Study: Spirituality Enhances Some Cancer Patients' Lives

When Houston doctors began a clinical trial investigating the benefits of Prozac on the quality of life for cancer patients exhibiting symptoms of depression, they were surprised to find that concern for their spiritual well-being was a roadblock for a number of patients.

There were perceived barriers to taking the anti-depressants, said Michael J. Fisch of the Department of Palliative Care and Rehabilitation Medicine at the University of Texas M.D. Anderson Cancer Center, a leader of the research team. The patients didn't want the meds messing with their heads and creating a disconnect from their spirituality.

Results from the study showed that Prozac did improve the quality of life of cancer patients with depression. Additionally, researchers found that spiritual well-being was not affected.

Neither the Prozac nor the placebo had any effect on the connection patients felt with their spirituality, said Fisch.

The variable of spiritual well-being in this study sparked further interest for Fisch and became an element in his July Journal of Clinical Oncology article, Assessment of quality of life in outpatients with advanced cancer: The accuracy of clinician estimations and the relevance of spiritual well-being. The research was performed by the Hoosier Oncology Group, an Indiana-based consortium of investigators.

The study was designed to see if physicians, based solely on their interaction with the patients, could gauge their quality-of-life impairment, said Fisch. I wondered, though, if we included and adjusted for spiritual well-being, would it account for variance? How good would the match be?

The research team used the patients from the prior study, since they had already completed a 34-item quality-of-life questionnaire called the FACT-G (Functional Assessment of Cancer Therapy General Version). Quality of life, in this context, relates to health, and the questions determine patients' levels of physical, emotional, mental, social and functional well-being. The questions were scored, and the patients' impairment was quantified.

Participants also completed the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale. The 12 questions were rated to determine the level of spiritual well-being in each individual. From the previous study, researchers noted that those with a higher spiritual well-being also had a higher quality-of-life score. The two were associated, but they were not cause and effect, Fisch said.

Without seeing the results of the FACT-G, and not having any other specific formula by which to determine a patient's quality of life, physicians were able to match the individual's assessment of impairment (mild, moderate or severe) 60 percent of the time. Of those that were miscategorized, physicians misjudged the patients with severe impairments most often, except in cases where severely impaired individuals had higher levels of spiritual well-being.

If patients had mild or moderate impairments, physicians were able to match them, said Fisch. But they classified patients with severe impairments as better than they were. The more severe the impairment, the less accurate the oncologists were at catching that.

These results suggest that patients with severe impairments tried very hard to mask their symptoms in order to preserve their dignity.

Sicker patients used thicker smoke screens, said Fisch. But those patients with adequate or higher spiritual well-being did not need to mask their symptoms, allowing physicians to assess their quality of life more accurately.

The patients with higher spiritual well-being had a great sense of inner peace that buoyed them. Fisch described it as a reservoir attached to the tank of quality of life. Each person has a certain level of quality of life that fills his or her tank, he said. As they get sicker, the tank may begin to spring leaks and lose its content more quickly. Patients who don't have a reservoir will do everything they can to hide the leaks and to maneuver in order to not dip below a level of dignity. Those with a sense of spiritual well-being, when able to connect to their reservoir, are routinely able to keep the tank at a good level.

Fisch and his team concluded that spiritual well-being is significantly associated with quality of life and that assessment of spiritual well-being is feasible and acceptable to outpatients with advanced cancer. Incorporation of some assessment of spiritual well-being into commonly measured domains of quality of life is worth serious consideration.

Further research related to spiritual well-being in cancer patients is needed, said Fisch, particularly related to its effect on symptom expression and clinician-patient communication and to its effect on patterns of change in quality of life assessed over time.

Frederica Saylor is listings editor of Research News.

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