Top

Supportive Care in Cancer

Published in:

01-12-2019 | Original Article

Spiritual, religious, and existential concerns of cancer survivors in a secular country with focus on age, gender, and emotional challenges

Authors: N. C. Hvidt, T. B. Mikkelsen, A. D. Zwisler, J. B. Tofte, E. Assing Hvidt

Published in: Supportive Care in Cancer | Issue 12/2019

Abstract

Purpose

The purpose of this study was to examine the associations between self-reported spiritual/religious concerns and age, gender, and emotional challenges among cancer survivors who have completed a 5-day rehabilitation course at a rehabilitation center in Denmark (the former RehabiliteringsCenter Dallund (RC Dallund)).

Methods

The data stem from the so-called Dallund Scale which was adapted from the NCCN Distress Thermometer and comprised questions to identify problems and concerns of a physical, psychosocial, and spiritual/religious nature. Descriptive statistics were performed using means for continuous variables and frequencies for categorical variables. Odds ratios were calculated by logistic regression.

Results

In total, 6640 participants filled in the questionnaire. Among participants, 21% reported one or more spiritual/religious concerns, the most reported concerns related to existence and guilt. Having one or more spiritual/religious concerns was significantly associated with age (OR 0.88), female gender (OR 1.38), and by those reporting emotional problems such as being without hope (OR 2.51), depressed (OR 1.49), and/or anxious (OR 1.95). Among participants, 8% stated they needed help concerning spiritual/religious concerns.

Conclusions

Cancer patients, living in a highly secular country, report a significant frequency of spiritual/religious and existential concerns. Such concerns are mostly reported by the young, female survivors and by those reporting emotional challenges. Spiritual/religious and existential concerns are often times tabooed in secular societies, despite being present in patients. Our results call for an increased systemic attention among health professionals to these concerns, and a particular focus on identifying and meeting the spiritual/religious and existential concerns of women, the young and those challenged by hopelessness, depression, and anxiety.

Hewitt M, Greenfield S, Stovall E (2006) From cancer patient to cancer survivor: lost in transition. National Academies Press

Henoch I, Danielson E (2008) Existential concerns among patients with cancer and interventions to meet them: an integrative literature review. Psycho-Oncology. 18(3):225–236CrossRef

Assing Hvidt E (2015) The existential cancer journey: travelling through the intersubjective structure of homeworld/alienworld. Health. 21:1–17. https://doi.org/10.1177/1363459315617312 CrossRef

Park CL (2012) Meaning making in cancer survivorship. In: Wong PTP (ed) The human quest for meaning. Theories, research and applications, 2nd edn. Routledge, New York

Breitbart W (2002) Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced Cancer. Support Care Cancer 10(4):272–280CrossRef

Kristeller JL, Rhodes M, Cripe LD, Sheets V (2005) Oncologist assisted spiritual intervention study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 35(4):329–347CrossRef

Zuckerman P (2008) Society without God : what the least religious nations can tell us about contentment. New York University Press, New York

Gundelach P (2011) Små og store forandringer danskernes værdier siden 1981. Hans Reitzels Forlag, Copenhagen

Rosen I (2009) I'm a believer - but I'll be damned if I’m religious. In: Belief and religion in the Greater Copenhagen area - a focus group study. Lund studies in Sociology of Religion. Lunds Universitet

10.

Assing Hvidt E, Iversen HR, Hansen HP (2013) “Someone to hold the hand over me”: the significance of transpersonal “attachment” relationships of Danish cancer survivors. Eur J Cancer Care 22(6):726–737CrossRef

11.

Assing Hvidt E (2013) Sources of ‘relational homes’ - a qualitative study of cancer survivors’ perceptions of emotional support. Ment Health Relig Cult 16(6):617–632CrossRef

12.

Johannessen-Henry CT, Deltour I, Bidstrup PE, Dalton SO, Johansen C (2013) Associations between faith, distress and mental adjustment – a Danish survivorship study. Acta Oncol 52(2):364–371. https://doi.org/10.3109/0284186X.2012.744141 CrossRefPubMed

13.

