Religious Faith and Health After Cancer
Religious Faith and Health After Cancer
Abstract & Commentary
By Howell Sasser, PhD. Dr. Sasser is Associate Professor of Epidemiology, New York Medical College, Valhalla, NY; he reports no financial relationship to this field of study.
Synopsis: This survey study assessed religious behavior, affective state, and health behaviors in a group of 167 adult cancer survivors. A measure of religious experience was associated with self-confidence, while religious struggle was associated with feelings of guilt, and all were associated with some health behaviors. After controlling for affective state, associations with the religion variables were no longer statistically significant, though a measurable indirect effect, mediated by affective state, could be detected.
Source: Park CL, et al. Religiousness/spirituality and health behaviors in younger adult cancer survivors: Does faith promote a healthier lifestyle? J Behav Med 2009; Epub ahead of print.
The nature and magnitude of the effect of religious faith on measures of health and illness continue to be topics of debate.1,2 Considerable attention has been devoted to the study of factors that might be indirect links (mediators) between expressions of religious faith and health outcomes.3,4 Such multifactor relationships are intuitively appealing, and offer intellectual ammunition both to those who endorse an effect of religion and to those who reject it. From a scientific perspective, however, much remains to be discovered, especially about the specificity of such patterns of association.
Park and colleagues add to the literature with a study of comparatively young cancer survivors.5 They begin by noting that patients finishing active cancer treatment and returning to "normal" life are obliged to decide what "normal" means to them. Old health habits may need to be re-established or changed in light of new realities. The role of religion and spirituality (hereafter R/S) in choosing and maintaining healthy behaviors is well documented, as is the role of R/S in post-treatment adjustment among cancer survivors.6-8 However, the latter research focuses mainly on mental health and coping. What is less clear is whether R/S plays a measurable part in the choices about physical health that cancer survivors make. The present study was designed to investigate this relationship.
Potential participants for the study were between the ages of 18 and 55, and had been diagnosed with cancer between 1 and 3 years earlier. Of 600 such persons contacted, 250 (42%) completed the study's baseline questionnaires. Of these, 167 (67%, or 28% of the original total) responded to a 1-year follow-up survey with questions relevant to the present report. About two-thirds of the study population were women, 89% were Caucasian, and 72% described themselves as Christian. A variety of types of cancer were represented, with breast (47%) and prostate (12%) the largest fractions.
The investigators noted that a limitation of prior research had been its focus on attendance at religious services as the measure of faith. They included it as well, but also used other scales to assess religiousness as an aspect of inner life and to assess religious struggle, a collective term used to describe the negative effects of religious faith. Two potential mediating factors, self-assurance and guilt/shame, were measured with a commonly used psychological scale. Health behaviors assessed were consumption of 5 servings of fruit and vegetables per day, days of moderate-to-vigorous exercise, days on which participants consumed no or moderate amounts of alcohol, adherence to physicians' advice, and adherence to medication regimens.
Frequency of religious attendance was not significantly correlated with any health behaviors or with the proposed mediating factors, and was not analyzed further. The two measures of R/S were both significantly correlated with the health measures and with the mediating variables, and the mediating variables were significantly correlated with some, but not all, of the health measures. To tease out the strength and direction of these associations, path analysis (a specialized regression technique) was used. When the measures of R/S were entered jointly with the mediators into models predicting the health behaviors, the direct relationships between religiousness and health behavior became non-significant, and a separate measure of indirect effect (through the mediator) usually became significant. This could be interpreted to mean that the effect of R/S on health was realized through its effect on the participants' psychological state, which in turn influenced their health behaviors.
Commentary
As might have been expected, a positive expression of R/S, mediated by a positive affective trait (self-assurance), was associated with a greater number of days of vigorous physical activity and with better adherence to physicians' advice. Likewise, a negative expression of R/S, mediated by a negative affective trait (guilt), was associated with poorer adherence to physicians' advice and fewer days with no or moderate alcohol consumption. That such pathways could not predict all the health behaviors is both a limitation of the study and a reassurance. The authors note that they chose only two affective dimensions among many. While they offer reasonable rationales for these choices, the reader is still left wondering whether other affective traits, or different constructions of the ones used, would have produced different or even contradictory results. At the same time, uniformly strong and statistically significant findings would raise just as much suspicion.
Of greater concern are a number of methodological weaknesses. Study participants were drawn from both sexes, a range of ages, and a variety of kinds of cancer. This creates a heterogeneity that may attenuate or mask genuine patterns. Unplanned concentrations within the population (i.e., more women than men, nearly half the population drawn from breast cancer survivors) can have the opposite effect, overemphasizing some apparent effects. Indeed, the authors report that in sub-analyses, women were more likely to abstain from alcohol and more likely not to follow the advice of their doctors. These concerns are magnified by the low response rate. The authors note that there were no significant demographic differences between those who responded and those who did not, but this does not alter the fact that the participants were different from the non-participants at least in so far as they chose to participate, suggesting differences in motivation and interest.
While, as the authors acknowledge, these results should be seen as suggestive rather than confirmatory, they do offer a useful model, both for future research and for clinicians. Given the importance of reinforcing healthy behaviors after cancer, exploring all possible motivating and discouraging factors with patients seems sensible. Neither religious faith nor affective state can be "prescribed," but patient and clinician awareness of them can be helpful in choosing strategies for maintenance of healthy behavior and predicting their success.
References
1. Koenig H. Medicine, Religion, and Health: Where Science and Spirituality Meet. West Conshohocken, PA: Templeton Press; 2008.
2. Sloan RP. Blind Faith: The Unholy Alliance of Religion and Medicine. New York: St. Martin's Press; 2008.
3. Holt C, et al. Exploring religion-health mediators among African American parishioners. J Health Psychol 2005;10:511-527.
4. Gillum RF, et al. Frequency of attendance at religious services and mortality in a U.S. national cohort. Ann Epidemiol 2008;18:124-129.
5. Park CL, et al. Religiousness/spirituality and health behaviors in younger adult cancer survivors: Does faith promote a healthier lifestyle? J Behav Med 2009 Jul 29; Epub ahead of print.
6. Benjamins MR, et al. Religious attendance, health maintenance beliefs, and mammography utilization: Findings from a nationwide survey of Presbyterian women. J Sci St Rel 2006;45:597-607.
7. Park CL, et al. Religiousness and adherence behavior in congestive heart failure patients. J Rel Spir Aging 2008;20:249-266.
8. Schnoll RA, et al. Spirituality, demographic and disease factors, and adjustment to cancer. Cancer Pract 2000;8:298-304.
This survey study assessed religious behavior, affective state, and health behaviors in a group of 167 adult cancer survivors. A measure of religious experience was associated with self-confidence, while religious struggle was associated with feelings of guilt, and all were associated with some health behaviors. After controlling for affective state, associations with the religion variables were no longer statistically significant, though a measurable indirect effect, mediated by affective state, could be detected.Subscribe Now for Access
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