Overview
Definition of Spirituality and Religion
Relation of Spirituality to Quality of Life
Screening and Assessment
Meeting the Patient's Spiritual and Religious Needs
Get More Information From NCI
Changes to This Summary (05/20/2008)
Questions or Comments About This Summary
About PDQ

Overview

Many cancer patients rely on spiritual and/or religious beliefs and practices to help them cope with their disease. This is called spiritual coping. Studies have shown that female caregivers also commonly rely on spiritual coping. Some patients and their family-caregivers may want doctors to address spiritual concerns, but may feel unsure about how to bring up the subject. Patients may express their spiritual needs in different ways, depending on their cultural and religious traditions. Cancer professionals are looking at new ways to address these religious and spiritual concerns as part of overall quality of life. Medical staff may therefore ask patients to identify spiritual issues that are important to them, not only for end-of-life issues but also during treatment.

Definition of Spirituality and Religion

For many people, spirituality and religion have different meanings.

The terms spirituality and religion are often used in place of each other, but for many people they have different meanings. Religion may be defined as a specific set of beliefs and practices, usually associated with an organized group. Spirituality may be defined as an individual's sense of peace, purpose, and connection to others, and beliefs about the meaning of life. Spirituality may be found and expressed through an organized religion or in other ways. Many patients consider themselves both spiritual and religious. Some patients may consider themselves spiritual, but not religious. Other patients may consider themselves religious, but not spiritual.

Spiritual distress is unresolved religious or spiritual conflict and doubt.

A serious illness like cancer may challenge a patient's beliefs or religious values, resulting in high levels of spiritual distress. Some cancer patients may feel that cancer is a punishment by God or may suffer a loss of faith after being diagnosed.

Other patients may experience mild spiritual distress when coping with cancer. For example, when prayer is used as a coping method, some patients may worry about how to pray or may doubt their prayers are being answered.

Relation of Spirituality to Quality of Life

Spiritual and religious well-being may be associated with improved quality of life.

It is not known for sure how spirituality is related to health. Some research shows that spiritual or religious beliefs and practices promote a positive mental attitude that may help a patient feel better and improve the well-being of family caregivers. Spiritual and religious well-being may be associated with improved quality of life in the following ways:

• Reduced anxiety, depression, and discomfort.
• Reduced sense of isolation (feeling alone).
• Better adjustment to the effects of cancer and its treatment.
• Increased ability to enjoy life during cancer treatment.
• A feeling of personal growth as a result of living with cancer.
• Improved health outcomes.

Spiritual distress may contribute to poorer health outcomes.

High levels of spiritual distress may interfere with the patient's ability to cope with cancer and cancer treatment. This distress may contribute to poorer health outcomes and less satisfaction with life. Health care providers may encourage patients to seek advice from appropriate spiritual or religious leaders to help resolve their conflicts, which may improve their health, quality of life, and ability to cope.

Screening and Assessment

A spiritual assessment may help the doctor understand if a patient will use religious or spiritual beliefs to cope with the cancer diagnosis and treatment.

Knowing the role that religion and spirituality play in the patient's life may help the doctor understand how religious and spiritual beliefs affect the patient's response to the cancer diagnosis and decisions about cancer treatment. Some doctors or caregivers may wait for the patient to bring up spiritual concerns. Others will ask for some initial information in an interview or on a form called a spiritual assessment.

A spiritual assessment will include asking about religious preference, beliefs, and spiritual practices.

Medical staff may not ask about every issue the patient feels is important. The patient should feel comfortable bringing up other spiritual or religious issues that he or she thinks may affect cancer care.

A spiritual assessment may include questions relating to the following issues:

• Religious denomination, if any.
• Beliefs or philosophy of life.
• Important spiritual practices or rituals.
• Use of spirituality or religion as a source of strength.
• Participation in a religious community.
• Use of prayer or meditation.
• Loss of faith.
• Conflicts between spiritual or religious beliefs and cancer treatments.
• Ways the caregivers may address the patient's spiritual needs.
• Concerns about death and the afterlife.
• End-of-life planning.

Meeting the Patient's Spiritual and Religious Needs

In addressing a patient's spiritual needs during cancer care, medical staff will take their lead from the wishes of the patient.

Spirituality and religion are very personal decisions. Patients can expect doctors and caregivers to respect their religious and spiritual beliefs and concerns. A cancer patient who relies on spirituality to cope with the disease may count on medical staff to respect that practice with support and referrals to appropriate spiritual or religious resources. Patients who do not choose to have spiritual issues addressed during cancer care may also count on medical staff to respect and support their views.

Doctors and caregivers will try to respond to their patients' concerns, but may avoid taking part in patients' religious rituals or debating religious beliefs.

Doctors may address a patient's spiritual needs in setting goals and planning treatment.

Doctors may address a patient's spiritual needs in the following ways:

• Identifying goals for care and making medical decisions that are consistent with the patient's spiritual and/or religious views and which also enable the doctor to maintain the integrity of his or her own spiritual and/or religious views.



• Respectfully supporting the patient's use of spiritual coping during the illness.



• Encouraging patients to speak with their clergy or spiritual leader.



• Referring the patient to a hospital chaplain, appropriate religious leader, or support group that addresses spiritual issues during illness.



• Referring the patient to other therapies that have been shown to improve spiritual well-being, including mindfulness relaxation and creative arts programs.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® ¹ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site ² provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ³. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (05/20/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ⁴. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ². PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁵. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A member of the clergy in charge of a chapel or who works with the military or with an institution, such as a hospital.

Ordained individuals who perform spiritual and/or religious functions.

To adjust to new situations and overcome problems.

The beliefs, values, and behaviors that are shared within a group, such as a religious group or a nation. Culture includes language, customs, and beliefs about roles and relationships.

In religion, describes a group whose members are organized under a common name and set of rules and have common beliefs and practices.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Extreme mental or physical pain or suffering.

A type of meditation based on the concept of being “mindful,” or having increased awareness, of the present. It uses breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Medical doctor.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

A group of people with similar disease who meet to discuss how better to cope with their disease and treatment.

Treatment.