# Resilience and post-traumatic stress symptoms in grandparents following their grandchild’s cancer diagnosis from a multicenter cohort study in Switzerland (The GROKids project)

## TL;DR

This study explores how grandparents cope with stress after their grandchild is diagnosed with cancer, identifying two resilience patterns and factors that influence them.

## Contribution

The study identifies resilience trajectories and factors influencing them in grandparents of children with cancer, a previously understudied group.

## Key findings

- Two resilience trajectories were identified: low-stable and high-declining.
- Higher health literacy and receiving more information were positively associated with resilience.
- Grandparents with low-stable resilience reported significantly higher post-traumatic stress symptoms.

## Abstract

Resilience is the dynamic ability to adapt to adversity using personal and social resources. Childhood cancer represents a major family stressor, and grandparents often provide emotional, practical, and financial support. Yet, their psychosocial outcomes and resilience remain poorly understood. We aimed to: (1) identify resilience trajectories (2), examine their association with post-traumatic stress symptoms, and (3) determine factors influencing resilience.

This multicenter cohort study included grandparents of children recently diagnosed with cancer and treated at one of eight participating pediatric oncology centers in Switzerland. Eligible grandparents were recruited and completed questionnaires at 3-, 6-, 12-, and 24- months post-diagnosis. Resilience (CD-RISC 10), post-traumatic stress symptoms (IES-R), information needs, health literacy (HLS-EU-Q12), partnership quality, and social support (MSPSS) were measured. We used group-based trajectory modeling to identify resilience trajectories (Aim 1), linear mixed models to examine associations of resilience trajectories with post-traumatic stress symptoms (Aim 2), and linear mixed-effects models to identify the internal and external resources for resilience (Aim 3).

We included data of 41 grandparents of 20 children with cancer. Mean age was 67.6 years; most were grandmothers (n = 25, 61%), unemployed or retired (n = 23, 59%), and partnered (n = 35, 90%). Two resilience trajectories emerged within two years after diagnosis: low-stable (n = 17, 43%) and high-declining (n = 23, 57%). Grandparents in the low-stable group reported significantly higher post-traumatic stress symptoms (β: -19.8, 90% CI -29.2, -10.4, p < 0.001). The following internal resources were positively associated with resilience: higher health literacy (β: 0.31, 90% CI 0.20, 0.42, p < 0.001), more information received (β: 1.53, 90% CI 1.27, 1.79, p < 0.001), and having income that meets needs (β: 7.56, 90% CI 1.86, 13.26, p = 0.029). No external resources showed significant associations.

Timely, clear, and tailored information may help strengthen grandparents’ resilience and reduce stress.

The online version contains supplementary material available at 10.1007/s12672-026-04490-7.