Association between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life among Latin American Patients with Advanced Cancer: A Multicenter Study

245 Background: Caregivers of cancer patients often face physical, and psychosocial hardship. The association between spirituality (S), religiosity (R), spiritual pain (SP), coping, and quality of life (QOL) have not been well characterized. The main purpose of this multicenter study was to determine these associations among LACs. Methods: We interviewed 319 LACs at palliative care clinics in Chile, Guatemala, and the US. LACs completed FICA (S/R assessment), ESAS–FS, PSWQ (worry), B-COPE/B-R-COPE (coping), and FACIT-Sp (spiritual well-being). Results: Median age 47 y, IQR=36, 59; 231 (73%) female, 207 (66%) married, 194 (61%) Catholic, 90 (28%) Non-Catholic Christian, 10 (3%) non-religious affiliation. Relationship: 111 (35%) spouses, 102 (32.5%) children, 31 (10%) siblings, 21 (7%) parents, and 59 (19%) others. 103 (32%) worked full-time, 38 (12%) worked-part-time, 96 (30%) homemaker, and 29 (9%) retired. 278 (92%) considered themselves moderately/highly spiritual and 75% moderately/highly religious, median: 8 (IQR: 6, 9) and 6 (4, 8) respectively. Median importance of S/R in their life was 10 (IQR: 7-10). The frequency and associations among the importance of S/R and different items were as follows: S/R is a source of strength and comfort (98%, r = 0.71; p < 0.0001), helps them to cope with patients’ illness (98%, r = 0.65; p < 0.0001). 44% of LACs reported that their spiritual/religious needs had not been supported by the medical team. 243/301 (81%) of LACs reported spiritual pain (median 6; IQR: 2-9). Spiritual pain significantly correlated with worse pain (r = 0.42, p < 0.0001), fatigue (r = 0.34, p < 0.0001), depression (r = 0.46, p < 0.0001), anxiety (r = 0.48, p < 0.0001), financial distress (r = 0.36, p < 0.0001), well-being (r = 0.3, p < 0.0001), worry (r = 0.42, p < 0.001), denial (r = 0.3, p < 0.0001), behavioral disengagement (r = 0.3, p < 0.0001), FACIT-sp (r = -0.18, p = 0.002), negative religious coping (r = 0.35, p < 0.0001). Conclusions: LACs report high level and importance of S/R in dealing with the patient’s illness and low level of S/R support from clinicians. 81% of LACs expressed spiritual pain that impacts their own symptoms, coping, and QOL. More research is needed.

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Spirituality, religiosity, spiritual pain, and quality of life among Latin American patients with advanced cancer (LAAdCa): A multicenter study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.246 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 246-246

Author(s):

Marvin Omar Delgado-Guay ◽

Alejandra Palma ◽

Eva Rossina Duarte ◽

Monica Grez ◽

Laura Tupper ◽

...

Keyword(s):

Quality Of Life ◽

Coping Strategies ◽

Latin American ◽

Multicenter Study ◽

Well Being ◽

Physical Symptoms ◽

Medical Team ◽

Emotional Symptoms ◽

Care Clinic

246 Background: The associations between spirituality (S), religiosity (R), spiritual pain (SP), symptom, coping and quality of life (QOL) have not been well characterized in LAAdCa. The main purpose of this Multicenter study was to analyze these associations. Methods: We interviewed 325 LAAdCa at a Palliative Care clinic in Chile, Guatemala, and USA. They completed FICA (S/R assessment), ESAS–FS (including SP), PSWQ (Worry), B-COPE and B-R-COPE (coping), FACIT-sp-ex (Spiritual Well-being). Results: Median age 58 (range: 19-85), 60% women, 62% Catholic, 30% Christian not Catholics, and 2% with no religion. 97% of LAAdCa considered themselves spiritual and 89% religious, median 7(IQR: 5-10) and 7(5-9) respectively. Median Importance of S/R in life (score 0 = none, 10 = very important) was 10 (IQR:8-10). The frequency and associations among the importance of S/R and different items were: helps them to cope with their illness (98%, r = 0.73; p < 0.0001), is a source of strength and comfort (99%, r = 0.79; p < 0.0001), and has a positive effect in physical symptoms (81%, r = 0.40; p < 0.0001), emotional symptoms (84%, r = 0.42, p < 0.0001), and helps to their caregivers to cope with pts' illness (100%, r = 0.66, p < 0.0001). 60% of LAAdCa reported that their S/R needs had not been supported by the medical team. 24% had received pastoral attention inside the hospital. 162/311 (52%) of LAAdCa reported spiritual pain (median 6; IQR: 5-8). Spiritual pain significantly correlated with worse pain (p = 0.02), fatigue (p = 0.0002), depression (p < 0.0001), anxiety (p < 0.0001), Financial distress (p < 0.0001), worry (p < 0.001), behavioral disengagement (p = 0.01), FACIT-sp-Ex (p = 0.0002), negative religious coping strategies (p < 0.0001), caregiver’s SP (p = 0.02), caregiver’s depression (p < 0.0001), caregiver’s anxiety (p = 0.0007), and worse caregiver’s QOL (p = 0.001). Conclusions: Majority of LAAdCa considered themselves spiritual and religious. S/R help to deal with their illness and correlates with less emotional distress, positive coping strategies and QOL. Still more than 50% LAAdCa reported SP and their S/R needs are not totally supported by the medical team. More research is needed.