Hvidtjorn D, Hjelmborg J, Skytthe A, Christensen K, Hvidt NC (2014) Religiousness and religious coping in a secular society: the gender perspective. J Relig Health 53(5):1329–1341. https://doi.org/10.1007/s10943-013-9724-z CrossRefPubMedPubMedCentral

14.

Trzebiatowska M, Bruce S (2012) Why are women more religious than men? 1st edn. Oxford University Press, OxfordCrossRef

15.

Dein S, Cook CC, Koenig H (2012) Religion, spirituality, and mental health: current controversies and future directions. J Nerv Ment Dis 200(10):852–855. https://doi.org/10.1097/NMD.0b013e31826b6dle CrossRefPubMed

16.

World Health Organization. International classification of functioning disability and health (ICF). 2001. http://www.who.int/classifications/icf/en/. Accessed 23.10.13 2013.

17.

Manning-Walsh J (2005) Spiritual struggle: effect on quality of life and life satisfaction in women with breast cancer. J Holist Nurs 23(2):120–140. https://doi.org/10.1177/0898010104272019 CrossRefPubMed

18.

Pargament KI, Desai KM, McConnell KM (2006) Spirituality: a pathway to posttraumatic growth or decline? In: Calhoun LG, Tedeschi RG (eds) Handbook of posttraumatic growth : research and practice. Mahwah, N.J. Lawrence Erlbaum Associates, pp 121–137

19.

Fitchett G, Risk JL (2009) Screening for spiritual struggle. J Pastoral Care Counsel 63(1–2):4–1-12PubMed

20.

Hansen H, Tjørnhøj-Thomsen T (2008) Cancer rehabilitation in Denmark: the growth of a new narrative. Med Anthropol Q 22(4):360–380CrossRef

21.

Tjørnhøj-Thomsen T, Hansen HP (2013) The ritualization of rehabilitation. Med Anthropol 32(3):266–285. https://doi.org/10.1080/01459740.2011.637255 CrossRefPubMed

22.

Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Rapid screening for psychologic distress in men with prostate carcinoma. Cancer 82(10):1904–1908. https://doi.org/10.1002/(SICI)1097-0142(19980515)82:10<1904::AID-CNCR13>3.0.CO;2-X CrossRefPubMed

23.

Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2014) Validation of the distress thermometer worldwide: state of the science. Psycho-Oncology. 23(3):241–250. https://doi.org/10.1002/pon.3430 CrossRefPubMed

24.

National Comprehensive Cancer Network (NCCN). NCCN distress thermometer and problem list. 2018. https://www.nccn.org/about/permissions/thermometer.aspx. Accessed 04 Nov 2018.

25.

Kristensen T. Dallundskalaen. [Visitation of cancer patients to a rehabilitation, Project anno 2004] Visitation af kræftpatienter til rehabilitering, projekt årgang 2004. Søndersø: RehabiliteringsCenter Dallund2005.

26.

Kristensen T, Hjortebjerg U, Larsen S, Mark K, Tofte J, Piester CB (2004) Rehabilitation after Cancer: 30 statements evaluated by more than 1.000 patients. Psycho-Oncology. 13:178 (poster)

27.

Armstrong RA (2014) When to use the Bonferroni correction. Ophthalmic Physiol Opt 34(5):502–508. https://doi.org/10.1111/opo.12131. CrossRefPubMed

28.

Strang P (1997) Existential consequences of unrelieved cancer pain. Palliat Med 11:299–305CrossRef

29.

Hansen HP, Tjornhoj-Thomsen T, Johansen C (2011) Rehabilitation interventions for cancer survivors: the influence of context. Acta Oncol 50(2):259–264. https://doi.org/10.3109/0284186X.2010.529460 CrossRefPubMed

30.

Rosedale M (2009) Survivor loneliness of women following breast cancer. Oncol Nurs Forum 36(2):175–183CrossRef

31.

Assing Hvidt E, Iversen HR, Hansen HP (2012) Belief and meaning orientations among Danish cancer patients in rehabilitation. A Taylorian perspective. Spiritual Care 1(3):1–22CrossRef

32.

la Cour P (2008) Existential and religious issues when admitted to hospital in a secular society: patterns of change. Ment Health Relig Cult 11(8):769–782CrossRef

33.

