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The Role of Religion/Spirituality for Cancer Patients and Their Caregivers

Article  in  Southern Medical Journal · January 2005

DOI: 10.1097/01.SMJ.0000146492.27650.1C · Source: PubMed

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 Featured CME Topic: Spirituality
The Role of Religion/Spirituality for Cancer
Patients and Their Caregivers
Andrew J. Weaver, MTH, PHD, and Kevin J. Flannelly,
Abstract: Research has shown that religiosity and spirituality sig-
nificantly contribute to psychosocial adjustment to cancer and its
treatments. Religion offers hope to those suffering from cancer, and
it has been found to have a positive effect on the quality of life of
cancer patients. Numerous studies have found that religion and spir-
ituality also provide effective coping mechanisms for patients as
well as family caregivers. Research indicates that cancer patients
who rely on spiritual and religious beliefs to cope with their illness
are more likely to use an active coping style in which they accept
their illness and try to deal with it in a positive and purposeful way.
Faith-based communities also offer an essential source of social
support to patients, and religious organizations can play a direct and
vital role in cancer prevention by providing screening, counseling,
and educational programs, especially in minority communities.
C ancer ranks among the most dreaded of diseases. A di-
agnosis can cause extreme fear, helplessness, and psy-
chologic trauma.1 The unforeseeable outcome of the treat-
ment compounds the anxiety and leads to patients feeling
powerless. Both cancer patients and their families may be
intimidated and confused by the healthcare delivery system
and the technology of modern treatment.2 Such a diagnosis
challenges every dimension of a person’s life: physical, emo-
tional, and spiritual.
Cancer is the product of cumulative lifestyle and envi-
ronmental factors that place everyone at risk. In the United
States each year, approximately 1.3 million cancers are diag-
nosed.3 The 5-year survival rate for all types combined is
62%, and 8.9 million people have a history of cancer. By
2010 approximately 1 in every 250 Americans will be a sur-
vivor of childhood cancer.4 It is the second leading cause of
death, resulting in more than 550,000 deaths—1 of 4 Americans
who die each year.3 Many researchers have found a strong re-
lation between patients’ reliance on religious beliefs and prac-
tices and the effectiveness of their coping with cancer.5–7
From the HealthCare Chaplaincy, New York, NY.
Reprint requests to Dr. Andrew Weaver, 260 18th Street, New York, NY
11215. E-mail: aweaver747@aol.com
Accepted September 10, 2004.
Copyright © 2004 by The Southern Medical Association
0038-4348/04/9712-1210
1210
PHD
Faith can give a suffering person a framework for finding
meaning and perspective through a source greater than self,8
and it can provide a sense of control over feelings of help-
lessness.9 Religious practice can provide access to social net-
works and established forms of assistance, including pastoral
care during times of acute distress.10
The Importance of Hope
Hope is particularly important for those suffering from
cancer,11–15 and a positive association between various self-
reported measures of hope and religiosity has been found in
quantitative studies specifically designed to examine this re-
lation.16 –18 For example, in a study of women with gyneco-
logic cancers, 93% said that faith had increased their capacity
to be hopeful.19 Ebright and Lyon,20 in research on females
who were recently diagnosed with breast cancer, found that
those who scored higher on the Herth Hope Index reported
less anxiety and fear about their disease. Furthermore, the
more they felt their religious beliefs helped them to deal with
treatment the more positive they felt about their ability to deal
with the situation. Another study of breast cancer patients
found that their level of hope was primarily a function of their
sense of spiritual well-being, as measured by the Spiritual
Well-Being Scale,21 rather than of demographic, prognostic, or
treatment variables.22 Qualitative research also indicates that re-
ligion provides hope to oncology patients.23,24 For example,
Saleh and Brockopp24 found religious practices and family re-
lationships to be the two most frequently identified sources of
hope among hospitalized patients with bone cancer.
Key Points
• Faith can give a person suffering from cancer a frame-
work for finding meaning and perspective.
• Religious practice offers access to supportive social
networks.
• Spiritual well-being in cancer patients has been asso-
ciated with the ability to enjoy life, even when expe-
riencing negative symptoms.
• Patients place a high value on interactions with clergy.
• Faith-based programs can be useful in promoting reg-
ular screening and educating people about cancer.
© 2004 Southern Medical Association
 Featured CME Topic: Spirituality

