Journal of Psychosocial Oncology

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjpo20

Mediating role of resilience between family

functioning and quality of life in patients with
advanced colorectal cancer

Liqing Jiang, Meng Wang, Ying Chen & Quan Liu

To cite this article: Liqing Jiang, Meng Wang, Ying Chen & Quan Liu (12 Jul 2023): Mediating role
of resilience between family functioning and quality of life in patients with advanced colorectal
cancer, Journal of Psychosocial Oncology, DOI: 10.1080/07347332.2023.2231431

To link to this article: https://doi.org/10.1080/07347332.2023.2231431

Published online: 12 Jul 2023.

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Journal of Psychosocial Oncology
https://doi.org/10.1080/07347332.2023.2231431

Research Article

Mediating role of resilience between family

functioning and quality of life in patients with
advanced colorectal cancer
Liqing Jiang, MN, RNa , Meng Wang, MN, RNa, Ying Chen, MN, RNb
and Quan Liu, MDb
Wuxi School of Medicine, Jiangnan University, Wuxi, China; bDepartment of Oncology, Affiliated
a

Hospital of Jiangnan University, Wuxi, China

ABSTRACT KEYWORDS
Objective: To better understand the relationship between fam- Advanced colorectal
ily functioning, resilience, and quality of life (including physical cancer; family
and mental component score, PCS and MCS) in patients with functioning; mediating
advanced colorectal cancer (CRC) to predict and improve their role; quality of life;
resilience
quality of life.
Methods: A cross-sectional study was conducted in which a
total of 165 patients with advanced colorectal cancer partici-
pated in a one-time survey. Measures included the Family
Functioning Assessment Device, the 10-item Connor-Davidson
Resilience Scale, and the SF-12 Health Survey Assessment Scale.
The data analysis methods included descriptive analysis, pear-
son’s correlation analysis, t-tests, and nonparametric tests.
Results: Of the patients with advanced CRC, 47.27% and
72.73% had moderate or low mental and physical health com-
ponents, respectively. The results indicated that in patients with
advanced CRC, family function was negatively correlated with
resilience (p < 0.01), family functioning was negatively correlated
with MCS (p < 0.01), and resilience was positively correlated
with PCS (p < 0.05) and MCS (p < 0.01). The mediating analysis
revealed that family functioning regulated MCS through resil-
ience (effect value = 13.17%).
Conclusions: Our findings suggest that the MCS of patients
with advanced CRC is influenced by both family functioning
and resilience. PCS in patients with advanced CRC appears to
be influenced by resilience but not by family functioning.

Introduction
Colorectal cancer (CRC) is the third most common cancer worldwide in
terms of incidence and mortality and is considered an indicator of eco-
nomic development.1,2 As a country in transition, the incidence of CRC
is on the rise in China. Since early screening programs for CRC were

CONTACT Quan Liu liuquan621@hotmail.com, quanliu@jiangnan.edu.cn

© 2023 Taylor & Francis Group, LLC
2 L. JIANG ET AL.

