The purpose of this study was to explore the correlates of both prayer for health and self-reported health status, and to assess the association between prayer for health and self-reported health among persons previously diagnosed with cancer. We were especially interested in the relationship between praying for health and the type of cancer with which persons had been diagnosed. We were not surprised to find that those with short-survival cancers and those who had been diagnosed with breast or colorectal cancer were more likely to use prayer than the referent (those who had been diagnosed with skin cancer). It was also not surprising that having been diagnosed with breast cancer or a short-survival cancer was inversely associated with reporting good or better health.
Prayer is generally the most commonly used CAM,12,29
and we found that American adults who are cancer survivors have frequently made use of this form of CAM. Just over two-thirds (68.5%) of these cancer survivors had used prayer for health and 88% of those persons had prayed during the past year. The first proportion is considerably higher than an estimate of 45% for the general population for engaging in any form of prayer21
and the 35% who used prayer for health concerns in another study.30
The present study found that being older, married, female, non-Hispanic black, and living in a region other than the West were all important indicators of praying for one's own health among cancer survivors. These associations are somewhat consistent with findings in the general population,21
but our finding that among cancer survivors married persons were more likely to use prayer for health compared to those who were divorced or separated is a new finding to our knowledge.
Perhaps surprisingly, we found no associations between prostate cancer and our two outcomes of interest. Possibly in this study men with prostate cancer did not see praying for their own health as important, but this observation may be related to the fact that men pray less21
rather than to the site of the cancer. In contrast, other studies have observed a positive association between (a) spirituality and (b) either quality of life or satisfaction or both among men with prostate cancer.29,31,32
An interesting relationship was found between veteran's status and the use of prayer for health in the bivariate analysis, as those persons with military experience used prayer for health less than those who were nonveterans, but this finding is likely driven by the fact that men pray less than women and that increased levels of education and income have been associated with less prayer for health.21
Indeed, after adjustment for sex, income, and education, the relationship was no longer significant.
Our findings for cancer survivors who had been diagnosed with breast cancer or a short-survival cancer (and marginally for those with colorectal cancer, OR: 0.58, 95% CI, 0.33–1.01) were comparable to other studies,26,33
as these groups had lower perceived health than those with other cancers. These NHIS-based studies found that persons with a history of cancer also had a greater number of other chronic conditions, more psychologic problems, more functional limitations, more health-related work limitations, and greater overall burden than those without a history of cancer.26,33
Our study, however, did not make comparisons with those without a history of cancer. Our findings about sociodemographic factors being related to perceived health were consistent with the literature.34–36
Similar to findings by Franzini and colleagues,35
health status varied by race/ethnicity and income with whites and those with greater resources having better health. Other predictors of health status included age, gender, marital status, other chronic medical conditions, and education as found in the current study.
Although the overall incidence of cancer has declined recently, it is known that cancer-related health disparities remain for certain population subgroups.2
Non-Hispanic blacks, especially males and people with low socioeconomic status, have the highest rates of both new cancers and cancer deaths.37
In the general population, non-Hispanic blacks have been found to use prayer for health more than non-Hispanic whites,3,21
and this pattern was consistent with our study.
We did not find an association between socioeconomic status and praying for one's own health, but we found a linkage between socioeconomic status and perceived health status, as those with higher levels of education and income reported better health. In other NHIS-based studies, persons with higher levels of education and income showed incremental increases in self-reported health status, while persons with chronic diseases showed incremental decreases in perceived health.25,33
Also, while age showed incremental increases in use of prayer, age also was tied to incremental decreases in health.
There were several strengths in the present study. This is a national sample conducted by trained Census Bureau workers, and the 2002 NHIS allowed for examination of CAM use and sociodemographic and health-related factors among cancer survivors, a group not studied in detail on a national level. The NHIS also had a sample large enough to examine the characteristics of interest as well as make within-and across-group comparisons. It oversampled both non-Hispanic blacks and Hispanics.
This study also had limitations. Since this was a cross-sectional study, we are only able to describe the use of prayer at a particular time period and were unable to examine past disease states that may have influenced prayer use. While we were able to measure the recency of prayer use (88% of those who had ever prayed had prayed within the past year), data on the frequency of prayer (how often), its ultimate purpose for health, or its specific health-related focus were unavailable. That is, we are not sure whether prayer for health by cancer survivors was used more for the medical condition of cancer itself, future prevention or healing, side-effects from treatment, or some combination of these factors. These additional topics were beyond the focus of this study. An additional limitation was that the 2002 NHIS included a limited number of clinical and psychosocial variables including age at diagnoses and affective distress-related questions (“During the past 30 days, how often did you feel...sad...nervous...hopeless, etc.). Variables such as religiosity, disease stage, treatment status, quality of life, and life satisfaction would have been quite helpful had they been included in the interview. We should also note that attempting to reduce 30 categories of cancer into 6 groups posed a challenge. Within many cancer sites there is high variability in both differentiation and prognosis, adding difficulty to this attempt. In addition, all of the “other” cancer types were placed in a single category, making it difficult to make inferences about this group.
Many patients believe that physicians should consider their patients' spiritual needs as part of their medical care.39–41
Even so, the role that physicians are to play in acknowledging and supporting the spiritual beliefs of patients continues to be debated.41,42
Recognizing that spiritual beliefs can influence patient medical decisions, recently Koenig has proposed the taking of a spiritual history to aid physicians in assessing whether to broach spiritual topics with patients.43
Spiritual histories should be administered to all patients to reduce possible group-level selection bias as physicians and other healthcare providers interact with their patients with cancer and other chronic diseases. Our data suggest that prayer for health is commonly used among cancer survivors and that there are specific sociodemographic and other correlates of its use. Exploring CAM and the use of prayer in clinical settings may help clinicians better understand both the coping and adaptation strategies of their patients with cancer as conduits to better health status. This study may also serve as a springboard for future studies that incorporate additional clinical and psychosocial variables and other types of CAM use among persons in the general population as well as those with a history of cancer.