Most studies indicate that increases in religiosity corre- iate statistics were used to control for other variables that
late with increases in hopefulness. However, a 1-year study of might influence QOL.30 This is not surprising, given the small
women who were newly diagnosed with breast cancer re- sample size. In contrast, the larger study reported that spiri-
ported a peculiar interaction between hope and religious cop- tuality had a substantial effect on QOL even when other
ing in their psychologic adjustment.25 In that study, religious factors were controlled for statistically.7 Moreover, the study
coping was related to better psychologic adjustment only by Brady et al7 provides evidence that patients’ level of spir-
among females who were initially rated as being low in hope. ituality has clinical implications. When patients were divided
Indeed, among women who were initially high in hope, turn- in half according to their levels of pain and fatigue, those who
ing to religion was associated with poorer adjustment. had higher spirituality scores reported higher QOL than pa-
Post-White et al26 used both quantitative and qualitative tients with comparable levels of pain or fatigue who had
methods to examine the relation between spirituality and hope lower spirituality scores.
in hospitalized oncology patients. While the patients’ scores
on the Herth Hope Index were unrelated to their scores on a Coping Strategies
spirituality scale developed by the researchers themselves, most People respond to stress differently and a variety of scales
patients said during interviews that “faith or belief in a higher have been developed to assess
power helped them feel more how people cope with the stress
hopeful.” The discrepancy be- of health problems.31–33 The
tween the quantitative and quali- Cancer: A dreaded disease various strategies people use to
tative findings provides a caution- • Cancer is the product of deal with illness and other stres-
ary tale about the use of untested cumulative lifestyle and sors have been broadly classi-
attitudinal scales in research on
environmental factors that place fied into two types of styles: (1)
these kinds of concepts. active coping or problem-solv-
everyone at risk.
ing and (2) passive or avoidant
Spirituality and • Cancer is the second leading
coping.34 –38 Freud38 regarded
Quality of Life cause of death, annually causing religious coping as a kind of de-
Quality of life (QOL) has more than 550,000 deaths, or 1 fense mechanism and viewed re-
become increasingly important of every 4 Americans who dies. ligious coping as a regressive,
for patients as treatment ad- • A cancer diagnosis can cause passive, and avoidant psycho-
vances extend the length of sur- extreme fear, helplessness, and logic phenomenon.39
vival. Although relatively few Recent research has found
psychologic trauma.
studies have examined the rela- that religious and spiritual be-
tionship between religion/spiri- • Researchers have found a strong liefs are associated with active
tuality and QOL, Mytko and relation between patients’ coping, not with avoidant or pas-
Knight27 conclude from their re- reliance on religious beliefs and sive coping strategies, among
view of the research, “... much of practices and their ability to cope patients with malignant melano-
the evidence suggests that religi- with cancer. ma.5,40 One study was con-
osity and spirituality contribute to ducted in New York City5 and
psychosocial adjustment to can- the other in Jerusalem40 using
cer and its treatments.” identical self-report measures of
Perceived QOL has become a common indicator of ad- coping style (Dealing with Illness-Coping Inventory) and reli-
justment, and a variety of scales have been developed to gious/spiritual beliefs and practices—the Systems of Belief In-
measure this concept. Most commonly used QOL scales in ventory (SBI). In both studies, SBI scores had a significant,
cancer research do not include spirituality as a test compo- positive correlation with active cognitive-coping methods, even
nent, but some researchers7,27 have argued for its inclusion after controlling for demographic variables and cancer stage.
because of its importance to patients.7,27–29 A 1999 special The results indicated that patients who exhibited greater reliance
issue of Psycho-Oncology devoted to spirituality contained on spiritual and religious beliefs were more likely to use an
two articles that are particularly pertinent.7,30 The sample active-cognitive coping style in which they accepted their illness
tested in one study consisted of 142 females with breast can- and tried to deal with it in a positive and purposeful manner.
cer, whereas the sample in the other study consisted of 762 These and other studies support the view that religious and spir-
men and 848 women with various kinds of cancer. Both itual beliefs can provide a helpful framework for many individ-
studies found a significant positive association between QOL uals who face the existential crises of a cancer diagnosis.41,42
and spirituality, using bivariate statistics, but the smaller study Prayer can serve as a means of self-soothing and of reduc-
did not find a significant effect of spirituality when multivar- ing such negative emotions as anger, depression, and fear,43 so

