A Longitudinal Investigation of Posttraumatic Growth in Adult Patients Undergoing Treatment for Acute Leukemia

  • Suzanne C. DanhauerEmail author
  • Gregory B. Russell
  • Richard G. Tedeschi
  • Michelle T. Jesse
  • Tanya Vishnevsky
  • Kristin Daley
  • Suzanne Carroll
  • Kelli N. Triplett
  • Lawrence G. Calhoun
  • Arnie Cann
  • Bayard L. Powell


An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one’s core beliefs may play in the development of PTG over time.


Leukemia Posttraumatic growth Adjustment Quality of life Hematologic malignancies 



The authors thank the physicians, physician assistants, nurses, and most of all, the patients and their families, who supported this work. Funding was provided by the Higginbotham Memorial Cancer Patient Support Fund.

Conflict of Interest

The authors declare no conflict of interest.


  1. Anderson, W. P., Jr, & Lopez-Baez, S. I. (2008). Measuring growth with the Posttraumatic Growth Inventory. Measurement and Evaluation in Counseling and Development, 40, 215–227.Google Scholar
  2. Andrykowski, M. A., Bishop, M. M., Hahn, E. A., Cella, D. F., Beaumont, J. L., Brady, M. J., et al. (2005). Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. Journal of Clinical Oncology, 23, 599–608.PubMedCrossRefGoogle Scholar
  3. Aspinwall, L. G., & MacNamara, A. (2005). Taking positive changes seriously. Cancer, 104, 2549–2556.PubMedCrossRefGoogle Scholar
  4. Aspinwall, L. G., & Tedeschi, R. G. (2010). Of babies and bathwater: A reply to Coyne and Tennen’s views on positive psychology and health. Annals of Behavioral Medicine, 39, 27–34.PubMedCrossRefGoogle Scholar
  5. Baker, F., Denniston, M., Zabora, J., Polland, A., & Dudley, W. N. (2002). A POMS short form for cancer patients: Psychometric and structural evaluation. Psycho-Oncology, 11, 273–281.PubMedCrossRefGoogle Scholar
  6. Barez, M., Blasco, T., Fernandez-Castro, J., & Viladrich, C. (2009). Perceived control and psychological distress in women with breast cancer: A longitudinal study. Journal of Behavioral Medicine, 32, 187–196.PubMedCrossRefGoogle Scholar
  7. Bates, G. W., Trajstman, S. E., & Jackson, C. A. (2004). Internal consistency, test-retest reliability and sex differences on the Posttraumatic Growth Inventory in an Australian sample with trauma. Psychological Reports, 94, 793–794.PubMedCrossRefGoogle Scholar
  8. Bellizzi, K. M. (2004). Expressions of generativity and posttraumatic growth in adult cancer survivors. International Journal of Aging and Human Development, 58, 267–287.PubMedCrossRefGoogle Scholar
  9. Bellizzi, K. M., & Blank, T. O. (2006). Predicting posttraumatic growth in breast cancer survivors. Health Psychology, 25, 47–56.PubMedCrossRefGoogle Scholar
  10. Black, E. K., & White, C. A. (2005). Fear of recurrence, sense of coherence and posttraumatic stress disorder in haematological cancer survivors. Psycho-Oncology, 14, 510–515.PubMedCrossRefGoogle Scholar
  11. Bower, J. E., & Segerstrom, S. C. (2004). Stress management, finding benefit, and immune function: Positive mechanisms for intervention effects on physiology. Journal of Psychosomatic Research, 56, 9–11.PubMedCrossRefGoogle Scholar
  12. Brunet, J., McDonough, M. H., Hadd, V., Crocker, P. R., & Sabiston, C. M. (2009). The Posttraumatic Growth Inventory: An examination of the factor structure and invariance among breast cancer survivors. Psycho-Oncology, 19, 830–838.CrossRefGoogle Scholar
  13. Calhoun, L. G., Cann, A., & Tedeschi, R. G. (2010). The posttraumatic growth model: Socio-cultural considerations. In T. Weiss & R. Berger (Eds.), Posttraumatic growth and culturally competent practice: Lessons learned from around the globe (pp. 1–14). Hoboken, NJ: Wiley.Google Scholar
  14. Calhoun, L. G., Cann, A., Tedeschi, R. G., & McMillan, J. (2000). A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress, 13, 521–527.PubMedCrossRefGoogle Scholar
  15. Cann, A., Calhoun, L. G., Tedeschi, R. G., Kilmer, R. P., Gil-Rivas, V., Vishnevsky, T., et al. (2010). The Core Beliefs Inventory: A brief measure of disruption in the assumptive world. Anxiety, Stress and Coping, 23, 19–34.CrossRefGoogle Scholar