incorporated into clinical practice guidelines, early detection of CRC has

increased. However, approximately 50% of patients are at an advanced
stage of cancer at diagnosis.3,4
CRC patients are forced to deal with the burden of symptoms (e.g.
fatigue and nausea),5 dysfunction (e.g., intestinal obstruction, intestinal
dysfunction, and stoma),6 and serious psychological problems (e.g., shame
caused by stoma) caused by the disease and treatment,7 which significantly
lowers their quality of life (QoL). However, the survival time of patients
with CRC has increased owing to improvements in treatment, and patients
with CRC hope to achieve better QoL.8
A cancer diagnosis and the subsequent care requirements impact not
only the affected individual but also the entire family. The family is a
unit: its members depend on one another and its influence on individual
behavior is clear.9 Family functioning reflects the effectiveness of family
system members in external events. The family stress model suggests that
when a family encounters cancer (a stressful event), the level of family
functioning determines the resilience of the family and its individual
members, and positive and good family functioning can improve the ability
of both the family as a whole and each member as an individual to cope
with stress.10,11 Studies have shown that good family functioning is linked
to better treatment compliance and improved coping strategies, with pos-
itive impacts on the physical and psychological aspects of CRC patients,
thereby improving their QoL.
Resilience refers to the ability to recover from or adapt after an unpleas-
ant event. Resilience can act as a protective factor, buffering against cancer
diagnosis and negative experiences. Previous research has shown that
cancer patients who are more resilient tend to have positive intrinsic traits
(e.g. positive emotional regulation and optimism),12,13 engage in healthier
habits (e.g., higher exercise adherence),14 or develop new life goals, result-
ing in better QoL.15
Kumpfer’s resilience framework model emphasizes that when people are
under stress or face challenges, protective or dangerous factors in the
external environment, such as family, interact with internal resources of
individual resilience (e.g., emotions, cognition) so as to achieve psycho-
logical reorganization: adaptation and maladaptation are restructured with
three outcomes.16 Family is a protective factor for resilience; healthy family
dynamics can protect patients with advanced CRC from traumatic events
(cancer diagnosis and treatment) and enhance their resilience, thereby
improving their QoL.17
Many studies have examined the QoL of patients with advanced CRC,
but most have focused on negative psychological aspects (e.g., anxiety,
depression). In contrast, the relationship between resilience (an important
 Journal of Psychosocial Oncology 3

part of positive psychology) and the QoL of patients with advanced CRC
has received relatively little attention is less understood. Moreover, the
correlation between resilience and QoL with family aspects that are com-
mon in patients with advanced CRC has not been well studied. Accordingly,
this study aimed to determine the relationships among family functioning,
resilience, and QoL in patients with advanced CRC. Our two main hypoth-
eses were as follows:

H1: Family functioning positively affects QoL and resilience.

H2: Resilience helps family functioning moderate QoL.

Methods
Study design and participants

This cross-sectional study used a paper-based questionnaire survey of

patients with advanced CRC who met the inclusion criteria at two tertiary
hospitals in Wuxi, Jiangsu Province, China. The patient inclusion criteria
were as follows: (1) diagnosed with advanced CRC (Stage III or IV), (2)
able to communicate autonomously and complete the questionnaire by
written or oral means, and (3) aged 18 years or older. The patient exclusion
criteria were as follows: (1) cognitive impairment or mental illness and
(2) physical frailty and inability to cooperate in completing the question-
naire. A total of 170 patients participated in the survey, five of whom
could not complete the questionnaire for various reasons (e.g. examination
and diet). Finally, 165 patients were included in the analysis, with a par-
ticipation rate of 97.06%.

Data collection procedure

This study was conducted in accordance with the Declaration of Helsinki

and was approved by the ethics committee of the Affiliated Hospital of
Jiangnan University (LS2022016). We recruited patients with advanced
CRC from May to October 2022 using convenience sampling in the oncol-
ogy departments of two tertiary hospitals in Wuxi, Jiangsu Province, China.
The goal and relevance of the experiment were disclosed to individuals
with advanced CRC prior to the examination. Participants completed
paper-based questionnaires after signing informed consent forms. Two
graduate students detraining in survey distribution and analysis served as
the investigators. The paper-based questionnaire took participants between
10 and 30 min to complete.
4 L. JIANG ET AL.

Tools

General questionnaire
The general questionnaire developed by the researchers collected general
information about the participants, including sex, age, marital status, type
of medical insurance, education level, employment status, monthly income
(yuan), tumor-node-metastasis staging (TNM), CRC type, treatment meth-
ods, time since diagnosis, operation conditions, chronic disease status, and
enterostomy conditions.

Family assessment device (FAD)

Family functioning was evaluated using the Chinese version of the FAD,18,19
which identifies family problems quickly and effectively. The scale contains
60 entries, each of which has four options and is rated on a 4-point Likert
scale (1 = strongly agree, 4 = strongly disagree). Some entries require
reverse-scoring. The total score on the scale ranges from 60 to 240, with
higher scores indicating worse family functioning. The Cronbach’s α coef-
ficient of the scale, which is widely used in survey research, was 0.86.