Southern Medical Journal • Volume 97, Number 12, December 2004 1211
Weaver and Flannelly • Role of Spirituality for Cancer Patients and Caregivers

it may not be surprising that a study by Soderstrom and Mar- ing as well as provide a source of emotional comfort when
tinson44 found the most common coping strategy for cancer faced with a life-threatening illness.57 Many of the breast
patients was praying alone or with others, as well as having cancer patients who were interviewed by Johnson and Spilka46
others pray for them. Prayer was also found to be an important
said they had an active and intimate relationship with God,
coping mechanism for parents of children with cancer. Among that helped them to feel less alone and gave them courage to
29 different coping strategies that fathers were asked about,deal with their disease. Similarly, many breast cancer patients
prayer was the one they said they used most often and was most
who were specifically asked to describe how their religion
helpful to them.45 Other research indicates that patients also
and spirituality helped them cope with their illness said that
place a high value on interactions with clergy and that pastoral
God was an ever-present support, constant companion, and
visits and prayers help them maintain hope and optimism.46 confidante who helped buttress their self-esteem and sense of
personal control throughout their illness.43 Moreover, a pos-
The frequent use of spirituality when coping with illness
or caregiver stress should be no surprise, given the impor- itive relationship with God was associated with greater opti-
tance of religious community to the majority of Ameri- mism and hopefulness.
cans.47,48 Moreover, the 353,000 Christian and Jewish clergy Patients tend to increase their focus on religious issues and
serving congregations in the United States49 are among the their connection to God as their cancer advances. For example,
most trusted professionals in society.48 Surveys by the Na- in a study of 108 women with various stages of cancer, about
tional Institute of Mental Health found that clergy are more half reported that they had become more religious since they
likely than psychologists and psychiatrists combined to have were diagnosed and none said they were less religious.19 Simi-
a person with a personal problem see them for assistance.50 larly, when 231 patients with end-stage cancer were asked what
More than 10,000 of these clergy serve as chaplains in hos- maintained their quality of life, their “relationship with God”
pitals and other healthcare institutions working closely withwas the most common response among 28 choices that included
medical professionals.51 “how well I eat,” “physical con-
tact with those I care about,” and
Faith Helps Caregivers The feeling that one has a positive “pain relief.”58 According to
Family caregivers of cancer these findings, terminal patients
relationship with God can give an maintained their relationship with
patients often face significant
physical, social, and emotional
individual a sense of self-acceptance God in spite of severe functional
hardships and indicate that they and belonging and also provide a difficulties and serious physical
rely heavily on their faith to source of emotional comfort when symptoms.
cope with these burdens. When faced with a life-threatening illness.
researchers at Johns Hopkins Faith-based
University surveyed those car- Communities Can
ing for persons with end-stage Help
cancer and Alzheimer disease,52 they discovered that success- Blacks are more likely to have cancer and are 30% less
ful coping was primarily associated with two variables: num-
likely to survive it than are whites. During the period from
ber of social contacts and support received from religious
1990 to 1996, the incidence rate per 100,000 was 442.9 among
faith. When these persons were followed for 2 years to de-
blacks, 402.9 for whites, and 275.4 in Hispanics.59 Early
termine the characteristics that predicted faster adjustment to
detection programs have resulted in a 35% improvement in
the caregiver role, again only the number of social contacts
and support received from personal religious faith predicted 5-year survival for colon and for breast cancer patients na-
53
better adaptation over time. Having support from one’s re- tionwide.60,61 Faith communities can play a vital role in pre-
ligion appears to be one of the most important factors respon- venting deaths by encouraging the use of screening. Research-
sible for successful coping with the stress of caregiving. Other ers have found that the participation of clergy and key lay
studies show that family members who are more religious feel members in church-based cancer control programs can im-
54
more positively about their role as caregivers and get along prove access to and participation in screening for cancer by
better with those they care for.55 This may be due in part to the blacks and Hispanics.62 As an example, a recent study pub-
fact that faith communities foster belief systems of responsibility lished in the American Journal of Public Health found that
and compassion that are likely to help the persons doing the church-based telephone counseling in ethnic minority com-
emotionally difficult work of caring for others.56 munities in Los Angeles significantly increased the regular
use of mammography screening.63 Such faith-based programs
can have a great impact in promoting regular screening and
Relationship With God Is Valued educating people about cancer.64 Their support and imple-
The feeling that one has a positive relationship with God mentation by religious communities will help ensure congre-
can give an individual a sense of self-acceptance and belong- gations that are healthy in both body and soul.

1212 © 2004 Southern Medical Association


Conclusion
Physicians need to be mindful of research showing that
religious beliefs and spiritual practices can be useful to many
patients and their caregivers coping with the impact of can-
cer. Medicine needs to further integrate these scientific find-
ings into clinical practice to promote better patient care.
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––Vance Havner
© 2004 Southern Medical Association