Strang S, Strang P, Ternestedt BM (2002) Spiritual needs as defined by Swedish nursing staff. J Clin Nurs 11(1):48–57. https://doi.org/10.1046/j.1365-2702.2002.00569.x CrossRefPubMed

34.

Klemm P, Miller MA, Fernsler J (2000) Demands of illness in people treated for colorectal cancer. Oncol Nurs Forum 27(4):633–639PubMed

35.

Fitchett G, Murphy PE, Kim J, Gibbons JL, Cameron JR, Davis JA (2004) Religious struggle - prevalence, correlates and mental health risks in diabetic, congestive heart failure, and oncology patients. Int J Psychiatry Med 34(2):179–196CrossRef

36.

King SD, Fitchett G, Murphy PE, Pargament KI, Martin PJ, Johnson RH, Harrison DA, Loggers ET (2017) Spiritual or religious struggle in hematopoietic cell transplant survivors. Psycho-Oncology. 26(2):270–277CrossRef

37.

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(1):49–58CrossRef

38.

Crockett A, Voas D (2006) Generations of decline: religious change in 20th-century britain. J Sci Study Relig 45(4):567–584CrossRef

39.

Galdas PM, Cheater F, Marshall P (2005) Men and health help-seeking behaviour: literature review. J Adv Nurs 49(6):616–623. https://doi.org/10.1111/j.1365-2648.2004.03331.x CrossRefPubMed

40.

Eakin EG, Strycker LA (2001) Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: patient and provider perspectives. Psychooncology. 10(2):103–113CrossRef

41.

Koenig HG (1994) Religion and hope. Religion in aging and health: theoretical foundations and methodological frontiers, pp 18–51

42.

Hvidt NC, Hvidtjørn D, Christensen K, Nielsen JB, Sondergaard J (2016) Faith moves mountains-mountains move faith: two opposite epidemiological forces in research on religion and health. J Relig Health 56:294–304. https://doi.org/10.1007/s10943-016-0300-1 CrossRefPubMedCentral

43.

Ahrenfeldt LJ, Möller S, Andersen-Ranberg K, Vitved AR, Lindahl-Jacobsen R, Hvidt NC (2017) Religiousness and health in Europe. Eur J Epidemiol 32(10):921–929. https://doi.org/10.1007/s10654-017-0296-1 CrossRefPubMed

44.

la Cour P, Hvidt NC (2010) Research on meaning-making and health in secular society: secular, spiritual and religious existential orientations. Soc Sci Med 71(7):1292–1299. https://doi.org/10.1016/j.socscimed.2010.06.024 CrossRefPubMed

45.

Assing Hvidt E, Søndergaard J, Gulbrandsen P, Ammentorp J, Timmermann C, Hvidt NC (2018) ‘We are the barriers’: Danish general practitioners’ interpretations of why the existential and spiritual dimensions are neglected in patient care. Commun Med 14(2):108–120. https://doi.org/10.1558/cam.32147 CrossRef

46.

Balboni MJ, Sullivan A, Enzinger AC, Epstein-Peterson ZD, Tseng YD, Mitchell C et al. Nurse and Physician Barriers to Spiritual Care Provision at the End of Life. J Pain Symptom Manage. 2014. https://doi.org/10.1016/j.jpainsymman.2013.09.020

Title: Spiritual, religious, and existential concerns of cancer survivors in a secular country with focus on age, gender, and emotional challenges
Authors: N. C. Hvidt
T. B. Mikkelsen
A. D. Zwisler
J. B. Tofte
E. Assing Hvidt
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 12/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-04775-4

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2019

A survey of patient and caregiver experience with malignant pleural mesothelioma

Vitamin D deficiency in oncology practice—more roads to cross

Chemotherapy-induced peripheral neuropathy—patient-reported outcomes compared with NCI-CTCAE grade

Effects of exercise on inflammation in patients receiving chemotherapy: a nationwide NCORP randomized clinical trial

Do-not-resuscitate status is correlated with the prescribed use of systemic strong opioid analgesics in patients with terminal cancer: an observational study

Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: which groups specifically benefit? Secondary analyses of a randomized controlled trial

Keynote webinar | Spotlight on antibody–drug conjugates in cancer