Short Form of 12 Health Survey Questionnaire (SF-12)

The SF-12 was designed to perform similar to the SF-36 while taking less
time to complete.20 The SF-12 reports two scores: the mental component
score (MCS) and physical component score (PCS), with 50 points for each
component. The Cronbach’s α of the questionnaire was 0.914.21

The 10-item Connor-Davidson Resilience Scale (CD-RISC 10)

Patient resilience was assessed using the 10-item Connor-Davidson
Resilience Scale,22 which contains ten items. Each item is rated on a 5-point
Likert scale, (0 = never, 4 = always) and the total score ranges from 0 to
40, with higher scores indicating higher levels of resilience. Cronbach’s α
for this study was 0.915.

Data analysis
Before data analysis, the Shapiro–Wilks test was used to check the nor-
mality of numeric variables using the SPSS version 24.0, and multivariate
normality was used to examine the normality of endogenous variables
using the Stata SE 12.0. Socio-demographic and clinical data, family func-
tioning, resilience, and QoL scores were analyzed using descriptive statis-
tics. Independent sample t-tests, one-way analysis of variance (ANOVA),
and non-parametric analyses were used to examine differences in demo-
graphic and linchpin characteristics among the main study variables. Study
 Journal of Psychosocial Oncology 5

variables with p < 0.05 were included in the mediation analysis equations
as covariates. Pearson’s correlation analysis was used to investigate the
relationships between family functioning, resilience, and QoL. We per-
formed a bias-corrected bootstrapping analysis (with 5,000 resamples)
using the SPSS PROCESS Macro Model 4 to verify the mediating effects
of resilience. Mediation analysis using the SPSS PROCESS macro was
based on a regression-based path analysis (see Figure 1).23

Results
General information

Table 1 presents participants’ general characteristics, of whom 61.2% were

male and 38.8% were female. The mean age of patients with advanced
CRC was 61.24 ± 7.47 years, and 82.4% of patients with advanced CRC
were concentrated in the age group of 46–69 years.
Table 1 shows the comparison of the PCS and MCS scores of patients
with advanced CRC with different socio-demographic and clinical
characteristics.

Status of family functioning, resilience, and QoL

Table 2 presents the descriptive characteristics of the main study variables.

The mean family functioning score was 129.11 ± 9.94, the mean CD-RISC-10
score was 24.33 ± 4.71, the mean PCS score in QoL was 43.41 ± 7.8.3
and the mean MCS score in QoL was 47.82 ± 7.66. Shapiro–Wilk tests
were performed for all study variables and showed no evidence of
non-normality.

Correlations between family functioning, resilience, and QoL

Table 3 presents the Pearson correlations between family functioning,

resilience, and QoL. The results showed that family functioning was neg-
atively correlated with resilience (r = −0.503, p < 0.01), family functioning
was negatively correlated with MCS in QoL (r = −0.425, p < 0.01), and
resilience was positively correlated with PCS (r = 0.180, p < 0.05) and
MCS (r = 0.587, p < 0.01) in QoL.

Size effect of the correlation between QoL and family functioning and
resilience

R2 and adjusted R2 are included in Table 4 to indicate the degree to which

family functioning and resilience can explain QoL; that is, the proportion
6 L. JIANG ET AL.

Table 1. General information of the participants.

