Longitudinal correlates of psychological resilience during particle radiotherapy among patients with head and neck cancer: A cross-lagged panel network analysis

Objective This study explored the longitudinal correlates of psychological resilience in patients with head and neck cancer (HNC) undergoing particle radiotherapy. Methods A longitudinal design was used to track 203 patients with HNC in Shanghai from December 2020 to December 2022. Psychological assessments were conducted at four time points: pre-particle radiotherapy (T1), treatment conclusion (T2), and 3/6 months post-treatment (T3/T4). A Cross-lagged panel network (CLPN) model analyzed dynamic interactions among six psychological resources (resilience, self-efficacy, hope, optimism, family support, and social support) across 18 dimensions based on ecological systems theory. Results CLPN analysis across three treatment phases revealed temporal dynamics in psychological resilience factors. The T1→T2 network highlighted the strong predictive value of Optimism with Support and Coping (β = 0.23) and Temporality and Future (β = 0.20). The T1→T3 network showed Partnership drove Resolve (β= 0.14) and Affection (β = 0.13), while Adaptive reduced Positive Readiness and Expectancy (PRE) (β = -0.11). From T2 to T3, Interconnectedness enhanced PRE (β =0.20) and decreased Affection (β = -0.15). PRE showed the highest vulnerability (in-EI: r = 1.63-2.92), while Optimism (out-EI : r = 3.52) and Growth (out-EI: r = 2.26) dominated causal influences in early and late phases, respectively. The T3→T4 network showed Meaning for Existence enhanced Affection (β = 0.12) and Hope for the Future (β = 0.11), while Generic Elements strongly reduced Partnership (β = -0.25). Conclusions Optimism emerges as the primary predictor of resilience in the early stages of particle radiotherapy, with Interconnectedness and PRE assuming greater significance in later phases. Clinical interventions should prioritize bolstering optimism in the initial treatment stages and fostering mechanisms for meaning-making in subsequent phases. The centrality of PRE highlights dynamic targets for resilience-focused interventions in HNC patients.