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Solace for the soul

Author: Betsy Batish

The fight against cancer requires a variety of tools, and research continues to show that spirituality and religion can play a significant role in patients’ well-being. A review of recent studies and literature related to this aspect of cancer care reflects the physical, mental and emotional benefit of spirituality in patients’ experiences with cancer.

Spirituality and religion

According to the National Cancer Institute (cancer.gov), when considering the research and the clinical literature related to the relationship between religion/spirituality and health, it is important to consider how researchers and authors define these concepts.

While spirituality and religion often overlap, the two are not the same. A person can be deeply spiritual but have no affiliation with a particular religion. In a 2010 article in Nursing Times, Penny Satori, PhD, provides clarification: “Spirituality is about meaning in life and relationship to others (including a god or gods) and can be expressed in many ways including music, art, nature, community or family. Spiritual practices include meditation and yoga, or undertaking voluntary work and contributing to the local community. Religion may influence the development of such relationship or there may be no religious association. Religious practices include prayer, attending religious services and being an active member of the religious community.”1

For those who may not consider themselves among the religious faithful, evidence supports that simply participating in spiritual exercises such as deep breathing, meditation or listening to relaxing music can still improve mental, physical and emotional health. In How God Changes Your Brain (Random House, 2010), Andrew Newberg, MD, and Mark Robert Waldman explain that while having religious faith may intensify the spiritual practices identified as having significant positive impacts on one’s health and well-being, it is not entirely necessary to be a religious believer for spiritual healing to occur.

“It doesn’t matter how you believe in God, and there is considerable evidence that such practices work even if you don’t believe,” the authors explain. “Part of the reason for this is that spirituality is often defined in terms of personal values and the search for meaning and truth, and thus spiritual practices can take on many forms.”

Reverend Percy McCray, Director of Pastoral Care at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois, believes that the inclusion of religious/ spiritual healing is important and that valuable insight can be gained by reviewing clinical research about the topic. “Over the past two decades working at CTCA®, I have learned that religion/ spirituality and clinical scientific research should not be mutually exclusive of each other,” Rev. McCray says. “They should be thought of and viewed together. The results can be synergistic when they are approached from a balanced perspective. Albert Einstein summarized it this way: ‘Science without religion is lame, religion without science is blind.’”

The healing power of prayer

But can a prayer really have healing power? Mounting evidence shows that participating in spiritual and religious activities can enhance positive changes in the human brain and yield better overall health and well-being for those who partake in such activities. A 2011 study by researchers from Yeshiva University, reported in the Journal of Religion and Health, supports previous research that religious participation promotes mental and physical health.

The researchers based their study on the Women’s Health Initiative observational study, which involved 92,539 postmenopausal females from a wide range of socioeconomic, ethnic and religious backgrounds. Those who said they attended religious services more than once a week in the previous month were 56 percent more likely to score above average on a scale measuring optimism and 27 percent less likely to have symptoms of depression.2

Those findings, Rev. McCray says, reflect the central role spirituality can play in a person’s experience with cancer: “That’s a strong argument to be made for the value and importance of religion and spirituality, especially for making sure that these factors are considered when helping a person walk through their journey with cancer or any other health care crisis they are facing.”

In How God Changes Your Brain, Dr. Newberg and Waldman present similar evidence, culled from intensive brain-scan studies, surveys and analyses. They conclude that active and positive spiritual belief physically changes the human brain for the better. “Activities involving meditation and intensive prayer permanently strengthen neural functioning in specific parts of the brain that are involved with lowering anxiety and depression, enhancing social awareness and empathy, and improving cognitive and intellectual functioning,” they explain. “The neural circuits activated by meditation buffer the deleterious effects of aging and stress and provide better control over emotions. At the very least, such practices help participants to remain calm, serene, peaceful, and alert. And for nearly everyone, it provides a positive and optimistic outlook on life.”

The relaxation response

In the 1970s cardiologist Herbert Benson, MD, a pioneer of mind-body research, defined the “relaxation response” as a physiologic state of deep rest induced by traditional spiritual practices such as meditation, yoga, deep breathing and prayer. Simply put, the relaxation response reduces stress and tension throughout the body as the participant breathes slowly and repeats a comforting word or phrase. Many studies have documented the effectiveness of the relaxation response in treating medical issues ranging from hypertension to infertility—as well as its ability to decrease the severity of side effects caused by cancer treatment.

A study published in May 2013 by Dr. Benson and a team of investigators at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center found that eliciting the relaxation response produces immediate changes in the expression of genes involved in immune function, energy metabolism and insulin secretion.3 The study, which examined 26 healthy adults as they completed an eight-week relaxation-response training course, showed that pathways controlled by the activation of a protein called NF-kB - known to have a prominent role in inflammation, stress, trauma and cancer— were suppressed after relaxation-response elicitation.3

Rev. McCray notes that patients may find significant benefit from this type of mind-body intervention: “If we can calm people down and ease side effects through a modality like this, if we can lower their sense of stress and anxiety, then we are positively improving both the physical and the emotional dynamics of the person who is walking through the stress-filled environment of cancer. We are empowering them to move forward in recovery.”

