Overcoming the Cancer Experience: Narrative Identity in Young Adult Survivors of Childhood Cancer

Although young adult survivors of childhood cancer (YAs) face a series of significant physical and psychosocial challenges, only a portion of these survivors will actually develop mental health difficulties. Research on narrative identity and posttraumatic growth suggests that developing a coherent life-story narrative, making meaning, and finding benefits from negative life events, can contribute to better psychosocial adjustment. The aim of the present study was twofold: understanding the mechanisms that link young adults’ cancer experience with positive psychosocial adjustment outcomes (i.e., empathy, attributional style, and coping), and investigating maternal distress-related communication and young adult attachment style as predictors of narrative identity and psychosocial adjustment. One hundred and eighteen YAs completed an adapted version of McAdams’ life-story interview (2001), which was coded for meaning making and coherence. YAs could choose to talk about cancer or non-cancer-related turning points. YAs completed online questionnaires assessing posttraumatic growth, attachment style, and three measures of psychosocial adjustment. Ninety-five mothers of YAs wrote a narrative of a past experience with their child’s cancer, and completed measures of distress-related disclosure, cancer-talk, and dispositional optimism. Results revealed that meaning making was higher for cancer-related than for non-cancer related turning points. Posttraumatic growth mediated the associations between cancer meaning making and both coping and empathy. Mothers’ cancer-talk frequency was related to YA cancer meaning making, and mothers’ distress-related disclosure was associated with YA posttraumatic growth. Mothers’ narrative coherence about a memory of their child’s cancer was unrelated to YA narrative coherence, but was positively related to YA negative attribution style, but only for mothers who scored low on optimism. Finally, secure attachment style was associated with YA narrative coherence about their cancer experience, and YA overall narrative coherence (cancer and non-cancer) mediated between YA secure attachment and YA empathy. These findings indicate that YA’s successful incorporation of the cancer experience into their narrative identities through meaning making and posttraumatic growth processes is linked to positive psychosocial adjustment outcomes. Also, mothers who engage in distress-related conversations with their children contribute to YA’s capacity to overcome their cancer experience. Implications for research on narrative identity development and clinical practice are discussed.Ph.D