Family
Patients functioning Resilience PCS MCS
Variables Categories n % p p p p
Gender Male 101 61.2 0.940 0.141 0.459 0.376
Female 64 38.8
Age (years) 18–45 8 4.8 0.050 0.220 0.500 0.835
46–69 136 82.4
≥70 21 12.7
Marital status Married 147 89.1 < 0.001 0.014 0.617 0.005
Divorced 7 4.2
Widowed 11 6.7
Type of Urban basic medicine insurance 115 69.7 0.019 0.015 0.022 0.016
medical New cooperative medical 50 30.3
insurance insurance
Education Primary school and below 29 17.6 < 0.001 < 0.001 0.009 < 0.001
level Junior high school 61 37.0
High school, technical 51 30.9
secondary school
College degree or above 24 14.5
Employment On the job 55 33.3 0.374 0.007 0.304 0.132
status Retirement or separation 110 66.7
Monthly ≤1000 13 7.9 < 0.001 < 0.001 0.00 < 0.001
income 1000–3000 39 23.6
(yuan) 3000–5000 43 26.1
≥5000 70 42.4
TNM Stage III 35 21.2 0.125 0.920 0.011 0.428
Stage IV 130 78.8
Colorectal Colon 49 29.7 0.180 0.003 0.023 < 0.001
cancer Rectum 116 70.3
type
Treatment Chemotherapy 70 42.4 0.572 0.001 0.030 < 0.001
methods Chemotherapy + Targeted- 70 42.4
therapy
Chemotherapy + Immunotherapy 3 1.8
Chemotherapy + Radiotherapy 9 5.5
Chemotherapy + Targeted- 5 3.0
therapy + Radiotherapy
Surgery only 3 1.8
Untreated 5 3.0
Time since ≤3 months 18 10.9 0.373 0.046 0.088 0.005
diagnosis 3–6 months 11 6.7
6–12 months 49 29.7
≥12 months 87 52.7
Operation Yes 148 89.7 0.272 0.281 < 0.001 0.143
status No 17 10.3
Chronic Yes 83 50.3 0.435 0.593 0.516 0.037
diseases No 82 49.7
status
Enterostomy Yes 36 21.8 0.028 0.065 < 0.001 0.644
conditions No 129 78.2
Note: MCS, mental component score; PCS, physical component score; TNM, tumor node metastasis.

Table 2. Descriptive characteristics of the study variables.

Variables Actual range M SD
Family function 104–155 129.11 9.94
Resilience 13–38 24.33 4.71
SF-12
PCS 22.34–61.28 43.41 7.83
MCS 27.91–63.87 47.82 7.66
Note: M, mean; MCS, mental component score; PCS, physical component score; SD, standard deviation; SF-12,
Short Form of 12 Health Survey Questionnaire.
 Journal of Psychosocial Oncology 7

Table 3. Correlations between family functioning, resilience, and QoL (PCS and MCS).
Correlation Matrix
Variables Resilience PCS MCS Family functioning
Resilience 1
PCS 0.180* 1
MCS 0.587** −0.018 1
Family functioning −0.503** −0.059 −0.425** 1
Note: PCS, physical component score; MCS, mental component score.
*
p < 0.05.
**
p < 0.01.

Table 4. The hierarchical multiple regression analyses of MCS.

MCS
Model 1 Model 2 Model 3
Block 1: Socio-demographic and clinical characteristics
Marital status −0.105 −0.073 −0.024
Type of medical insurance −0.014 0.015 0.026
Education level 0.144 0.104 0.075
Monthly income (yuan) 0.241* 0.175 0.148
TNM −0.030 −0.074 −0.085
 Colorectal cancer type −0.030 −0.075 −0.023
Time since diagnosis −0.236 −0.283 −0.202**
 Chronic disease status −0.123** −0.276** −0.186**
Block 2: Family function – −0.385*** −0.214**
Block 3: Resilience – – 0.386***
R2 0.259 0.386 0.481
 Adjusted R2 0.221 0.350 0.447
ΔR2 0.259 0.127 0.095
Note: *p < 0.05 (two-tailed); **p < 0.01 (two-tailed); ***p < 0.001 (two-tailed).
TNM, tumor-node-metastasis staging; MCS, mental component score.

of all variance in QoL that can be explained by family functioning and

resilience through the regression relationship. In Model 2, family func-
tioning was strongly and positively linked to MCS and was unrelated to
PCS, accounting for 12.7% of the variation. Additionally, in Model 3,
resilience and MCS showed a substantial positive correlation, in accounted
for 9.5% of the variance. Resilience was not associated with PCS but was
significantly and positively associated with MCS. These findings suggest
that the effects of family functioning on MCS may be partially moderated
by resilience. When resilience was added to the model, the regression
coefficient (β) of the association between family functioning and MCS
increased from −0.385 to −0.214.