  16. Carboon, I., Anderson, V. A., Pollard, A., Szer, J., & Seymour, J. F. (2005). Posttraumatic growth following a cancer diagnosis: Do world assumptions contribute? Traumatology, 11, 269–283.CrossRefGoogle Scholar
  17. Caudell, K. A. (1996). Psychoneuroimmunology and innovative behavioral interventions in patients with leukemia. Oncology Nursing Forum, 23, 493–502.PubMedGoogle Scholar
  18. Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., et al. (2000). Assessing symptom distress in cancer patients: The M.D. Anderson Symptom Inventory. Cancer, 89, 1634–1646.Google Scholar
  19. Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20, 176–185.PubMedCrossRefGoogle Scholar
  20. Cordova, M. J., Giese-Davis, J., Golant, M., Kronenwetter, C., Chang, V., & Spiegel, D. (2007). Breast cancer as trauma: Posttraumatic stress and posttraumatic growth. Journal of Clinical Psychology in Medical Settings, 14, 308–319.CrossRefGoogle Scholar
  21. Coyne, J. C., & Tennen, H. (2010). Positive psychology in cancer care: Bad science, exaggerated claims, and unproven medicine. Annals of Behavioral Medicine, 39, 16–26.PubMedCrossRefGoogle Scholar
  22. Coyne, J. C., Tennen, H., & Ranchor, A. V. (2010). Positive psychology in cancer care: A story line resistant to evidence. Annals of Behavioral Medicine, 39, 35–42.PubMedCrossRefGoogle Scholar
  23. Curran, S. L., Andrykowski, M. A., & Studts, J. L. (1995). Short form of the Profile of Mood States (POMS-SF): Psychometric information. Psychological Assessment, 7, 80–83.CrossRefGoogle Scholar
  24. Daiter, S., Larson, R. A., Weddington, W. W., & Ultmann, J. E. (1988). Psychosocial symptomatology, personal growth, and development among young adult patients following the diagnosis of leukemia or lymphoma. Journal of Clinical Oncology, 6, 613–617.PubMedGoogle Scholar
  25. Edman, L., Larsen, J., Hagglund, H., & Gardulf, A. (2001). Health-related quality of life, symptom distress and sense of coherence in adult survivors of allogeneic stem-cell transplantation. European Journal of Cancer Care (England), 10, 124–130.CrossRefGoogle Scholar
  26. Engelkemeyer, S. M., & Marwit, S. J. (2008). Posttraumatic growth in bereaved parents. Journal of Traumatic Stress, 21, 344–346.PubMedCrossRefGoogle Scholar
  27. Greenberg, D. B., Kornblith, A. B., Herndon, J. E., Zuckerman, E., Schiffer, C. A., Weiss, R. B., et al. (1997). Quality of life for adult leukemia survivors treated on clinical trials of Cancer and Leukemia Group B during the period 1971-1988: Predictors for later psychologic distress. Cancer, 80, 1936–1944.PubMedCrossRefGoogle Scholar
  28. Henselmans, I., Sanderman, R., Baas, P. C., Smink, A., & Ranchor, A. V. (2009). Personal control after a breast cancer diagnosis: Stability and adaptive value. Psycho-Oncology, 18, 104–108.PubMedCrossRefGoogle Scholar
  29. Hjermstad, M. J., Loge, J. H., Evensen, S. A., Kvaloy, S. O., Fayers, P. M., & Kaasa, S. (1999). The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation. Bone Marrow Transplantation, 24, 1219–1228.PubMedCrossRefGoogle Scholar
  30. Horlick-Jones, T. (2011). Understanding fear of cancer recurrence in terms of damage to ‘everyday health competence’. Sociology of Health & Illness, 33, 884–898.CrossRefGoogle Scholar
  31. Hoskins, C. N., Budin, W. C., & Maislin, G. (1996). Medical factors and patterns of adjustment to breast cancer. Psycho-Oncology, 3, 31–44.CrossRefGoogle Scholar
  32. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.Google Scholar
  33. Lelorain, S., Bonnaud-Antignac, A., & Florin, A. (2010). Long term posttraumatic growth after breast cancer: Prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology in Medical Settings, 17, 14–22.PubMedCrossRefGoogle Scholar
  34. Lepore, S. J., Silver, R. C., Wortman, C. B., & Wayment, H. A. (1996). Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. Journal of Personality and Social Psychology, 70, 271–282.PubMedCrossRefGoogle Scholar
  35. Lesko, L. M. (1998). Hematopoietic dyscrasias. In J. C. Holland (Ed.), Psycho-Oncology. New York: Oxford University Press.Google Scholar
