There have been a number of studies examining the role of either religious involvement, spirituality, or both, in a variety of outcomes (e.g., quality of life, depression, anxiety, hope) among individuals with cancer.
Among African Americans and Latinos in an urban outpatient palliative care unit (57% with a cancer diagnosis), those who were uninsured and had a religious affiliation had more hopeful pain and symptom attitudes, and those who reported an affiliation but had Medicaid were less hopeful (Francoeur, Payne, Raveis, & Shim, 2007
). This suggests that religious involvement may serve as a coping mechanism to deal with lack of insurance. In a sample of older cancer patients, intrinsic religiosity was positively correlated with hope, spirituality, well-being, and positive mood, and was negatively correlated with depression (Fehring, Miller, & Shaw, 1997
). Patients with high levels of intrinsic religiosity and spiritual well-being had significantly higher hope and positive mood than those patients low in intrinsic religiosity.
In a study of individuals with advanced cancer in the United Kingdom, spiritual well-being was found to be significantly and negatively associated with both anxiety and depression (McCoubrie, & Davies, 2006
). This pattern held for existential well-being scores, but not for religious well-being scores, which involved strength of belief.
Other studies have examined the role of religious involvement and/or spirituality in quality of life among those with cancer. In a sample of individuals with advanced cancer, religious coping was found to have a positive association with overall quality of life. Use of positive religious coping was associated with better overall quality of life, and better existential and support quality of life (Tarakeshwar, et al., 2006
). Patients with greater use of positive religious coping also reported more physical symptoms. However, negative religious coping was associated with poorer overall quality of life, and poorer existential and psychological quality of life.
In another patient sample, it was proposed that the association between spirituality, distress, and quality of life would be moderated by perceived life threat (Laubmeier, Zakowski, & Bair, 2004
). However, spirituality was associated with lower distress and quality of life and perceived life threat did not moderate this relationship. Existential well-being rather than religious well-being accounted for most of the variance in the study outcomes. In a Grecian sample of Greek Christian Orthodox patients, global quality of life was associated with religious beliefs, however this relationship was modest (Assimakopoulos, Karaivazoglou, Ifanti, Gerolymos, Kalofonos, & Iconomou, 2009
). In a Croatian sample of women with breast cancer, moderate levels of religious involvement were associated with worse self-rated physical health, and the perception that illness decreased one’s faith was negatively associated with a number of quality of life domains (Aukst-Margetic, et al., 2009
In a diverse sample of over 1,600 patients with a history of cancer and/or HIV/AIDS, spiritual well-being was associated with quality of life to the same extent as was physical well-being (Brady, Peterman, Fitchett, Mo, & Cella, 1999
). Spiritual well-being maintained this association after controlling for potential confounding variables. It was concluded that spirituality is particularly salient among those with life-threatening illness and makes unique contributions to the prediction of quality of life, such that it should be assessed in the context of quality of life studies.
A mediational model of spirituality and adjustment to cancer suggested that being a woman, being ill for a longer period, and lower disease stage, predicted sense of purpose and religious beliefs, which then predicted family and social adjustment and psychological health (Schnoll, Harlow, & Brower, 2000
). A recent study among men with prostate cancer reported a mediational model of religious involvement, spirituality, and depression, suggesting that the meaning and peace aspect of spirituality mediates the relationship between religiosity and depression (Nelson, et al., 2009
). These studies suggest that interventions targeting spirituality, and specifically meaning and peace, may be indicated. Religious involvement may facilitate development of meaning of the illness, which helps one to cope (Kappeli, 2000
; Laubmeier, et al., 2004
). A meaning-making process may serve as an interpretive framework for patient suffering (Kappeli, 2000
). A review on religious involvement and illness coping suggests that religion helps to ease stress (Siegel, et al., 2001
Fewer studies have examined physical outcomes such as symptoms or disease progression. In a German sample of individuals with head and neck cancer, quality of life was assessed at four points in time (Becker, et al., 2006
). Those who were characterized as “believers” reported fewer side effects at all time points than “nonbelievers.” Another study found that while the Mormon lifestyle is associated with lower incidence of breast cancer, Mormon women who do get breast cancer have lower survivorship rates than non-Mormon women (Merrill & Folsom, 2005
). It was suggested that this was due to parity and breastfeeding.
Literature reviews have attempted to synthesize the literature in this emerging area. In a review examining the positive and negative effects of religious coping with a cancer diagnosis, it was reported that religious/spiritual coping may serve multiple functions in a patient’s adjustment to cancer, such as preserving self-esteem, offering a sense of meaning, providing comfort, and giving hope (Thune-Boyle, Stygall, Keshtgar, & Newman, 2006
). While most studies reviewed reported positive relationships between religious coping and outcomes, some reported negative or no relationships. Methodological limitations involving measurement and confounding variables were cited. In another review focused on physical and emotional health and quality of life, it was also concluded that measures of religiosity and spirituality were necessary to fully understand the experience of those with cancer (Mytko & Knight, 1999
These studies illustrate that this is a complex and developing area of study from a measurement and methodology standpoint, reflecting studies with multiple populations and a wide variety of outcomes. Such factors may in part explain variation in study outcomes and conclusions. A compounding factor in the complexity is that the field is dealing with constructs that are both confusing (religion vs. spirituality) and multidimensional in nature (Hill & Hood, 1999