Spirituality is Associated with Better Psychological Health of Adolescents with Cancer
By John M. de Castro, Ph.D.
“Spirituality plays a significant role for adolescents with cancer as it contributes to increased comfort and calmness, and better coping mechanisms when confronted with the illness, which indirectly improves the adolescent’s quality of life.” – Sembiring Lina Mahayati
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. Adolescents with cancer are particularly vulnerable with high levels of anxiety, depression, fatigue, and pain interference.
Religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer. It is thought that people take comfort in the spiritual when facing mortality. Hence, spirituality and mindfulness may be useful tools for the survivors of cancer to cope with their illness. Thus, there is a need to study the relationships of spirituality on the ability of adolescent cancer survivors to positively adjust to their situation.
In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298609/ ) Grossoehme and colleagues recruited adolescents, aged 14 to 21 years, who were diagnosed with cancer. They had them complete measures of spirituality, feeling God’s presence; praying privately; attending religious services; identifying as religious; identifying as spiritual, emotional distress–anxiety; emotional distress–depressive symptoms; fatigue; and pain interference, health-related quality of life
They found that the higher the levels of feeling God’s presence and identifying as a very religious person the lower the levels of anxiety, depressive symptoms, and fatigue. Structural equation modelling revealed that the levels of feeling God’s presence and identifying as a very religious person also were indirectly associated with anxiety, depressive symptoms, and fatigue via a positive association with a sense of meaning and peace. That is, the greater the feelings God’s presence and religiosity the greater the feelings of peace and meaningfulness in life and these feelings were in turn negatively associated with negative emotional states.
These results are correlational and as such no conclusions about causation can be definitively made. But the results clearly show that there are relationships between being spiritual and religious and better emotional states in adolescent cancer victims. They also suggest that this relationship is mediated by feelings of meaningfulness and peace. It could be speculated that these relationships occur due to causal connections and interpreted that being spiritual produces a state of peacefulness and meaning in life that counteracts the negative emotions associated with cancer. It remains for future research to determine if increasing spirituality would lead to better emotional adjustments to a cancer diagnosis.
Hence, spirituality is associated with better psychological health of adolescents with cancer.
“As is true with older cancer survivors, spirituality is related to many aspects of well-being for AYA survivors, but relations are more consistent for meaning/peace and struggle.” – Crystal Park
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Grossoehme, D. H., Friebert, S., Baker, J. N., Tweddle, M., Needle, J., Chrastek, J., Thompkins, J., Wang, J., Cheng, Y. I., & Lyon, M. E. (2020). Association of Religious and Spiritual Factors With Patient-Reported Outcomes of Anxiety, Depressive Symptoms, Fatigue, and Pain Interference Among Adolescents and Young Adults With Cancer. JAMA network open, 3(6), e206696. https://doi.org/10.1001/jamanetworkopen.2020.6696
Key Points
Question
Among adolescents and young adults with cancer, is there an association between spirituality and patient-reported outcomes, and are these outcomes associated with a sense of meaning, peace, and comfort provided by faith?
Findings
In this cross-sectional study of 126 adolescents and young adults with cancer, structural equation modeling revealed that meaning and peace were associated with aspects of spirituality and religiousness as well as anxiety, depressive, and fatigue symptoms.
Meaning
In this study, participants’ sense of meaning and peace was associated with religiousness and with anxiety and depression, possibly representing an underappreciated intervention target.
Question
Among adolescents and young adults with cancer, is there an association between spirituality and patient-reported outcomes, and are these outcomes associated with a sense of meaning, peace, and comfort provided by faith?
Findings
In this cross-sectional study of 126 adolescents and young adults with cancer, structural equation modeling revealed that meaning and peace were associated with aspects of spirituality and religiousness as well as anxiety, depressive, and fatigue symptoms.
Meaning
In this study, participants’ sense of meaning and peace was associated with religiousness and with anxiety and depression, possibly representing an underappreciated intervention target.
Abstract
Importance
The associations of spiritual and religious factors with patient-reported outcomes among adolescents with cancer are unknown.
Objective
To model the association of spiritual and religious constructs with patient-reported outcomes of anxiety, depressive symptoms, fatigue, and pain interference.
Design, Setting, and Participants
This cross-sectional study used baseline data, collected from 2016 to 2019, from an ongoing 5-year randomized clinical trial being conducted at 4 tertiary-referral pediatric medical centers in the US. A total of 366 adolescents were eligible for the clinical trial, and 126 were randomized; participants had to be aged 14 to 21 years at enrollment and be diagnosed with any form of cancer. Exclusion criteria included developmental delay, scoring greater than 26 on the Beck Depression Inventory II, non-English speaking, or unaware of cancer diagnosis.
Exposures
Spiritual experiences, values, and beliefs; religious practices; and overall self-ranking of spirituality’s importance.
Main Outcomes and Measures
Variables were taken from the Brief Multidimensional Measurement of Religiousness/Spirituality (ie, feeling God’s presence, daily prayer, religious service attendance, being very religious, and being very spiritual) and the spiritual well-being subscales of the Functional Assessment of Chronic Illness Therapy (meaning/peace and faith). Predefined outcome variables were anxiety, depressive symptoms, fatigue, and pain interference from Patient-Reported Outcomes Measurement Information System pediatric measures.
Results
A total of 126 individuals participated (72 [57.1%] female participants; 100 [79.4%] white participants; mean [SD] age, 16.9 [1.9] years). Structural equation modeling showed that meaning and peace were inversely associated with anxiety (β = –7.94; 95% CI, –12.88 to –4.12), depressive symptoms (β = –10.49; 95% CI, –15.92 to –6.50), and fatigue (β = –8.90; 95% CI, –15.34 to –3.61). Feeling God’s presence daily was indirectly associated with anxiety (β = –3.37; 95% CI, –6.82 to –0.95), depressive symptoms (β = –4.50; 95% CI, –8.51 to –1.40), and fatigue (β = –3.73; 95% CI, –8.03 to –0.90) through meaning and peace. Considering oneself very religious was indirectly associated with anxiety (β = –2.81; 95% CI, –6.06 to –0.45), depressive symptoms (β = −3.787; 95% CI, –7.68 to –0.61), and fatigue (β = –3.11, 95% CI, –7.31 to –0.40) through meaning and peace. Considering oneself very spiritual was indirectly associated with anxiety (β = 2.11; 95% CI, 0.05 to 4.95) and depression (β = 2.8, 95% CI, 0.07 to 6.29) through meaning and peace. No associations were found between spiritual scales and pain interference.
Conclusions and Relevance
In this study, multiple facets of spirituality and religiousness were associated with anxiety, depression, and fatigue, all of which were indirectly associated with the participant’s sense of meaning and peace, which is a modifiable process. Although these results do not establish a causal direction, they do suggest palliative interventions addressing meaning-making, possibly including a spiritual or religious dimension, as a novel focus for intervention development.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298609/Importance