Spiritual Concerns Decrease Quality of Life in Cancer Patients
By John M. de Castro, Ph.D.
“For some, a cancer diagnosis has the opposite effect on their sense of spirituality. It makes them doubt their beliefs or religious values, challenges their faith, and can cause spiritual distress. Some people become angry with God for allowing them to get cancer or wonder if they are being punished. Spiritual distress can make it harder for patients to cope with cancer and its treatment.” – National Comprehensive Cancer Network
Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.
Religion and spirituality become much more important to people when they’re diagnosed with cancer, when living with advanced cancer, and at end of life care. It is thought that people take comfort in the spiritual when facing their own mortality. There is very little information available, however, regarding the effectiveness of religion and spirituality in relieving the psychological burdens of cancer or on the quality of life of advance cancer patients. Additionally, the impact of spiritual concerns that the patient might have are not known. Concerns such as feelings of being abandoned by God or needing forgiveness for actions in their lives might lead to anxiety and worry rather than comfort.
In today’s Research News article “The Relationship of Spiritual Concerns to the Quality of Life of Advanced Cancer Patients: Preliminary Findings.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206727/
Winkelman and colleagues study the relationship of patients’ spiritual concern to their quality of life with advanced cancer. They recruited terminal cancer patients who were undergoing palliative radiation treatments. They completed measures of religiousness, spirituality, spiritual concerns including spiritual struggles and spiritual seeking, and quality of life including physical and existential quality of life. The patients died on average of 180 days after completing the measures.
The majority of the patients experienced one or more forms of spiritual struggle (58%), and most (82%) experienced spiritual seeking. Their struggles included “wondering why God has allowed this to happen” and “wondering whether God has abandoned me.” The most common spiritual seekings were “seeking a closer connection to God” and “thinking about what gives meaning to life.” They found that the greater the spiritual concerns, spiritual struggles, or spiritual concerns, the lower the patient’s quality of life. Virtually all of the patients indicated that spiritual care was important in their treatment.
These results are somewhat surprising in that religiousness and spirituality were not associated with comfort but with poorer quality of life in these terminal cancer patients. In particular, it appears that concerns about the spiritual meaning of their situation were very common and greatly troubled the patients leading to poorer quality of life. Being at peace with God is a very important goal of these patients and their concerns interfered with attaining that peace. Hence, it appears that in hospice and palliative care there should be greater attention paid to the religiousness and spirituality of the patients, particularly to their spiritual concerns, struggles, and seeking. This is important as spiritual concerns trouble them deeply and decrease the quality of life of terminal cancer patients.
“When we took a closer look, we found that patients with stronger spiritual well-being, more benign images of God (such as perceptions of a benevolent rather than an angry or distant God), or stronger beliefs (such as convictions that a personal God can be called upon for assistance) reported better social health. In contrast, those who struggled with their faith fared more poorly.” – Allen Sherman
CMCS – Center for Mindfulness and Contemplative Studies
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Winkelman, W. D., Lauderdale, K., Balboni, M. J., Phelps, A. C., Peteet, J. R., Block, S. D., … Balboni, T. A. (2011). The Relationship of Spiritual Concerns to the Quality of Life of Advanced Cancer Patients: Preliminary Findings. Journal of Palliative Medicine, 14(9), 1022–1028. http://doi.org/10.1089/jpm.2010.0536
Religion and/or spirituality (R/S) have increasingly been recognized as key elements in patients’ experience of advanced illness. This study examines the relationship of spiritual concerns (SCs) to quality of life (QOL) in patients with advanced cancer.
Patients and Methods
Patients were recruited between March 3, 2006 and April 14, 2008 as part of a survey-based study of 69 cancer patients receiving palliative radiotherapy. Sixteen SCs were assessed, including 11 items assessing spiritual struggles (e.g., feeling abandoned by God) and 5 items assessing spiritual seeking (e.g., seeking forgiveness, thinking about what gives meaning in life). The relationship of SCs to patient QOL domains was examined using univariable and multivariable regression analysis.
Most patients (86%) endorsed one or more SCs, with a median of 4 per patient. Younger age was associated with a greater burden of SCs (β = −0.01, p = 0.006). Total spiritual struggles, spiritual seeking, and SCs were each associated with worse psychological QOL (β = −1.11, p = 0.01; β = −1.67, p < 0.05; and β = −1.06, p < 0.001). One of the most common forms of spiritual seeking (endorsed by 54%)—thinking about what gives meaning to life—was associated with worse psychological and overall QOL (β = − 5.75, p = 0.02; β = −12.94, p = 0.02). Most patients (86%) believed it was important for health care professionals to consider patient SCs within the medical setting.
SCs are associated with poorer QOL among advanced cancer patients. Furthermore, most patients view attention to SCs as an important part of medical care. These findings underscore the important role of spiritual care in palliative cancer management.