Depression poses a serious problem among US cancer survivors, who numbered 13.7 million in 2012, according to the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI).1,2 Researchers report that as many as 46% of cancer survivors cope with depressive symptomatology.3 Practitioners are aware of the common causes of depression among cancer survivors, such as the difficulties of coping with the symptoms and effects of the disease. Surgery, chemotherapy, and radiotherapy can all contribute to depression as well.4 But these are not the only causes for depression among cancer survivors; there are others, too, such as the conflict of spiritual well-being.5
THE CONFLICT WITHIN
Spirituality and prayer become important tools for someone coping with a potentially fatal illness. However, researchers in cancer survivorship report that this spiritual support could have negative connotations. Patricia Gonzalez and her group at the Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, explain that spiritual well-being may actually create distress in certain circumstances.6 Secure religious beliefs enable a patient to cope with the stress of cancer as she follows what she might consider to be God’s plan. Because the patient is involved with her religion, she is able to let go of her anger as she turns to a higher power for support and distraction from worry.
However, not all patients are secure in their beliefs when faced with such a serious illness, and they may question their beliefs or their faith. “Negative religious coping reflects a spiritual struggle within oneself. It is conveyed by patients as feeling abandoned or punished by God or by questioning God’s power or love,” the researchers wrote.6
Gonzalez and her group sought to determine whether the state of spiritual well-being could predict whether patients would become depressed. They examined the relationship between spiritual well-being and depressive symptomatology among survivors of cancer.
The group enrolled 102 English- and Spanish-speaking adult cancer survivors who attended local cancer support groups. Most of the participants had had breast cancer: 22% were survivors for 5 to 10 years, and 11% were survivors for 10 years or more. All completed study questionnaires, in English or Spanish, by themselves or with assistance.
The researchers used the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp) to measure patients’ spiritual well-being.7 Subscales assess different spiritual dimensions, such as faith (the extent of religiousness and religious activity) and meaning/peace (the affective and cognitive dimension of spiritual well-being). Meaning/peace is more strongly related to positive emotional well-being than is faith, and a high score in meaning/peace indicates lower cancer-related distress and less depressive symptomatology.
The study results supported the researchers’ hypothesis: When cancer survivors are secure in their spiritual well-being, they have a buffer against stress that helps them cope with their illness. In evaluating the differences between faith and meaning/peace, the group found that the latter might offer more protection from depressive symptoms for cancer survivors. Faith may lead survivors to believe that everything will turn out all right, whereas meaning/peace helps patients to accept and move beyond their experience.
Prior research indicates that patients often interpret a cancer diagnosis to mean that they cannot take life for granted. They may see it as a wake-up call. A person often experiences a positive transformation following a cancer diagnosis—a traumatic event—that is typically accompanied by beneficial changes (eg, personal strength, spiritual growth, greater appreciation for life).6 The researchers hypothesize that “perhaps meaning/peace instills cancer survivors with a sense of appreciation for everyday living that uniquely creates value and stimulates potential in maximizing quality of life, particularly psychological well being.”6 On the other hand, cancer survivors who depend on faith do not show such growth. They see their suffering as a means to a better end, leaving them vulnerable to spiritual conflict and depression.
Gonzalez and her group suggest that practitioners who work with cancer survivors encourage them to find a greater sense of meaning/peace, which might thereby shield them against depression.
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
1. Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2010. In US Department of Health and Human Services. National Vital Statistics Reports. Volume 61, Number 4. 2013. Hyattsville, MD: US Department of Health and Human Services.
2. Basic information about cancer survivorship. http://www.cdc.gov/cancer/survivorship/basic_info/. Last reviewed May 29, 2013. Last updated: September 25, 2013. Accessed April 10, 2014.
3. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thail. 2007;90(10):2164-2174.
4. Chochinov H. Depression in cancer patients. Lancet Oncol. 2001;2(8):499-505.
5. Johnson KS, Tulsky JA, Hays JC, et al. Which domains of spirituality are associated with anxiety and depression in patients with advanced illness? J Gen Intern Med. 2011;26(7):751-758.
6. Gonzalez P, Castañeda SF, Dale J, et al. Spiritual well-being and depressive symptoms among cancer survivors [published online ahead of print April 2, 2014]. Support Care Cancer. 2014.
7. Monod S, Brennan M, Rochat E, et al. Instruments measuring spirituality in clinical research: a systematic review. J Gen Intern Med. 2011;26(11):1345-1357.