World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 739-750

Resilience in Recovery: The Interplay of Coping Strategies and Psychological Factors Among Breast Cancer Survivors

↓ **Table 1.** Participants’ Inclusion and Exclusion Criteria
Inclusion criteria	Exclusion criteria
Source: Authors’ original creation.
Female patients	Patients aged under 20 years
Patients aged 20 years and above	Patients with a history of cognitive impairment or mental illness that may interfere with their ability to complete the questionnaires
Diagnosed with breast cancer, having undergone mastectomy within the past 5 years	Women diagnosed with advanced or terminal breast cancer
Ability to read and understand Arabic	Patients with severe comorbidities that could limit participation
Regular attendance at oncology clinics or follow-up for treatment	Patients currently undergoing palliative care
	Women who are unwilling or unable to provide informed consent
	Patients receiving ongoing psychiatric treatment, including medication for sleep disorders or severe depressive episodes, that may influence psychological responses
	Patients participating in other conflicting clinical studies

↓ Table 1. Participants’ Inclusion and Exclusion Criteria

Inclusion criteria

Exclusion criteria

Source: Authors’ original creation.

Female patients

Patients aged under 20 years

Patients aged 20 years and above

Patients with a history of cognitive impairment or mental illness that may interfere with their ability to complete the questionnaires

Diagnosed with breast cancer, having undergone mastectomy within the past 5 years

Women diagnosed with advanced or terminal breast cancer

Ability to read and understand Arabic

Patients with severe comorbidities that could limit participation

Regular attendance at oncology clinics or follow-up for treatment

Patients currently undergoing palliative care

Women who are unwilling or unable to provide informed consent

Patients receiving ongoing psychiatric treatment, including medication for sleep disorders or severe depressive episodes, that may influence psychological responses

Patients participating in other conflicting clinical studies

↓ **Table 2.** Frequency and Percentage Distribution of Demographic Characteristics of Participants (N = 104)
Characteristics	n (%)
Source: Authors’ original creation.
Age (years)
< 40	12 (11.5)
40–49	36 (34.6)
50+	56 (53.9)
Marital status
Single	10 (9.6)
Married	70 (67.3)
Widowed/ divorced	24 (23.1)
Level of education
Uneducated	19 (18.3)
High school or below	50 (48.1)
University or higher	35 (33.7)
Employment status
Employed	10 (9.6)
Unemployed	57 (54.8)
Retired	37 (35.6)
Comorbidities
Yes	71 (68.3)
No	33 (31.7)
Surgeries related to the disease (n = 104)
Complete breast removal with axillary lymph nodes right side	37 (35.6)
Complete breast removal with axillary lymph nodes left side	55 (52.9)
Complete breast removal with axillary lymph nodes both sides	12 (11.5)

↓ Table 2. Frequency and Percentage Distribution of Demographic Characteristics of Participants (N = 104)

Characteristics

n (%)

Source: Authors’ original creation.

Age (years)

< 40

12 (11.5)

40–49

36 (34.6)

50+

56 (53.9)

Marital status

Single

10 (9.6)

Married

70 (67.3)

Widowed/ divorced

24 (23.1)

Level of education

Uneducated

19 (18.3)

High school or below

50 (48.1)

University or higher

35 (33.7)

Employment status

Employed

10 (9.6)

Unemployed

57 (54.8)

Retired

37 (35.6)

Comorbidities

Yes

71 (68.3)

33 (31.7)

Surgeries related to the disease (n = 104)

Complete breast removal with axillary lymph nodes right side

37 (35.6)

Complete breast removal with axillary lymph nodes left side

55 (52.9)

Complete breast removal with axillary lymph nodes both sides

12 (11.5)

