Spirituality in radiation oncology—From belief to bedside: A new focus for research?

Purpose

Spirituality (from Latin spiritus), in a broader sense, means any kind of spiritual matters in contrast to sheer rational thinking and a material world. Within the scope of life-threatening and their corporal and existential identity menacing cancer disease, many patients look for help, sense and support in transcendental and metaphysic complements to the conventional cancer treatment. This return to spirituality and religiosity after tumor diagnosis has been more frequently observed in the last few years and is growing importance for cancer patients.

Methods

A total of 150 patients from two different well-circumscribed patients collectives were evaluated by standardized interviews before the commencement of radiation treatment: There were 75 consecutive patients with breast cancer and 75 with prostate cancer. Tumor and disease parameters as well as religious affiliation were documented. The interviews were carried out by a German Version of FACIT-Sp questionnaire for spiritual well-being. According to the recommendations of the American College of Physicians, additional questions in terms of a “spiritual history” were asked. Quality of life (QoL) was assessed by the SF-12 questionnaire.

In addition, a Medline literature search was carried out using the terms Spirituality & Cancer & Coping. There were no limits.

Results

Overall, 28% of patients were Catholics, 72% Protestants. General spiritual practices included prayer (62% of cases), meditation (31%), reading of religious texts (27%) and contemplation (22%). The majority of patients (74%) would characterize themselves as more or less religious and 70% would integrate their religiosity in the cancer coping. The FACIT-Sp showed a mean value of 32.74. Gender, tumor type and tumor stage had no significant influence. There was a strong correlation between higher religiosity and QoL.

Since the first publication in 1994, a total of 122 papers on this topic has been cited in Medline. Of these, 52 articles were published in nursing journals. Most authors came from North America (77%), followed by Europe (12%), Asia (6%) and Australia (5%). Publications from Germany were found only 7 times. In the first years there were only sporadic publications on this topic (mean: 2.9 articles/year). A marked increase of frequency of publications was seen since 2002–2003 (Mean 19.8 articles/year).

Conclusions

Spirituality and religiosity play a major role for cancer patients. There is a correlation with QoL that can be used for intervention by pastoral care. Spirituality should be a new focus for research in radiation oncology.

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