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Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning

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Abstract

Purpose

Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model.

Methods

Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M = 61; months post-diagnosis, M = 17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M = 67; months post-diagnosis, M = 19). Participants completed measures of SpWB (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp)) and HRQL (Functional Assessment of Cancer Therapy-Colorectal) in both studies. Measures of general distress (Profile of Mood States-Short Form) and cancer-specific distress were also completed in study 1 and study 2, respectively.

Results

After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace.

Conclusions

This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.

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References

  1. Aiken LS, West SG, Reno RR (1991) Multiple regression: testing and interpreting interactions. Sage Publications, Newbury Park

    Google Scholar 

  2. American Cancer Society (2008) Cancer facts & figures 2008. American Cancer Society, Atlanta

  3. Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM, Cress RD, O'Connor LC, West DW, Wright WE (2005) Patients' perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23:6576–6586

    Article  PubMed  Google Scholar 

  4. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D (1999) A case for including spirituality in quality of life measurement in oncology. Psychooncology 8:417–428

    Article  PubMed  CAS  Google Scholar 

  5. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2010) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19:21–28

    Article  PubMed  Google Scholar 

  6. Canada AL, Murphy PE, Fitchett G, Peterman AH, Schover LR (2008) A 3-factor model for the FACIT-Sp. Psychooncology 17:908

    Article  PubMed  Google Scholar 

  7. Cella DF (1994) Quality of life: concepts and definition. J Pain Symptom Manage 9:186–192

    Article  PubMed  CAS  Google Scholar 

  8. Cella DF (1995) Methods and problems in measuring quality of life. Support Care Cancer 3:11–22

    Article  PubMed  CAS  Google Scholar 

  9. Cella D (1998) Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 25:43–46

    PubMed  CAS  Google Scholar 

  10. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    PubMed  CAS  Google Scholar 

  11. Cimprich B, Ronis DL, Martinez-Ramos G (2002) Age at diagnosis and quality of life in breast cancer survivors. Cancer Pract 10:85–93

    Article  PubMed  Google Scholar 

  12. Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E (1999) Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psychooncology 8:429–438

    Article  PubMed  CAS  Google Scholar 

  13. Dunkel-Schetter C, Feinstein LG, Taylor SE, Falke RL (1992) Patterns of coping with cancer. Health Psychol 11:79–87

    Article  PubMed  CAS  Google Scholar 

  14. Dunn J, Lynch B, Aitken J, Leggett B, Pakenham K, Newman B (2003) Quality of life and colorectal cancer: a review. Aust N Z J Public Health 27:41–53

    Article  PubMed  Google Scholar 

  15. Dunn J, Lynch B, Rinaldis M, Pakenham K, McPherson L, Owen N, Leggett B, Newman B, Aitken J (2006) Dimensions of quality of life and psychosocial variables most salient to colorectal cancer patients. Psychooncology 15:20–30

    Article  PubMed  Google Scholar 

  16. Edmondson D, Park CL, Blank TO, Fenster JR, Mills MA (2008) Deconstructing spiritual well-being: existential well-being and HRQOL in cancer survivors. Psychooncology 17:161–169

    Article  PubMed  Google Scholar 

  17. Fernsler JI, Klemm P, Miller MA (1999) Spiritual well-being and demands of illness in people with colorectal cancer. Cancer Nurs 22:134–140

    Article  PubMed  CAS  Google Scholar 

  18. Fitchett G, Peterman AH, Cella DF (1996) Spiritual beliefs and quality of life in cancer and HIV patients. Paper presented at the Third World Congress on Psycho-Oncology, New York, New York, 3–6 October 1996

  19. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR (2002) Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94:39–49

    PubMed  Google Scholar 

  20. Hahn EA, Rao D, Cella D, Choi SW (2008) Comparability of interview- and self-administration of the Functional Assessment of Cancer Therapy-General (FACT-G) in English- and Spanish-speaking ambulatory cancer patients. Med Care 46:423–431

    Article  PubMed  Google Scholar 

  21. Hill PC, Pargament KI, Hood RW, McCullough ME, Swyers JP, Larson DB, Zinnbauer BJ (2000) Conceptualizing religion and spirituality: points of commonality, points of departure. J Theory of Soc Behav 30:51–78

    Article  Google Scholar 

  22. Laubmeier KK, Zakowski SG, Bair JP (2004) The role of spirituality in the psychological adjustment to cancer: a test of the transactional model of stress and coping. Int J Behav Med 11:48–55

    Article  PubMed  Google Scholar 

  23. Lee V, Robin Cohen S, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62:3133–3145

    Article  PubMed  Google Scholar 

  24. Litwin M, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, Brook RH (1995) Quality of life outcomes in men treated for localized prostate cancer. J Am Med Assoc 273:129–135