↓ **Table 3.** Mean and Standard Deviation for Brief-COPE (N = 104)
Dimension	Mean ± SD
Source: Authors’ original creation. Items from Brief-COPE [15].
1. “Problem-focused coping”	2.28 ± 0.69
Active coping
2. “I have been concentrating my efforts on doing something about the situation I’m in.”	2.38 ± 0.96
7. “I have been taking action to try to make the situation better.”	2.41 ± 0.92
Subtotal	2.39 ± 0.84
Use of informational support
10. “I have been getting help and advice from other people.”	2.59 ± 1.01
23. “I have been trying to get advice or help from other people about what to do.”	2.57 ± 0.9
Subtotal	2.58 ± 0.79
Positive reframing
12. “I have been trying to see it in a different light, to make it seem more positive.”	2.25 ± 0.88
17. “I have been looking for something good in what is happening.”	2.15 ± 0.81
Subtotal	2.2 ± 0.75
Planning
14. “I have been trying to come up with a strategy about what to do.”	1.98 ± 0.9
25. “I have been thinking hard about what steps to take.”	1.92 ± 0.95
Subtotal	1.95 ± 0.82
2. “Emotion-focused coping”	2.10 ± 0.33
Emotional support
5. “I have been getting emotional support from others.”	2.75 ± 0.84
15. “I have been getting comfort and understanding from someone.”	2.25 ± 0.98
Subtotal	2.5 ± 0.77
Venting
9. “I have been saying things to let my unpleasant feelings escape.”	1.67 ± 0.69
21. “I have been expressing my negative feelings.”	1.84 ± 0.85
Subtotal	1.75 ± 0.58
Humor
18. “I have been making jokes about it.”	1.2 ± 0.55
28. “I have been making fun of the situation.”	1.02 ± 0.14
Subtotal	1.11 ± 0.28
Acceptance
20. “I have been accepting the reality of the fact that it has happened.”	2.34 ± 0.66
24. “I have been learning to live with it.”	2.64 ± 0.74
Subtotal	2.49 ± 0.59
Religion
22. “I have been trying to find comfort in my religion or spiritual beliefs.”	3.38 ± 0.78
27. “I have been praying or meditating.”	3.32 ± 0.86
Subtotal	3.35 ± 0.74
Self-blame
13. “I have been criticizing myself.”	1.34 ± 0.81
26. “I have been blaming myself for things that happened.”	1.51 ± 0.92
Subtotal	1.42 ± 0.76
3. “Avoidant Coping”	1.82 ± 0.39
Self-distraction
1. “I have been turning to work or other activities to take my mind off things.”	2.68 ± 0.92
19. “I have been doing something to think about it less, such as going to movies, watching TV, reading, daydreaming, sleeping, or shopping.”	2.63 ± 0.84
Subtotal	2.65 ± 0.76
Denial
3. “I have been saying to myself ‘this isn’t real.’”	1.52 ± 0.75
8. “I have been refusing to believe that it has happened.”	1.42 ± 0.65
Subtotal	1.47 ± 0.58
Behavioral disengagement
6. “I have been giving up trying to deal with it.”	1.3 ± 0.62
16. “I have been giving up the attempt to cope.”	1.38 ± 0.78
Subtotal	1.34 ± 0.58

↓ Table 3. Mean and Standard Deviation for Brief-COPE (N = 104)

Dimension

Mean ± SD

Source: Authors’ original creation. Items from Brief-COPE [15].

1. “Problem-focused coping”

2.28 ± 0.69

Active coping

2. “I have been concentrating my efforts on doing something about the situation I’m in.”

2.38 ± 0.96

7. “I have been taking action to try to make the situation better.”

2.41 ± 0.92

Subtotal

2.39 ± 0.84

Use of informational support

10. “I have been getting help and advice from other people.”

2.59 ± 1.01

23. “I have been trying to get advice or help from other people about what to do.”

2.57 ± 0.9

Subtotal

2.58 ± 0.79

Positive reframing

12. “I have been trying to see it in a different light, to make it seem more positive.”

2.25 ± 0.88

17. “I have been looking for something good in what is happening.”

2.15 ± 0.81

Subtotal

2.2 ± 0.75

Planning

14. “I have been trying to come up with a strategy about what to do.”

1.98 ± 0.9

25. “I have been thinking hard about what steps to take.”

1.92 ± 0.95

Subtotal

1.95 ± 0.82

2. “Emotion-focused coping”

2.10 ± 0.33

Emotional support

5. “I have been getting emotional support from others.”

2.75 ± 0.84

15. “I have been getting comfort and understanding from someone.”

2.25 ± 0.98

Subtotal

2.5 ± 0.77

Venting

9. “I have been saying things to let my unpleasant feelings escape.”

1.67 ± 0.69

21. “I have been expressing my negative feelings.”

1.84 ± 0.85

Subtotal

1.75 ± 0.58

Humor

18. “I have been making jokes about it.”

1.2 ± 0.55

28. “I have been making fun of the situation.”

1.02 ± 0.14

Subtotal

1.11 ± 0.28

Acceptance

20. “I have been accepting the reality of the fact that it has happened.”

2.34 ± 0.66

24. “I have been learning to live with it.”

2.64 ± 0.74

Subtotal

2.49 ± 0.59

Religion

22. “I have been trying to find comfort in my religion or spiritual beliefs.”