Nurturing the spirit in a health care setting

With ever-growing evidence in support of the positive impact of spirituality on a person’s well-being, incorporating spiritual support into the health care setting is increasingly important to health care professionals and patients alike. According to the National Cancer Institute, research indicates that both patients and family caregivers commonly rely on spirituality and religion to help them cope with serious physical illnesses, and they desire to have specifc spiritual and religious needs and concerns acknowledged or addressed by medical staff.4

In an interview a few years ago, Harold G. Koenig, MD, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center and author of The Healing Power of Faith (Touchstone, 2001), provided the following guidance for health care professionals: “What doctors and health care professionals can do is acknowledge [religion], because it’s important to 90 percent of their patients. They can make sure that the patient has religious resources at the hospital, [and] consider the patient’s beliefs when designing the course of treatment so it doesn’t conflict with their beliefs.”5

Many hospitals are choosing to establish spiritual support programs and employ a chaplain or other spiritual leader to assist in meeting the needs of patients. At CTCA, for example, patients may choose to integrate spiritual care into their treatment in a variety of ways, including individual and group prayer, counseling by a faith representative, weekly interfaith worship and communion services, and patient and caregiver classes focused on healing, faith and life. In addition, when requested, clinicians, including physicians and nurses, often pray with patients as part of the care they provide.

At the front lines of delivering patient care, nurses are also in a prime position to help ensure that patients’ spiritual needs are met while they are undergoing treatment. Results of a 2010 survey by the Royal College of Nursing showed that the majority of nurses surveyed felt that spirituality was a fundamental aspect of nursing, and they identified the most important spiritual needs:

  • Respect for privacy, dignity and religious and cultural beliefs
  • Taking time to give patients support and reassurance, especially in times of need
  • Showing kindness, concern and cheerfulness when giving care
  • Allowing patients to discuss anxieties or fears6

The survey also revealed that nurses recognize that supporting patients’ spiritual needs can potentially improve the overall quality of the care they provide.

It is also important for health care professionals to recognize that every patient has unique spiritual needs. Learning of those needs early in the treatment process enables providers to nurture a patient’s faith, helping the patient better cope with the spiritual and emotional challenges associated with the illness. A collaborative study published in the Journal of Clinical Oncology regarding quality of life based on religiousness and spiritual support among advanced cancer patients recommends that spiritual history become a routine part of clinical care among patients with advanced illness.7

In addition, the study suggests that training of non-pastoral medical staff to identify spiritual needs, integrating pastoral staff into the medical team and strengthening connections between the medical system and outside religious communities—all have the potential to improve patient well-being. “Some first steps toward this integration include inquiring about patients’ spiritual supports and inviting their involvement in care,” the study states. “Direct communication between the medical team and spiritual supporters when desired by patients may also be beneficial at times.”7

Rev. McCray believes that as health care providers become involved in this aspect of each patient’s journey, it is key that they are receptive to the personal way each patient chooses to integrate spirituality into his or her care. “Every person is uniquely different, especially when it comes to their spiritual needs,” he says. “It behooves a provider in the health care environment to be an engaged listener— to find out each patient’s unique story, to understand his or her wants, needs and desires. From there, based on that criteria, we can collaborate to tailor the patient’s spiritual journey with cancer.”

Rev. McCray also feels strongly about the value of instituting a structured program and protocol for meeting spiritual needs in a health care setting to ensure that patients’ spiritual needs are fully integrated into their overall care plan, as is the case at CTCA. “At CTCA we’ve been providing spiritual support for our patients for over 20 years,” he says. “There’s enough evidence now, a strong sense of quantification and qualification, to support the incorporation of the element of spirituality in a health care environment. It is a helpful aid, when provided in combination with traditional and complementary health care modalities, which can truly make a difference for someone battling cancer.”

References

1. Satori, P. (2010). Spirituality 1: Should spiritual and religious beliefs be part of patient care? Nursing Times, 106(28), 14–17.

2. Salmoirago Blotcher, E., Fitchett, G., Ockene, J., Schnall, E., et al. (2011). Religion and healthy lifestyle behaviors among postmenopausal women: the Women’s Health Initiative. Journal of Behavioral Medicine, 34, 360–371.

3. Bhasin, M. K., Dusek, J. A., Chang, B. H., Joseph, M. G., et al. (2013). Relaxation response induces temporal transcriptome changes in energy, metabolism, insulin secretion and infammatory pathways. PLoS ONE, 8(5), e62817. doi: 10.1371/journal.pone.0062817.

4. Spirituality in Cancer Care (PDQ®). National Cancer Institute. Retrieved February 26, 2014, from http://cancer. gov/cancertopics/pdq/supportivecare/spirituality/ HealthProfessional.

5. Schneider, L. What Religion Can Do for Your Health. Beliefnet. Retrieved February 26, 2014, from http://www. beliefnet.com/Health/2006/05/What-Religion-Can-Do- For-Your-Health.

6. McSherry, W., & Jamieson, S. (2011). An online survey of nurses’ perceptions of spirituality and spiritual care. Journal of Clinical Nursing, 20(11–12), 1757–1767. doi: 10.1111/j.1365-2702.2010.03547.

7. Balboni, T. A., Vanderwerker, L. C., Block, S. D. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25(5), 555–560. doi: 10.1200/jco.2006.07.9046.

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