Spirituality and religion in oncology

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Adjustment to Cancer

Research has correlated measures of spirituality and of spiritual well-being with better quality of life (QOL) and/or psychosocial functioning in the context of prostate cancer,[6-8] breast cancer,[9-11] oncology-related anxiety and depression,[12, 13] radiation therapy,[14] and gynecologic cancer.[15, 16] In a study by Steinhauser et al,[17] patients viewed “being at peace with God” and “freedom from pain” as the most important characteristics of QOL in terminal illness. Similarly, religious coping has been associated with better patient psychological well-being and overall QOL among patients with advanced cancer.[18] At least 11 studies of posttraumatic growth have shown links to R/S, most of them beneficial.[19] Investigators have found positive religious coping, readiness to face existential questions, religious participation, and intrinsic religiousness to be typically associated with posttraumatic growth.

However, distress or struggle over spiritual concerns (eg, feeling abandoned by God) has been found to be prevalent among patients with advanced cancer.[18, 20-23] In a study of 100 patients with advanced cancer in an outpatient palliative care clinic in Texas, most of whom considered themselves both spiritual and religious, spiritual pain was both common and associated with lower self-perceived religiosity and QOL.[24] In a Boston-based study of 75 patients with advanced cancer, the majority (86%) endorsed at least one spiritual concern, with a median of 4 concerns noted per patient. Younger age was associated with a greater burden of spiritual concerns, and increased spiritual concerns were associated with worse psychological QOL.[18] A longitudinal study of women with breast cancer[25] suggested that women who are less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a process of spiritual struggle and doubt that can influence their long-term adjustment. In an effort to identify patterns of differences, Kristeller et al[26] distinguished 4 clusters within a study of 114 cancer patients: those with high R/S (45%), who showed the lowest levels of depression; those with low R/high S (25%), who also demonstrated good adjustment; negative religious copers (14%), who were found to have the highest levels of depression; and those with low R/S, who demonstrated the poorest adjustment to cancer.

Qualitative studies of oncology patients concerning the role of R/S in their illness[9, 21, 27-29] have identified a number of recurring themes. The study by Alcorn et al[21] of 68 randomly selected US patients with advanced cancer found 5 primary themes: coping, practices, beliefs, transformation, and community (Table 1)...........