  36. Leung, D., & Esplen, M. J. (2010). Alleviating existential distress of cancer patients: Can relational ethics guide clinicians? European Journal of Cancer Care, 19, 30–38.PubMedCrossRefGoogle Scholar
  37. Levine, D. W., Dailey, M. E., Rockhill, B., Tipping, D., Naughton, M. J., & Shumaker, S. A. (2005). Validation of the Women’s Health Initiative Insomnia Rating Scale in a multicenter controlled clinical trial. Psychosomatic Medicine, 67, 98–104.PubMedCrossRefGoogle Scholar
  38. Lindstrom, C. M., Cann, A., Calhoun, L. G., & Tedeschi, R. G. (2011). The relationship of core belief challenge, rumination, disclosure, and sociocultural elements to posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/a0022030.
  39. Linley, P. A., Andrews, L., & Joseph, S. (2007). Confirmatory factor analysis of the Posttraumatic Growth Inventory. Journal of Loss and Trauma, 12, 321–332.CrossRefGoogle Scholar
  40. Manne, S., Ostroff, J., Winkel, G., Fox, K., Grana, G., & Goldstein, L. (2004). Posttraumatic growth after breast cancer: Patient, partner, and couple perspectives. Psychosomatic Medicine, 66, 442–454.PubMedCrossRefGoogle Scholar
  41. Michael, S. T., & Snyder, C. R. (2005). Getting unstuck: The roles of hope, finding meaning, and rumination in adjustment to bereavement among college students. Death Studies, 29, 435–458.PubMedCrossRefGoogle Scholar
  42. Millar, K., Purushotham, A. D., McLatchie, E., George, W. D., & Murray, G. D. (2005). A 1-year prospective study of individual variation in distress, and illness perceptions, after treatment for breast cancer. Journal of Psychosomatic Research, 58, 335–342.PubMedCrossRefGoogle Scholar
  43. Molassiotis, A., van den Akker, O. B. A., Milligan, D. W., Goldman, J. M., & Boughton, B. J. (1996). Psychological adaptation and symptom distress in bone marrow transplant recipients. Psycho-Oncology, 1, 9–22.CrossRefGoogle Scholar
  44. Montgomery, M., & McCrone, S. H. (2010). Psychological distress associated with the diagnostic phase for suspected breast cancer: Systematic review. Journal of Advanced Nursing, 66, 2372–2390.PubMedCrossRefGoogle Scholar
  45. Montgomery, C., Pocock, M., Titley, K., & Lloyd, K. (2003). Predicting psychological distress in patients with leukaemia and lymphoma. Journal of Psychosomatic Research, 54, 289–292.PubMedCrossRefGoogle Scholar
  46. Moore, A. M., Gamblin, T. C., Geller, D. A., Youseff, M. N., Hoffman, K. E., Gemmell, L., et al. (2011). A prospective study of posttraumatic growth as assessed by self-report and family caregiver in the contet of advanced cancer. Psycho-Oncology, 20, 479–487.PubMedCrossRefGoogle Scholar
  47. Morris, B. A., Shakespeare-Finch, J., Rieck, M., & Newbery, J. (2005). Multidimensional nature of posttraumatic growth in an Australian population. Journal of Traumatic Stress, 18, 575–585.PubMedCrossRefGoogle Scholar
  48. Oh, S., Heflin, L., Meyerowitz, B. E., Desmond, K. A., Rowland, J. H., & Ganz, P. A. (2004). Quality of life of breast cancer survivors after a recurrence: A follow-up study. Breast Cancer Research and Treatment, 87, 45–57.PubMedCrossRefGoogle Scholar
  49. Persson, L., Hallberg, I. R., & Ohlsson, O. (1997). Survivors of acute leukaemia and highly malignant lymphoma–retrospective views of daily life problems during treatment and when in remission. Journal of Advanced Nursing, 25, 68–78.PubMedCrossRefGoogle Scholar
  50. Persson, L., Larsson, G., Ohlsson, O., & Hallberg, I. R. (2001). Acute leukaemia or highly malignant lymphoma patients’ quality of life over two years: A pilot study. European Journal of Cancer Care (England), 10, 36–47.CrossRefGoogle Scholar
  51. Peterman, A. H., Fitchett, G., Brady, M. J., Cella, D., & Hernandez, L. (2002). Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 49–58.PubMedCrossRefGoogle Scholar
  52. Ransom, S., Sheldon, K. M., & Jacobsen, P. B. (2008). Actual change and inaccurate recall contribute to posttraumatic growth following radiotherapy. Journal of Consulting and Clinical Psychology, 76, 811–819.PubMedCrossRefGoogle Scholar