    Article  CAS  Google Scholar 

  25. Marler PL, Hadaway CK (2002) "Being Religious" or "Being Spiritual" in America: a zero-sum proposition? J Sci Study Relig 41:289–300

    Article  Google Scholar 

  26. McNair DM, Lorr M, Droppleman LF (1992) Profile of Mood States (POMS). Educational and Industrial Testing Service, San Diego

    Google Scholar 

  27. Murphy PE, Canada AL, Fitchett G, Stein K, Portier K, Crammer C, Peterman AH (2010) An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II). Psychooncology 19:264–272

    Article  PubMed  Google Scholar 

  28. Pargament KI (1997) The psychology of religion and coping: theory, research, practice. Guilford Press, New York

    Google Scholar 

  29. Park CL (2005) Religion as a meaning-making framework in coping with life stress. J Soc Issues 61:707–729

    Article  Google Scholar 

  30. Parker PA, Baile WF, de Moor C, Cohen L (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 12:183–193

    Article  PubMed  Google Scholar 

  31. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D (2002) Measuring spiritual well-being in people with cancer: the Functional Assessment of Chronic Illness Therapy–Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24:49–58

    Article  PubMed  Google Scholar 

  32. Powell LH, Shahabi L, Thoresen CE (2003) Religion and spirituality. linkages to physical health. Am Psychol 58:36–52

    Article  PubMed  Google Scholar 

  33. Siegel K, Anderman SJ, Schrimshaw EW (2001) Religion and coping with health-related stress. Psychol Health 16:631–653

    Article  Google Scholar 

  34. Skibber JM, Hoff PM, Minisky BD (2001) Cancer of the rectum. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer, principles and practice of oncology. Lippincott, Williams & Wilkins, Philadelphia, pp 1271–1312

    Google Scholar 

  35. Skibber JM, Minsky BD, Hoff PM (2001) Cancer of the colon. In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer, principles and practice of oncology. Lippincott, Williams & Wilkins, Philadelphia, pp 1216–1262

    Google Scholar 

  36. Sprangers MA, Taal BG, Aaronson NK, te Valde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38:361–369

    Article  PubMed  CAS  Google Scholar 

  37. Stefanek M, McDonald PG, Hess SA (2005) Religion, spirituality and cancer: current status and methodological challenges. Psychooncology 14:450–463

    Article  PubMed  Google Scholar 

  38. Targ EF, Levine EG (2002) The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psych 24:238–248

    Article  Google Scholar 

  39. Thune-Boyle IC, Stygall JA, Keshtgar MR, Newman SP (2006) Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Soc Sci Med 63:151–164

    Article  PubMed  Google Scholar 

  40. Victorson D, Cella D, Wagner LI, Kramer L, Smith ML (2007) Measuring quality of life in cancer survivors. In: Feuerstein M (ed) Handbook of cancer survivorship. Springer, New York, pp 79–112

    Chapter  Google Scholar 

  41. Visser MR, Smets EM (1998) Fatigue, depression and quality of life in cancer patients: how are they related? Support Care Cancer 6:101–108

    Article  PubMed  CAS  Google Scholar 

  42. Wan GJ, Counte MA, Cella DF, Hernandez L, Deasy S, Shiomoto G (1999) An analysis of the impact of demographic, clinical, and social factors on health-related quality of life. Value Health 2:308–318

    Article  PubMed  CAS  Google Scholar 

  43. Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D (1999) Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Qual Life Res 8:181–195

    Article  PubMed  CAS  Google Scholar 

  44. Yost KJ, Hahn EA, Zaslavsky AM, Ayanian JZ, West DW (2008) Predictors of health-related quality of life in patients with colorectal cancer. Health Qual Life Outcomes 6:66

    Article  PubMed  Google Scholar 

  45. Zinnbauer BJ, Pargament KI, Scott AB (1999) The emerging meanings of religiousness and spirituality: problems and prospects. J Pers 67:889–920

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, 625 North Michigan Ave., 27th Floor, Chicago, IL, 60611, USA

    John M. Salsman & David Cella

  2. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA

    John M. Salsman & David Cella

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA

    Kathleen J. Yost

  4. Northern California Cancer Center, Freemont, CA, 94538, USA

    Dee W. West

Authors
  1. John M. Salsman
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  2. Kathleen J. Yost
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  3. Dee W. West
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  4. David Cella
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Corresponding author

Correspondence to John M. Salsman.

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Grant support

This research was supported by the National Cancer Institute (5 R01 CA61679), the Surveillance, Epidemiology, and End Results Special Study program (NO1-PC-65107), and by an unrestricted educational grant from Ortho-Biotech, Inc.

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Salsman, J.M., Yost, K.J., West, D.W. et al. Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning. Support Care Cancer 19, 757–764 (2011). https://doi.org/10.1007/s00520-010-0871-4

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  • DOI: https://doi.org/10.1007/s00520-010-0871-4

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