Mediating effects of resilience on the relationship between family

functioning and MCS

Based on the results of the Pearson correlation and stratified regression

analyses, we chose the MCS component of QoL as an outcome indicator
of the mediation model. Model 4 in the SPSS PROCESS macro was used
to test the mediating role of resilience in the relationship between family
8 L. JIANG ET AL.

functioning and MCS. Because MCS in patients with advanced CRC was
associated with marital status, type of medical insurance, education level,
monthly income (yuan), CRC type, TNM stage, treatment methods, and
time since diagnosis, the significance of direct, indirect, and overall effects
in the mediation model was determined after controlling for these eight
variables (see Table 5).
After adjusting for these eight variables, we found that 1) family func-
tioning was significantly correlated with MCS in Model 1 (β = −0.2968,
p < 0.0001), (2) family functioning was significantly correlated with resil-
ience in Model 2 (β = −0.2091, p < 0.0001), and (3) when family func-
tioning and resilience were incorporated into the mediation model in
Model 3, they were significantly correlated with MCS (β = −0.1651,
p < 0.0001). Meanwhile, the standardized family functioning regression
coefficient (β) decreased from −0.2968 to −0.1651 years, respectively (see
Table 5) (Figure 1).
Additionally, the nonparametric bootstrapping method supported the
significance of the indirect effect of family functioning on MCS through
resilience (95% bootstrap CI = −0.2129, −0.0736). The indirect effect of
resilience was responsible for 13.17% of the variance in MCS caused by
family functioning (see Table 6). These results support our theory that
resilience mediates the relationship between family functioning and MCS.
Figure 2 shows the mediation model and standardized path coefficients
(a–d) displayed.