3.38 ± 0.78

27. “I have been praying or meditating.”

3.32 ± 0.86

Subtotal

3.35 ± 0.74

Self-blame

13. “I have been criticizing myself.”

1.34 ± 0.81

26. “I have been blaming myself for things that happened.”

1.51 ± 0.92

Subtotal

1.42 ± 0.76

3. “Avoidant Coping”

1.82 ± 0.39

Self-distraction

1. “I have been turning to work or other activities to take my mind off things.”

2.68 ± 0.92

19. “I have been doing something to think about it less, such as going to movies, watching TV, reading, daydreaming, sleeping, or shopping.”

2.63 ± 0.84

Subtotal

2.65 ± 0.76

Denial

3. “I have been saying to myself ‘this isn’t real.’”

1.52 ± 0.75

8. “I have been refusing to believe that it has happened.”

1.42 ± 0.65

Subtotal

1.47 ± 0.58

Behavioral disengagement

6. “I have been giving up trying to deal with it.”

1.3 ± 0.62

16. “I have been giving up the attempt to cope.”

1.38 ± 0.78

Subtotal

1.34 ± 0.58

↓ **Table 4.** Overall Total Mean and Standard Deviation for Brief Coping Strategies
Subscales for coping	Overall total, mean ± SD
Source: Authors’ original creation. Scales from Brief-COPE [15].
“Problem-focused coping”	2.2 ± 0.75
“Emotion-focused coping”	1.82 ± 0.39
“Avoidant coping”	1.34 ± 0.58
Total	1.17 ± 0.69

↓ Table 4. Overall Total Mean and Standard Deviation for Brief Coping Strategies

Subscales for coping

Overall total, mean ± SD

Source: Authors’ original creation. Scales from Brief-COPE [15].

“Problem-focused coping”

2.2 ± 0.75

“Emotion-focused coping”

1.82 ± 0.39

“Avoidant coping”

1.34 ± 0.58

Total

1.17 ± 0.69

↓ **Table 5.** Mean and Standard Deviation of DASS-10 (N = 104)
	Mean ± SD
Source: Authors’ original creation. Scales from DASS-10 [16].
Anxiety–stress
1. “I felt I was close to panic.”	2.91 ± 0.80
4. “I was intolerant of anything that kept me from getting on with what I was doing.”	2.47 ± 0.77
6. “I felt scared without any good reason.”	3.13 ± 0.78
7. “I tend to overreact to situations.”	2.34 ± 0.85
8. “I was worried about situations in which I might panic and make a fool of myself.”	2.31 ± 0.83
9. “I found it difficult to relax.”	2.78 ± 0.88
Subtotal	2.63 ± 0.25
Depression
2. “I found it difficult to work up the initiative to do things.”	2.68 ± 0.74
3. “I felt down-hearted and blue.”	2.82 ± 0.80
5. “I felt that I have nothing to look forward to.”	2.41 ± 0.79
10. “I couldn’t seem to experience any positive feelings at all.”	2.28 ± 0.78
Subtotal	2.55 ± 0.24

↓ Table 5. Mean and Standard Deviation of DASS-10 (N = 104)

Mean ± SD

Source: Authors’ original creation. Scales from DASS-10 [16].

Anxiety–stress

1. “I felt I was close to panic.”

2.91 ± 0.80

4. “I was intolerant of anything that kept me from getting on with what I was doing.”

2.47 ± 0.77

6. “I felt scared without any good reason.”

3.13 ± 0.78

7. “I tend to overreact to situations.”

2.34 ± 0.85

8. “I was worried about situations in which I might panic and make a fool of myself.”

2.31 ± 0.83

9. “I found it difficult to relax.”

2.78 ± 0.88

Subtotal

2.63 ± 0.25

Depression

2. “I found it difficult to work up the initiative to do things.”

2.68 ± 0.74

3. “I felt down-hearted and blue.”

2.82 ± 0.80

5. “I felt that I have nothing to look forward to.”

2.41 ± 0.79

10. “I couldn’t seem to experience any positive feelings at all.”

2.28 ± 0.78

Subtotal

2.55 ± 0.24

↓ **Table 6.** Summary of Descriptive and Correlation Interpretation between Anxiety and Depression (N= 104)
DASS-10 subscales	Total, mean ± SD	Interpretation
Source: Authors’ original creation.
Anxiety–stress	2.63 ± 0.25	Moderate level of anxiety-stress
Depression	2.55 ± 0.24	Moderate level of depressive symptoms
Total	2.59 ± 0.25

↓ Table 6. Summary of Descriptive and Correlation Interpretation between Anxiety and Depression (N= 104)

DASS-10 subscales

Total, mean ± SD

Interpretation

Source: Authors’ original creation.

