Healing doesn’t end with treatment. As cancer survivorship grows, many continue to struggle with anxiety and depression – often in silence.

As cancer survivorship rises, many people living with or beyond cancer face lasting physical and emotional challenges – particularly anxiety and depression, which affect about 30% of this population. Emotional distress is often unspoken, leading to fear, despair, and diminished quality of life.

Growing research highlights resilience – the ability to recover from adversity – is a key factor in helping individuals manage distress and improve well-being. This underscores the urgent need for health care providers to adopt a whole-person approach that supports not just the body, but also the emotional and psychological needs of people with cancer.

As Breast Cancer Awareness Month highlights the importance of survivorship, researchers from Florida Atlantic University’s Christine E. Lynn College of Nursing have completed the first scoping review focused on caring-healing modalities (CHMs) designed to boost resilience and reduce emotional distress such as depression and anxiety in people with cancer.

Results, published in the journal Nursing Reports, help to shift attention from treatment to healing by exploring how CHMs such as mindfulness, peer support and expressive therapies can reduce emotional distress and build resilience in people with cancer. Notably, the majority of the included studies in this review focused on breast cancer survivors, highlighting the pressing need to address their emotional and spiritual well-being long after treatment ends.

“Our findings highlight something too often overlooked in survivorship care: healing doesn’t end when treatment does,” said Judyta Kociolek, corresponding author and director of the FAU Clinical Research Unit, and an oncology nurse prior to starting a career in research. “What patients often need most is to be seen, heard and treated as whole human beings, so they can feel empowered in their recovery and cancer journey. These caring-based practices help them reclaim that sense of self.”

Driven by Watson’s Theory of Human Caring, the review analyzed 16 global studies – including randomized controlled trials and systematic reviews – on CHMs delivered in hospitals, outpatient clinics and at home. The interventions varied widely, from mindfulness-based programs and therapeutic group discussions to expressive writing and psychoeducation.

What these diverse approaches had in common were deeply human elements: shared emotional expression, empathetic listening, and a healing environment. CHMs created safe, quiet spaces where individuals could process fear, grief, hope and transformation – together or on their own.

“This kind of healing environment isn’t just about peace and quiet – it’s a form of caring in action,” said Rita Gengo, Ph.D., co-author and an assistant professor in the Christine E. Lynn College of Nursing. “When you reduce noise, create privacy and invite calm, you allow people to breathe, reflect and begin to mend emotionally. The setting itself becomes part of the therapy.”

The review found that group-based interventions were especially powerful. Whether in person or online, these sessions created supportive spaces where survivors could share their stories, reduce feelings of isolation, and discover inner strength. Many CHMs reflected principles similar to those in Watson’s Caritas Processes – such as authentic presence, building trust, and fostering care-centered teaching – a connection noted by the researchers.

Watson’s Caritas Processes are a set of guiding principles in nursing that emphasize caring for the whole person – mind, body and spirit. They focus on compassion, deep human connection, and treating patients with dignity, empathy and respect. These processes encourage nurses to be fully present, build trusting relationships, and support healing beyond just physical care.

“Caring-healing modalities grounded in human connection offer something profoundly transformative,” said Lenny Chiang-Hanisko, Ph.D., co-author and an associate professor in the Christine E. Lynn College of Nursing. “Through caring partnerships, people can access a deeper sense of self, expand their emotional capacity, and awaken their innate ability to heal.”

Several studies in the review incorporated mindfulness-based techniques such as Mindfulness-Based Stress Reduction, Mindful Self-Compassion, and Attention and Interpretation Therapy, which encouraged individuals to be present, breathe, and acknowledge both positive and negative emotions without judgment. These programs helped participants cultivate resilience and self-compassion, while also reducing symptoms of anxiety and depression.

Importantly, CHMs were delivered in a variety of formats – face-to-face, online or through a hybrid approach – making them accessible and adaptable across different care settings. Some were brief, lasting 20 to 30 minutes, while others extended over months, allowing for deeper transformation. The review found that both short and long-term CHMs had clinical value, with longer programs more closely aligned with Watson’s emphasis on sustained caring-healing relationships.

While the review focused primarily on resilience and emotional distress, many studies also reported improvements in quality of life, self-compassion, physical symptoms like fatigue, insomnia and pain, and even biomarkers related to stress. By integrating subjective experiences with objective data, CHMs pave the way toward precision nursing that honors both science and soul.

“By bringing together personal experience and biological insight, we’re creating a future where care is deeply individualized,” said Kociolek. “It’s a vision of nursing that’s both scientifically rigorous and profoundly human.”

This review also identifies important gaps and opportunities. Research on CHMs is still limited for other cancers, such as prostate or colorectal cancer, and funding for complementary therapies remains a barrier. The researchers call for expanded testing, greater reimbursement, and the inclusion of CHMs in standard survivorship care.

-FAU-