Cancer patients and their caregivers may draw strength from their faith when faced with the illness that has overwhelmed them physically and emotionally.
Cancer ranks among the most feared of all diseases. It is the product of cumulative lifestyle and environmental factors that place everyone at risk.
In the United States each year, about 1.2 million cancers are diagnosed. According to the National Institutes of Health, the overall annual cost of cancer treatment comes to $107 billion. Cancer is the second leading cause of death, resulting in more than 550,000 deaths, or one in every four Americans who die each year (American Cancer Society, 2000). A diagnosis of cancer challenges every dimension of a person’s life: physical, emotional, and spiritual. A cancer diagnosis can shatter the sense of invulnerability and control of one’s life, provoking anxiety and fear. Compounding this are the unknowns about the outcome of treatment, which can further increase feelings of loss of control.
Researchers are finding a strong relationship between patients’ reliance on religious beliefs and practices and the effectiveness of their coping with cancer. Faith can give a suffering person a framework for finding meaning and perspective through a source greater than self and can provide a sense of control over feelings of helplessness. The practice of faith also provides the natural social support of community. In a study of 100 older adults diagnosed with cancer, a consistent, positive relationship was discovered between religious practice, spiritual well-being, and hope and low anxiety and depression.
Hope is particularly important for those suffering with cancer. Researchers have found a strong link between religious beliefs and hope. In a study of cancer patients at the University of Michigan Medical Center, 93% said that their faith had increased their capacity to be hopeful. Hope enables people to actively cope with difficult and uncontrollable life situations. Patients with a strong sense of hope report a high quality of life, and hopefulness is linked to better adjustment by radiation therapy patients being treated for cancer. Robust hope can give a patient strength and courage to face the stress of illness and treatment while hopelessness brings passivity and resignation.
Quality of life is becoming more important for cancer patients as treatment advances extend the length of survival. Researchers studying a random sample of 296 breast cancer survivors in Southern California found that spiritual care was more important to the patients’ quality of life than counseling sessions, support groups, peer support, and even spouse support. Spiritual well-being among these patients often involves feelings of hopefulness, sense of purpose, participation in prayer or meditation, and church attendance. A second study of 1,337 cancer patients in the United States and Puerto Rico found that spiritual well-being influenced their quality of life as much as did their emotional and physical well-being. Spiritual well-being was associated with the ability to enjoy life even when experiencing negative symptoms, and the relationship remained strong even after controlling for many other factors associated with quality of life.
Other studies have found that the most common coping strategy for cancer patients is praying alone or with others, as well as having others pray for them. Cancer patients also place a high value on interactions with clergy, noting that pastoral visits and prayers help them maintain hope and optimism.
The frequent use of religion and spirituality when coping with illness and caregiver stress is no surprise given how important a religious community is to the majority of Americans. There are nearly 500,000 places of worship with a presence in almost every U.S. community. According to a recent Gallup poll, approximately 70% of Americans claim membership in a church or synagogue and about 40% attend one of these places of worship at least weekly. The Gallup Research Center reports that the 353,000 Christian and Jewish clergy serving congregations in the United States (4,000 rabbis, 49,000 Catholic priests, and 300,000 Protestant ministers according to the U.S. Department of Labor) are among the most trusted professionals in society. Surveys by the National Institute of Mental Health found that clergy are more likely than psychologists and psychiatrists combined to have a person with a mental health diagnosis see them for assistance. More than 10,000 of these clergy serve as chaplains in hospitals and other health-care institutions working closely with medical professionals.
Family caregivers of those with chronic illness often rely heavily upon their religious faith to cope with the burden of providing care. Researchers at Johns Hopkins University surveyed caregivers of persons with end-stage cancer and Alzheimer’s Disease. They discovered that successful coping was associated with only two variables: number of social contacts and support received from religious faith. When these persons were followed over two years to determine what characteristics predicted faster adjustment to the caregiver role, again only number of social contacts and support received from personal religious faith predicted better adaptation over time. Thus, having support from one’s faith appears to be one of the most important factors responsible for successful coping with the stress of caregiving. Religious teaching can foster an ethos of care and responsibility that is an important recourse for those facing the stress of long-term caregiving. Furthermore, those who have an active faith tend to have a better relationship with the care recipients than do non-religious caregivers, which can reduce their risk of depression.
Cancer patients tend to focus on religious issues more and more as the illness advances. When 231 patients with end-stage cancer were asked what maintained their quality of life, their “relationship with God” was the most common response among 28 choices that included “how well I eat,” “physical contact with those I care about,” and “pain relief.” According to these findings, terminal cancer patients maintained their relationship with God in spite of severe functional difficulties and serious physical symptoms. In a study of 108 women in Michigan at various stages of cancer, about half felt they had become more religious since they were diagnosed.
African Americans are more likely to develop cancer and are 30% less likely to survive it than European Americans. During the period from 1990-1996, the incidence rates were 442.9 per 100,000 among African Americans, 402.9 per 100,000 for European Americans, and 275.4 among Hispanic Americans, according to a study last year by the American Cancer Society. Early detection programs have resulted in a 35%t improvement in five-year survival for colon and breast cancer patients in the American population as a whole.
Faith-based communities can play a vital role in preventing cancer through screening. Research has found that the participation of clergy and key lay members in church-based cancer control programs can improve access to and participation in screening for cancer by African Americans and Hispanic Americans. A recent study published in the American Journal of Public Health found that church-based telephone-counseling in ethnic minority communities in Los Angeles significantly increased cancer mammography adherence. Such church-based programs may have great impact by promoting regular cancer screening. These should be supported and implemented by faith communities to help ensure a healthy congregation, both body and soul.
Andrew J. Weaver, Ph.D., is a United Methodist minister and a clinical psychologist. He is co-director of research for the HealthCare Chaplaincy in New York City. Harold G. Koenig, M.D., is associate professor of psychiatry and internal medicine, as well as director of the Center for the Study of Religion/Spirituality and Health at Duke University Medical Center. This article is reprinted with kind permission of the United Methodist Reporter, Dallas, Texas.