Discussion
This study aimed to investigate how patients with advanced CRC are
affected by their families’ overall functioning and to confirm that resilience
mediates the link between family functioning and QoL in these patients.
In our study, approximately half of the patients (47.88%) with advanced
CRC had moderate or low QoL, which is consistent with the results of
previous studies. Research on interventions to enhance the QoL of patients
with advanced CRC is ongoing. Our study found that both physical and
mental health aspects of QoL were significantly influenced by monthly
income (yuan). Cancer has a significant economic impact on individuals,
families, and society.3 Patients who earn more money may be able to
afford the cost of disease treatment and experience less financial strain.24,25
According to the earlier research findings, patients’ QoL improves as
financial stress and the cost of medical care decreases.26
Additionally, patients with advanced CRC who were better educated
tended to have a better QoL. One reason for this difference may be that
more educated people have a better understanding and greater acceptance
of their disease.27 Additionally, patients with higher levels of education
Table 5. Mediating effects of resilience on the relationship between family functioning and MCS.
Family functioning → MCS (Model 1)
Variables B SE t p LLCI ULCI
Marital status −1.0535 0.9593 −1.0982 0.2738 −2.9485 0.8415
Type of medical insurance 0.2447 1.2079 0.2026 0.8397 −2.1414 2.6307
Education level 0.8426 0.6163 1.3672 0.1735 −0.3748 2.0599
Monthly income (yuan) 1.3572 0.6395 2.1223 0.0354 0.0939 2.6205
TNM −1.3803 1.2274 −1.1245 0.2625 −3.8049 1.0443
Colorectal cancer type −1.2527 1.1341 −1.1046 0.2711 −3.4930 0.9876
Time since diagnosis −2.1367 0.5145 −4.1534 0.0001 −3.1530 −1.1205
Chronic disease status −2.6903 1.0258 −2.6225 0.0096 −4.7168 −0.6639
Family functioning −0.2968 0.0524 −5.6608 <0.0001 −0.4004 −0.1932
Family functioning → Resilience (Model 2)
B SE t p LLCI ULCI
Marital status −1.1279 0.5998 −1.8803 0.0619 −2.3128 −0.0570
Type of medical insurance −0.2932 0.7553 −0.3882 0.6984 −1.7852 1.1987
Education level 0.3734 0.3853 0.9689 0.3341 −0.3878 1.1345
Monthly income (yuan) 0.3394 0.3999 0.8486 0.3974 −0.4506 1.1293
TNM 0.3287 0.7675 0.4282 0.6691 −1.1874 1.8447
Colorectal cancer type −1.3727 0.7091 −1.9357 0.0547 −2.7735 0.0282
Time since diagnosis −0.9135 0.3217 −2.8397 0.0051 −1.5489 −0.2780
Chronic disease status 0.2341 0.6415 0.3650 0.7156 −1.0330 1.5012
Family functioning −0.2091 0.0328 −6.3774 <0.0001 −0.2739 −0.1443
Family functioning, resilience → MCS (Model 3)
B SE t p LLCI ULCI
Marital status −0.3420 0.8946 −0.3834 0.7019 −2.1104 1.4243
Type of medical insurance 0.4294 1.1144 0.3853 0.7005 −1.7721 2.6308
Education level 0.6074 0.5700 1.0656 0.2883 −0.5186 1.7334
Monthly income (yuan) 1.1434 0.5911 1.9345 0.0549 −0.0242 2.3111
TNM −1.5873 1.1325 −1.4016 0.1631 −3.8246 0.6500
Colorectal cancer type −0.3880 1.0584 −0.3666 0.7144 −2.4788 1.7028
Time since diagnosis −1.5613 0.4866 −3.2087 0.0016 −2.5226 −0.6001
Chronic disease status −2.8378 0.9464 −2.9986 0.0032 −4.7074 −0.9682
Journal of Psychosocial Oncology

Family functioning −0.1651 0.0543 −3.0392 0.0028 −0.2724 −0.0578

Resilience 0.6299 0.1185 5.3178 <0.0001 0.3959 0.8639
Note: B, unstandardized regression coefficient; LLCI, lower-level confidence interval; SE, standard error; TNM, tumor-node-metastasis
9

staging; ULCI, upper-level confidence interval.

10 L. JIANG ET AL.

Figure 1. Diagram of paths in the mediation model.

Table 6. Mediating model examination by bootstrapping method.

Family functioning → MCS Effect ratio
Effect SE BootLLCI BootULCI t p (%)
Total effect 0.0524 −0.4004 −0.1932 −5.6608 <0.0001 29.68
Direct effect 0.0543 −0.2724 −0.0578 −3.0392 0.0028 16.51
Indirect effect 0.0350 −0.2129 −0.0736 – – 13.17
Note: SE, standard error; LLCI, lower-level confidence interval; ULCI, upper-level confidence interval.

Figure 2. Proposed models that investigate mediated effects (** p < 0.01; *** p < 0.001).
 Journal of Psychosocial Oncology 11