Anxiety–stress

2.63 ± 0.25

Moderate level of anxiety-stress

Depression

2.55 ± 0.24

Moderate level of depressive symptoms

Total

2.59 ± 0.25

↓ **Table 7.** Differences in Mean Scores of Copings (Brief-COPE) and Psychological Well-Being (DASS-10) by Demographic Characteristics (N = 104)
Characteristics	Brief-COPE (1–4), mean ± SD	DASS-10 (1–4), mean ± SD
Source: Authors’ original creation.
Age
< 40 years	2.12 ± 0.37	2.63 ± 0.25
40–49 years	2.13 ± 0.38	2.63 ± 0.25
≥ 50 years	1.99 ± 0.41	2.55 ± 0.24
P value	0.448	0.035
Marital status
Single	1.98 ± 0.48	2.55 ± 0.30
Married	2.13 ± 0.35	2.45 ± 0.25
Widow/divorced	2.04 ± 0.46	2.60 ± 0.35
P value	0.391	0.071
Level of education
Uneducated	1.98 ± 0.46	2.70 ± 0.30
High school or below	2.08 ± 0.41	2.50 ± 0.25
University or higher	2.17 ± 0.30	2.40 ± 0.20
P value	0.198	0.088
Employment status
Employed	2.12 ± 0.37	2.40 ± 0.30
Unemployed	2.08 ± 0.39	2.75 ± 0.25
Retired	2.10 ± 0.40	2.50 ± 0.20
P value	0.940	0.075
Comorbidities
Yes	2.07 ± 0.42	2.80 ± 0.35
No	2.15 ± 0.33	2.50 ± 0.30
P value	0.334	0.940
Type of surgery
Right side	2.08 ± 0.38	2.70 ± 0.28
Left side	2.05 ± 0.34	2.90 ± 0.32
Both sides	2.35 ± 0.59	2.45 ± 0.25
P value	0.061	0.257

↓ Table 7. Differences in Mean Scores of Copings (Brief-COPE) and Psychological Well-Being (DASS-10) by Demographic Characteristics (N = 104)

Characteristics

Brief-COPE (1–4), mean ± SD

DASS-10 (1–4), mean ± SD

Source: Authors’ original creation.

Age

< 40 years

2.12 ± 0.37

2.63 ± 0.25

40–49 years

2.13 ± 0.38

2.63 ± 0.25

≥ 50 years

1.99 ± 0.41

2.55 ± 0.24

P value

0.448

0.035

Marital status

Single

1.98 ± 0.48

2.55 ± 0.30

Married

2.13 ± 0.35

2.45 ± 0.25

Widow/divorced

2.04 ± 0.46

2.60 ± 0.35

P value

0.391

0.071

Level of education

Uneducated

1.98 ± 0.46

2.70 ± 0.30

High school or below

2.08 ± 0.41

2.50 ± 0.25

University or higher

2.17 ± 0.30

2.40 ± 0.20

P value

0.198

0.088

Employment status

Employed

2.12 ± 0.37

2.40 ± 0.30

Unemployed

2.08 ± 0.39

2.75 ± 0.25

Retired

2.10 ± 0.40

2.50 ± 0.20

P value

0.940

0.075

Comorbidities

Yes

2.07 ± 0.42

2.80 ± 0.35

2.15 ± 0.33

2.50 ± 0.30

P value

0.334

0.940

Type of surgery

Right side

2.08 ± 0.38

2.70 ± 0.28

Left side

2.05 ± 0.34

2.90 ± 0.32

Both sides

2.35 ± 0.59

2.45 ± 0.25

P value

0.061

0.257

↓ **Table 8.** Pearson Correlation Between Coping (Brief-COPE) and Psychological Well-Being (DASS-10) (N = 104)
Variables	Brief-COPE	DASS-10
**Correlation is significant at the 0.01 level. Source: Authors’ original creation.
Brief-COPE
Correlation	1
P value
DASS-10
Correlation	−0.501**
P value	< 0.001	1

↓ Table 8. Pearson Correlation Between Coping (Brief-COPE) and Psychological Well-Being (DASS-10) (N = 104)

Variables

Brief-COPE

DASS-10

**Correlation is significant at the 0.01 level. Source: Authors’ original creation.

Brief-COPE

Correlation

P value

DASS-10

Correlation

−0.501**

P value

< 0.001