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Resilience in cancer treatment
Nelleke Ottevanger
(Physiologic) changes due to aging
Biology of aging; observation and principles – Robert Arking (2006)
Multimorbidity
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 to 12yr
12 to18 yr
18 to25 yr
25 to35 yr
35 to45 yr
45 to55 yr
55 to65 yr
65 to75 yr
75 yr +
4 or more
3
2
1
No
Number of diseases with age
Statline – Statistics Netherlands (accessed 2008)
Aging and multimorbidity
Cassel, C.K., Geriatric medicine : an evidence-based approach. 2003, Springer: New York.
Levenstrap
6
Heterogeneity =
“defining feature”
aging
Levenstrap
Perturbatie
Resilience
Resilience• Medicine• “the ability to bounce back when being pertubated by
health stressors”
• Psychology: “rebound or recover from adversity”• Trauma• Loss
• Ecology/ecosystems: great barrier reef• Engineering
Dodge, R., Daly, A. P., Huyton, J., & Sanders, L. D. (2012). The challenge of defining wellbeing. Int J Wellbeing, 2(3), 222-235.
Frailty meet conditie, niet performance
In medicine
• resistance and recovery should be assessed
• Frailty is worthwhile, and has validated measuring instruments
• limitations:
• Frailty identifies manifest vulnerability kwetsbaarheid• Frailty assess mainly what does not go well anymore
healthy ill / frail
Good functioning → loss of resilience → ‘symptoms’
Resilience and wellbeingResilience in medicine
• “the ability to bounce back whenbeing pertubated by healthstressors”
• Psychology: “rebound or recover from adversity”
• Trauma• loss
Wellbeing
• “In essence, stable wellbeing is when individuals have the psychological, social and physical
resources they need to meet a particular psychological, social and/or physical challenge. When
individuals have more challenges than resources, the see-saw dips, along with their wellbeing, and
vice-versa. ”
Dodge, R., Daly, A. P., Huyton, J., & Sanders, L. D. (2012). The challenge of defining wellbeing. Int J Wellbeing, 2(3), 222-235.
Resilience
• Resistance
• Recovery• Adaptability
Links, J. M., Schwartz, B. S., Lin, S., Kanarek, N., Mitrani-Reiser, J., Sell, T. K., . . . Kendra, J. M. (2017). COPEWELL: A Conceptual Framework and System Dynamics Model for Predicting Community Functioning and Resilience After Disasters. Disaster Med Public Health Prep, 1-11. doi:10.1017/dmp.2017.39
Delayed recovery Incomplete recovery
Death or other critical transition
Fun
ctio
n
Time
Disease, treatment orother stressor
Diminished resistance
Resilience:“the ability to bounce
back when beingperturbated by healthstressors”
Psychological
Physical
Knowledge gaps• Development
• ValidationOf reliable resilience measures
Different patient groups (alongspectrum vital <-> frail)
Different systems• Psychology• Physiology: organ + regulatory
systems• Whole person/body
Different perturbations/challenges
Whitson, H. E., Duan-Porter, W., Schmader, K. E., Morey, M. C., Cohen, H. J., & Colon-Emeric, C. S. (2016). Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct. J Gerontol A Biol Sci Med Sci, 71(4), 489-495
Resilience trajectories predictable?
• Psychology: mainly static (personality) trait
• Geriatrics… Frailty: mainly static risk factor
• Ecology: dynamic behaviour of a complex system
• Basins of attraction
High resilience
Undesired state Desired state
Resilience trajectories predictable?
• Psychology: mainly static (personality) trait
• Geriatrics… Frailty: mainly static risk factor
• Ecology: dynamic behaviour of a complex system
• Basins of attraction
Low resilience
Undesired state Desired state
What are indicators of resilience
• Dynamic indicators of resilience (DIOR)
• Life Space assessment
• Mobility measure
• Time up and go
• Blood pressure challenge
• Grip work
Blood pressure challenge test
Sit-to-stand test fororthostatic hypotension
Lagro et al. 2014 J Gerontol A Biol Sci Med Sci
Life space assessment tool
Objectives for GCIG trials
• Assess trajectories for gynaecological therapies
• Corrleate trajectories with QOL questionnaires
• Assess DIORs
• Assess stress tests