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Reduction of Cancer-Related Fatigue With Dexamethasone: A Double-Blind, Randomized, Placebo-Controlled Trial in Patients With Advanced Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2012.44.4661 ◽

2013 ◽

Vol 31 (25) ◽

pp. 3076-3082 ◽

Cited By ~ 181

Author(s):

Sriram Yennurajalingam ◽

Susan Frisbee-Hume ◽

J. Lynn Palmer ◽

Marvin O. Delgado-Guay ◽

Janet Bull ◽

...

Keyword(s):

Quality Of Life ◽

Advanced Cancer ◽

Symptom Distress ◽

Controlled Study ◽

Total Quality ◽

Double Blind ◽

Cancer Related Fatigue ◽

Dexamethasone Group ◽

Edmonton Symptom Assessment Scale

Purpose Cancer-related fatigue (CRF) is the most common symptom in patients with advanced cancer. The primary objective of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of dexamethasone and placebo on CRF. Patients and Methods Patients with advanced cancer with ≥ three CRF-related symptoms (ie, fatigue, pain, nausea, loss of appetite, depression, anxiety, or sleep disturbance) ≥ 4 of 10 on the Edmonton Symptom Assessment Scale (ESAS) were eligible. Patients were randomly assigned to either dexamethasone 4 mg or placebo orally twice per day for 14 days. The primary end point was change in the Functional Assessment of Chronic Illness–Fatigue (FACIT-F) subscale from baseline to day 15. Secondary outcomes included anorexia, anxiety, depression, and symptom distress scores. Results A total of 84 patients were evaluable (dexamethasone, 43; placebo, 41). Mean (± standard deviation) improvement in the FACIT-F subscale at day 15 was significantly higher in the dexamethasone than in the placebo group (9 [± 10.3] v 3.1 [± 9.59]; P = .008). The improvement in FACIT-F total quality-of-life scores was also significantly better for the dexamethasone group at day 15 (P = .03). The mean differences in the ESAS physical distress scores at day 15 were significantly better for the dexamethasone group (P = .013, respectively). No differences were observed for ESAS overall symptom distress (P = .22) or psychological distress score (P = .76). Frequency of adverse effects was not significantly different between groups (41 of 62 v 44 of 58; P = .14). Conclusion Dexamethasone is more effective than placebo in improving CRF and quality of life in patients with advanced cancer.

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Meaning-Centered Group Psychotherapy: An Effective Intervention for Improving Psychological Well-Being in Patients With Advanced Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.57.2198 ◽

2015 ◽

Vol 33 (7) ◽

pp. 749-754 ◽

Cited By ~ 226

Author(s):

William Breitbart ◽

Barry Rosenfeld ◽

Hayley Pessin ◽

Allison Applebaum ◽

Julia Kulikowski ◽

...

Keyword(s):

Quality Of Life ◽

Group Psychotherapy ◽

Outcome Measures ◽

Advanced Cancer ◽

Well Being ◽

Physical Symptom ◽

Symptom Distress ◽

Spiritual Well Being ◽

Hastened Death

Purpose To test the efficacy of meaning-centered group psychotherapy (MCGP) to reduce psychological distress and improve spiritual well-being in patients with advanced or terminal cancer. Patients and Methods Patients with advanced cancer (N = 253) were randomly assigned to manualized eight-session interventions of either MCGP or supportive group psychotherapy (SGP). Patients were assessed before and after completing the treatment and 2 months after treatment. The primary outcome measures were spiritual well-being and overall quality of life, with secondary outcome measures assessing depression, hopelessness, desire for hastened death, anxiety, and physical symptom distress. Results Hierarchical linear models that included a priori covariates and only participants who attended ≥ three sessions indicated a significant group × time interaction for most outcome variables. Specifically, patients receiving MCGP showed significantly greater improvement in spiritual well-being and quality of life and significantly greater reductions in depression, hopelessness, desire for hastened death, and physical symptom distress compared with those receiving SGP. No group differences were observed for changes in anxiety. Analyses that included all patients, regardless of whether they attended any treatment sessions (ie, intent-to-treat analyses), and no covariates still showed significant treatment effects (ie, greater benefit for patients receiving MCGP v SGP) for quality of life, depression, and hopelessness but not for other outcome variables. Conclusion This large randomized controlled study provides strong support for the efficacy of MCGP as a treatment for psychological and existential or spiritual distress in patients with advanced cancer.

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