in the form and conditions (Yang & Smith, 2016). Resilience is
of the length of the respondent’s involvement in a process of self-defense from stressful situations
the study. To overcome this problem, respondents against life experiences that have implications for
were given explanation again regarding involvement psychological well-being. Humans are basically
without negative consequences even though the able to adapt to the environment and psychological
research could not be completed to the end. changes. However, there are some conditions
where individuals are unable to control their life
Results situations, this is when resilience is needed so that
individuals can control their life situations (Ifeagwazi
et al., 2015).
Univariate Analysis Results Resilience is needed to withstand stressors.
The results of the univariate analysis for the Resilience will result in good personal growth, and
characteristics of the respondents, namely recent this will respond to the patient’s readiness to face
education, marital status, domicile, information about challenges or stressors. Good personal growth
breast cancer and chemotherapy are displayed in makes patients ready to face challenges so that
the form of frequency and percentage distributions patients have positive psychological well-being
because these data are categorical data, while the (Ivtzan et al., 2013). The whole process above can
respondent’s age and length of illness are displayed be assessed through the psychological well-being
in the form of mean, standard deviation, value of the patient.
minimum and maximum because the data is in the The results of this study indicate that many
form of numeric data. The results of the univariate respondents experienced low resilience in the
analysis of research variables, namely resilience initial session of chemotherapy, but the percentage
and psychological well-being are shown in the form of resilience decreased or increased in the
of frequency and percentage distributions because next session. The percentage of low resilience
the data are categorical data. experienced by many respondents who underwent
The table above shows that the average chemotherapy session 2 and increased in session
respondent is 49 years old with an average length of 3. However, in sessions 4 and 5 the percentage of
illness of 12 months. low resilience increased again and decreased again
The table above shows the lowest percentage in session 6. This condition occurs because of the
of resilience experienced by respondents who patient’s resistance to undergoing chemotherapy
underwent the 2nd chemotherapy session and changes and can increase if the individual is able
increased in the next session. However, the to get through the stressor well. Patients who are
percentage of low resilience increased in sessions able to adapt to the changes they experience during
4 and 5. This table shows low resilience because chemotherapy will show increased resilience. This
it is difficult for the patient to get out of the problem is in line with the opinion of Moser et al. (2012)
at hand, moderate resilience shows that it is difficult which states that resilience is dynamic, depending
for the patient to rise from the problem but still tries on a person’s physical condition. K. E. Lee & Lim
to find a solution to the problem, and high resilience (2019) explained that an increase in resilience
shows that the patient is able to control the situation occurs if a person can adapt to a stressor by
that occurs from all possible adversities. The table going through the changes caused by the stressor.
also shows the percentage of respondents with the This is in accordance with Wu et al., (2016) who
least negative psychological well-being experienced explained that breast cancer patients undergoing
by respondents in session 2 and fluctuated in the chemotherapy patients will experience side effects

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

41
 Original Article

Baeda, A.G., et al. (2022)