typically have better family functioning and higher levels of resilience,

both of which promote stronger confidence and more optimistic attitudes
in dealing with the disease, which can help them effectively maintain a
good QoL.28
According to the previous studies, family members are the primary
source of social support for the majority of CRC patients. Positive and
effective family functioning indicates greater family support (family mem-
bers primarily include parents, spouses, and children) and stronger family
relationships. Patients have access to more protective resources, can better
mitigate the negative effects of stressful events (e.g. cancer), acquire pos-
itive coping attitudes, maintain or promote greater resilience, and improve
their QoL.29 Zhang et al. found that nurse-led family interventions could
enhance communication and coping among couples with gynecological
cancer, with a corresponding increase in quality-of-life levels.30 Interventions
aimed at emotional aspects of family functioning are more targeted and
simpler to implement. Many previous studies have demonstrated that
home-based exercise improves well-being, QoL, mental health, and physical
activity levels in CRC survivors,31 although the physical health component
of QoL was unrelated to family functioning in our study.
Resilience was found to be strongly and favorably related to QoL,
impacting both physical and psychological health. From the perspective
of physical health, patients with higher resilience tend to have more
health-promoting behaviors, such as good treatment compliance,32 physical
exercise,33 and a reasonable diet and structure.34 In terms of psychological
health, important components of resilience (e.g. social support and hope)
have been shown to improve the QoL of patients with advanced-stage
cancer.28,35 This has led to several studies investigating the impact of
resilience therapies on the QoL of cancer patients, with promising results
in terms of increased QoL. Nelson et al. reached a consensus on psycho-
logical intervention measures (e.g. music therapy) based on an adolescent
resilience model. Implementing a resilience intervention can improve the
QoL of teenage cancer patients by minimizing the negative effects of the
disease on their mental health and assisting them in developing a positive
coping attitude.36 Gao et al. developed a family-based psychological resil-
ience intervention plan for patients with breast cancer that can improve
their psychological resilience, assist them in actively coping with the chal-
lenges of the disease, and help them achieve a better QoL.37

Limitations
This study has several limitations. Firstly, the cross-sectional survey design
made it impossible to assess the influence of time on our findings. Second,
the research objects were limited to hospitals in Wuxi City, Jiangsu
12 L. JIANG ET AL.

Province; thus, the sample lacks universality. Third, the questionnaire

elicited participants’ subjective perceptions, which may have deviation from
the objective results. Fourth, findings based on studies conducted using
convenience and purposeful sampling methods may not be generalizable
to the entire population.

Clinical implications
On the one hand, family functioning (e.g. affective responsiveness) and
key factors within resilience (tenacity, optimism, etc.) can directly affect
one’s mental health. Interventions targeting emotional aspects of family
functioning are more targeted and easier to implement. Psychoeducational
therapies, which are believed to enhance cancer patients’ QoL by delaying
the emergence of negative emotions (e.g. depression and anxiety), have
been attempted on a number of occasions with cancer patients.
And on the other hand, through resilience, family functioning might
indirectly affect the mental health of patients with advanced cancer.
According to the findings of a home-based resilience intervention program
for breast cancer patients, enhancing their resilience can help them suc-
cessfully manage the disease’s obstacles and enjoy a higher QoL. As the
previously mentioned, the physical health of CRC survivors improved with
moderate-to-high-intensity exercise and excellent compliance.
In conclusion, researchers should incorporate resilience and family into
the future studies to create more effective intervention options that are
both affordable and successful, ultimately enhancing the QoL of patients
with advanced CRC.

Conclusion
This study aimed to explore the relationships among family functioning,
resilience, and QoL (PCS and MCS) in patients with advanced CRC. To
that end, the researchers examined general profiles related to QoL (PCS
and MCS), family functioning, and resilience. The findings contribute to
further understanding that good family functioning and resilience can
directly improve mental health and improves MCS by enhancing individual
resilience.
This study has several implications for clinical practice. However, owing
to the limitations of this study, it is necessary to expand the research
sample and scope and increase the diversity of the research sample in the
future to further clarify the strength of the correlation between family
function, resilience, and MCS. Our study initially found moderate-strength
associations between family functioning, resilience, and MCS.
 Journal of Psychosocial Oncology 13

Acknowledgments
We thank the patients and medical staff who participated in this study. Thanks to Associate
Professor Chen Ying and Associate Professor Liu Quan for their suggestions on the research
plan and thesis writing

Disclosure Statement
No potential conflict of interest was reported by the authors.

Funding
This work was supported by the Precision Medicine Project of Wuxi Health Commission
under Grant jzyx04 and Translational Medicine Research Project of Wuxi Health
Commission under Grant ZH202103.

ORCID
Liqing Jiang http://orcid.org/0000-0001-8424-5248

Data availability statement

The data that support the findings of this study are available from the corresponding
author upon reasonable request.

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