  53. Sasaki, T., Akaho, R., Sakamaki, H., Akiyama, H., Yoshino, M., Hagiya, K., et al. (2000). Mental disturbances during isolation in bone marrow transplant patients with leukemia. Bone Marrow Transplantation, 25, 315–318.PubMedCrossRefGoogle Scholar
  54. Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22, 487–497.PubMedCrossRefGoogle Scholar
  55. Shacham, S. (1983). A shortened version of the Profile of Mood States. Journal of Personality Assessment, 47, 305–306.PubMedCrossRefGoogle Scholar
  56. Shapiro, S. L., Lopez, A. M., Schwartz, G. E., Bootzin, R., Figueredo, A. J., et al. (2001). Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology, 57, 501–519.PubMedCrossRefGoogle Scholar
  57. Smith, B. W., Dalen, J., Bernard, J. F., & Baumgartner, K. B. (2008). Posttraumatic growth in non-Hispanic White and Hispanic women with cervical cancer. Journal of Psychosocial Oncology, 26, 91–109.PubMedCrossRefGoogle Scholar
  58. Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research, practice, and theory. Mahwah, NJ: Erlbaum.Google Scholar
  59. Stanton, A. L., Danoff-Burg, S., & Huggins, M. E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors or adjustment. Psycho-Oncology, 11, 93–102.PubMedCrossRefGoogle Scholar
  60. Taku, K., Cann, A., Calhoun, L. G., & Tedeschi, R. G. (2008). The factor structure of the Posttraumatic Growth Inventory: A comparison of five models using confirmatory factor analysis. Journal of Traumatic Stress, 21, 158–164.PubMedCrossRefGoogle Scholar
  61. Tartaro, J., Roberts, J., Nosarti, C., Luecken, L., David, A., & Crayford, T. (2005). Who benefits?: Distress, adjustment and benefit-finding among breast cancer survivors. Journal of Psychosocial Oncology, 23, 45–64.PubMedCrossRefGoogle Scholar
  62. Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–472.PubMedCrossRefGoogle Scholar
  63. Tedeschi, R. G., & Calhoun, L. G. (2004). Target Article: ‘Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18.CrossRefGoogle Scholar
  64. Thombre, A., & Sherman, A. C. (2010). Posttraumatic growth among cancer patients in India. Journal of Behavioral Medicine, 33, 15–23.PubMedCrossRefGoogle Scholar
  65. Triplett, K. N., Tedeschi, R. G., Cann, A., Calhoun, L. G., & Reeve, C. L. (2011). Posttraumatic growth, meaning in life, and life satisfaction in response to trauma. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/a0024204.
  66. Valley, A. W., & Balmer, C. M. (2000). Cancer treatment and chemotherapy. In J. T. Dipiro, L. R., Talbert, G. C. Yee, G. R. Matzke, B. G. Wells, & L. M. Posey (Eds.), Pharmacotherapy: A pathophysiologic approach 1957–2012 (4th ed). Stamford, CT: Appleton & Lange.Google Scholar
  67. Weiss, T. (2002). Posttraumatic growth in women with breast cancer and their husbands: An intersubjective validation study. Journal of Psychosocial Oncology, 20, 65–80.CrossRefGoogle Scholar
  68. Widows, M. R., Jacobsen, P. B., Booth-Jones, M., & Fields, K. K. (2005). Predictors of posttraumatic growth following bone marrow transplantation for cancer. Health Psychology, 24, 266–273.PubMedCrossRefGoogle Scholar
  69. Xuereb, M. C., & Dunlop, R. (2003). The experience of leukaemia and bone marrow transplant: Searching for meaning and agency. Psycho-Oncology, 12, 397–409.PubMedCrossRefGoogle Scholar
  70. Zittoun, R., Achard, S., & Ruszniewski, M. (1999). Assessment of quality of life during intensive chemotherapy or bone marrow transplantation. Psycho-Oncology, 8, 64–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Suzanne C. Danhauer
    • 1
    • 3
    Email author
  • Gregory B. Russell
    • 1
  • Richard G. Tedeschi
    • 2
  • Michelle T. Jesse
    • 1
    • 2
  • Tanya Vishnevsky
    • 1
    • 2
  • Kristin Daley
    • 1
    • 2
  • Suzanne Carroll
    • 1
  • Kelli N. Triplett
    • 1
    • 2
  • Lawrence G. Calhoun
    • 2
  • Arnie Cann
    • 2
  • Bayard L. Powell
    • 1
  1. 1.Comprehensive Cancer Center of Wake Forest UniversityWinston-SalemUSA
  2. 2.UNC CharlotteCharlotteUSA
  3. 3.Department of Social Sciences & Health PolicyWake Forest School of MedicineWinston-SalemUSA

Personalised recommendations