such as hair loss, nausea, vomiting, and fatigue. Conclusion
This will make the patient experience psychological
stress, therefore high resilience is needed so that Many patients experienced low resilience at the
the patient is able to adapt to the stressor. beginning of chemotherapy, increasing in the next
Another factor that can affect resilience is the session but decreasing in the last session. There
level of education. The results of this study indicate is a significant relationship between resilience and
that most of the respondents were at elementary psychological well-being. The higher the level of
school education level, but their resilience can show resilience, the more positive the welfare of patients
an increase because respondents have received undergoing chemotherapy. Future researchers are
information from health workers and have access to expected to analyze the relationship between family
telephones that can help patients obtain information resilience and the resilience of patients undergoing
related to their complaints. This is supported by chemotherapy.
Yurtsever (2010) which states that the information
provided will make individuals aware of information References
about the disease they are experiencing, therapy,
taboos, and directions so that individuals can American Cancer Society (2016). Breast cancer
prepare themselves for the situation to be faced. facts &amp; Figures 2012-2014, Breast
The results of this study also show that there Cancer Facts & Figures. https:doi.org/10.1007/
is a significant relationship between resilience and s10549-012-2018-4.Mesothelin
psychological well-being. The higher the patient’s Baati, I., Mnif, L., Masmoudi, J., Allouche, C.,
level of resilience, the higher the probability that Damak, R., Halwani, N., Feki, A., Ayadi, N.,
the patient will have positive psychological well- & Jaoua, A. (2010). The psychological impact
being. High resilience can make psychological well- of chemotherapy-induced alopecia. European
being positive. This is because patients undergoing Psychiatry, 25, 869. https://doi.org/10.1016/
chemotherapy believe that God will provide S0924-9338(10)70860-9
healing so that they feel optimistic. Optimism Bicakli, D. H., Ozveren, A., Uslu, R., Dalak, R. M.,
has a great capacity to influence individuals in Cehreli, R., Uyar, M., Karabulut, B., & Akcicek,
adapting to changes or stressors. The respondent’s F. (2018). The effect of chemotherapy on
ability to adapt to changes that occur increases nutritional status and weakness in geriatric
self-acceptance, independence, and personal gastrointestinal system cancer patients.
development during chemotherapy. This is in line Nutrition (Burbank, Los Angeles County,
with the research of Souri & Hasanirad (2011) which Calif.), 47, 39–42. https://doi.org/10.1016/j.
explains that resilience plays a role in psychological nut.2017.09.013
well-being. According to him, resilience comes Connor, K. M., & Davidson, J. R. (2003).
from religious values that direct a person towards Development of a new resilience scale: The
optimism. Values in society explain the context of connor-davidson resilience scale (CD-RISC).
religion and faith is a key element in optimism. This Depression and anxiety, 18(2), 76–82. https://
is supported by Ivtzan et al. (2013) which explains doi.org/10.1002/da.10113
that personal development which is one of the Costa, D. S. J. Rebecca Mercieca-bebber, Claudia
domains in psychological well-being is strongly Rutherford, Liam Gabb & Madeleine T King.
influenced by religious factors and one’s spirituality. (2016) ‘The impact of cancer on psychological
Individuals with higher personal development will and social outcomes’, Australian Psychologist,
take the initiative to explore, seek, mingle and create 51(2), pp. 89–99. https://doi.org/10.1111/
meaning in their lives. ap.12165.
According to another research on resilience Chon, S. Y., Champion, R. W., Geddes, E. R., &
and psychological well-being, namely Yang & Rashid, R. M. (2012). Chemotherapy-induced
Smith (2016), individuals who are able to accept alopecia. Journal of the American Academy
change will have good personal development so as of Dermatology, 67(1), e37–e47. https://doi.
to increase their readiness to adapt and deal with org/10.1016/j.jaad.2011.02.026
stressors. Research by K. E. Lee & Lim (2019) also De Couto, M. C. P. P., Koller, S. H. and Novo, R.
explained that patients who are able to adapt to (2011) ‘Stressful life events and sychological
stressors are individuals who show improvement in well-being in a brazilian sample of older
physical and psychological aspects. persons: The role of resilience’, Ageing
The respondent’s low resilience is due to changes International, 36(4), pp. 492–505. https://doi.
in physical condition due to chemotherapy. The org/10.1007/s12126-011-9123-2
increased resilience of respondents indicates that Escalante, J., McQuade, R. M., Stojanovska, V., &
respondents are able to adapt to the changes they Nurgali, K. (2017). Impact of chemotherapy
experience so that they can accept their conditions on gastrointestinal functions and the enteric
and can develop personally. Thus, the respondent nervous system. Maturitas, 105, 23–29. https://
will show positive psychological well-being. doi.org/10.1016/j.maturitas.2017.04.021

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

42
 Original Article

Impact of Resilience on Psychological Well-Being

Fathania, D., Rahayuwati, L., & Yani, D. I. (2019). Cyclooxygenase-2 polymorphisms and breast
Factors that correlate with the health services cancer associated risk in Pakistani patients.
seeking on breast cancer patients. 7(1). https:// Pathology oncology research : POR, 21(1),
doi.org/10.24198/jkp 97–101. https://doi.org/10.1007/s12253-014-
Ifeagwazi, C. M., Chukwuorji, J. B. C. and Zacchaeus, 9792-8
E. A. (2015) ‘Alienation and psychological Moser, A., Silliman, R.A., Stuck, A.E., Clough-Gorr,
wellbeing: Moderation by Resilience’, Social K.M. (2012) ‘Resilience in older breast cancer
Indicators Research, 120(2), pp. 525–544. survivors’, Journal of Geriatric Oncology,
https://doi.org/10.1007/s11205-014-0602-1 3(1), pp. S87–S90. https://doi.org/10.1016/j.
Ivtzan, I., Chan, C. P., Gardner, H. E., & Prashar, jgo.2012.10.109
K. (2013). Linking religion and spirituality with DeSantis, C. E., Ma, J., Goding Sauer, A., Newman,
psychological well-being: examining self- L. A., & Jemal, A. (2017). Breast cancer
actualisation, meaning in life, and personal statistics, 2017, racial disparity in mortality by
growth initiative. Journal of religion and health, state. CA: a cancer journal for clinicians, 67(6),
52(3), 915–929. https://doi.org/10.1007/ 439–448. https://doi.org/10.3322/caac.21412
s10943-011-9540-2 Rahayuwati, L., Ibrahim, K., Nurhidayah, I., &
Ye, Z. J., Peng, C. H., Zhang, H. W., Liang, M. Z., Hendrawati, S. (2020). The correlation of socio
Zhao, J. J., Sun, Z., Hu, G. Y., & Yu, Y. L. demographic and knowledge factors toward
(2018). A biopsychosocial model of resilience therapy options among breast cancer Patients.
for breast cancer: A preliminary study in 8(3). https://doi.org/10.24198/jkp
mainland China. European journal of oncology Souri, H. and Hasanirad, T. (2011) ‘Relationship
nursing : the official journal of European between resilience, optimism and
Oncology Nursing Society, 36, 95–102. https:// psychological well-being in students of
doi.org/10.1016/j.ejon.2018.08.001 medicine’, Procedia - Social and Behavioral
Karyono, Dewi, K. S. and Lela, T. (2008) ‘Media Sciences, 30, 1541–1544. https://doi.
Medika’, Penanganan stres dan kesejahteraan org/10.1016/j.sbspro.2011.10.299
psikologis pasien kanker payudara yang Torre, L. A., Sauer, A. M., Chen, M. S., Jr, Kagawa-
menjalani radioterapi di RSUD Dr. Moewardi Singer, M., Jemal, A., & Siegel, R. L. (2016).
Surakarta, 43(2). Cancer statistics for Asian Americans, Native
Kuchuk, I., Bouganim, N., Beusterien, K., Grinspan, Hawaiians, and Pacific Islanders, 2016:
J., Vandermeer, L., Gertler, S., Dent, S. F., Converging incidence in males and females.
Song, X., Segal, R., Mazzarello, S., Crawley, CA: a cancer journal for clinicians, 66(3), 182–
F., Dranitsaris, G., & Clemons, M. (2013). 202. https://doi.org/10.3322/caac.21335
Preference weights for chemotherapy side Wang, X. and Tian, J. (2010) ‘A Path Analysis
effects from the perspective of women with Method for Measuring the Resilience of Cancer
breast cancer. Breast cancer research and Patients’, pp. 2–5.
treatment, 142(1), 101–107. https://doi. Wu, Z., Liu, Y., Li, X., & Li, X. (2016). Resilience and
org/10.1007/s10549-013-2727-3 associated factors among mainland Chinese
Lai, X. B., Ching, S., Wong, F., Leung, C., Lee, L. women newly diagnosed with breast cancer.
H., Wong, J., & Lo, Y. F. (2018). The cost- PloS one, 11(12). https://doi.org/10.1371/
effectiveness of a nurse-led care program for journal.pone.0167976
breast cancer patients undergoing outpatient- Witdiawati, Rahayuwati, L., & Sari, S. P. (2017).
based chemotherapy - A feasibility trial. Studi kualitatif pola kehidupan pasien kanker
European journal of oncology nursing : the payudara A Qualitative Study on Breast
official journal of European Oncology Nursing Cancer Patients ’ Life. 5(1), 73–85. http://
Society, 36, 16–25. https://doi.org/10.1016/j. dx.doi.org/10.24198/jkp.v5n1.9
ejon.2018.07.001 Yang, F., & Smith, G. D. (2016). Stress, resilience
Lee, K. E. and Lim, K. H. (2019) ‘Mediation effect and psychological well-being in Chinese
of adaptation on the quality of life in patients undergraduate nursing students. Nurse
with gastric cancer undergoing gastrectomy : Education Today 49, 90-95. https://doi.
A structure equation model’, Asian Nursing org/10.1016/j.nedt.2016.10.004
Research, 1(2), pp. 1–9. https://doi. Yurtsever, S. (2010) ‘European Journal of Oncology
org/10.1016/j.anr.2019.01.001 Nursing Relationship between social support
Mawarpury, M. (2013) ‘Coping sebagai prediktor and fatigue in geriatric patients receiving
kesejahteraan psikologis : Studi meta analisis’, outpatient chemotherapy’, European Journal
Psycho Idea, 11(1), pp. 38–47. of Oncology Nursing, 14(5), pp. 61–67. https://
Ministry of Health Republic of Indonesia. (2017). doi.org/10.1016/j.ejon.2009.07.001
Pusat data dan informasi Kementerian Zimmermann, F. F., Burrell, B. and Jordan, J.
Kesehatan RI. Ministry of Health Republic of (2018) ‘The acceptability and potential
Indonesia benefits of mindfulness-based interventions in
Moatter, T., Aban, M., Iqbal, W., & Pervez, S. (2015). improving psychological well-being for adults

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

43
 Original Article

Baeda, A.G., et al. (2022)

with advanced cancer: A systematic review’,

Complementary Therapies in Clinical Practice,
30, pp. 68–78. https://doi.org/10.1016/j.
ctcp.2017.12.014

Jurnal Keperawatan Padjadjaran, Volume 10, Issue 1, April 2022

44