Research, Cancer, and God

by Andrew J. Weaver and George F. Handzo (July / August 2002 • Volume 18 • Number 4)

Two chaplains share what current research is discovering about the place of religious faith as cancer patients and their caregivers cope with the disease

It was Christmas Eve, when Christians want to be close to loved ones. But, like that other couple so long ago, Mr. and Mrs. Preston were far from home in a strange and lonely place for reasons they did not choose.

They had traveled from Nebraska to New York City for Mrs. Preston's cancerous tumor to be removed. It was a trip that could not wait until after the holidays. The diagnosis had shattered their sense of invulnerability, provoking anxiety and fear. Compounding this were the unknowns about the outcome of surgery.

For the first time in their married lives, they would not spend Christmas in their home church. The Prestons knew that their congregation and family were praying for them, but it was still difficult to experience the comfort of God's presence in the dark and stillness of that night.

Into their isolation came the hospital chaplain, a Lutheran minister making his Christmas Eve rounds. He brought greetings from their home pastor who had called to inquire about them and to make sure they were visited. They shared their feelings, the Eucharist, and prayer.

In this small gathering, God became present. Their faith and the Christmas story came alive and gave them renewed strength to face the unknown. There would be more visits and prayers, but for the Prestons, God had surely come and dwelt among them. They no longer felt abandoned and alone; they had companionship for the journey.

This is one story among thousands in which cancer patients are receiving ministry each year by chaplains and pastors.

A Dreaded Disease
Cancer ranks among the most dreaded of all diseases. It is the product of cumulative lifestyle and environmental factors that place everyone at risk.

In the United States each year, about 1.2 million cancers are diagnosed. The 5-year survival rate for all types combined is 59 percent, and 8.2 million people are living with cancer. It is the second leading cause of mortality, resulting in more than 550,000 deaths or 1 in every 4 Americans who die each year.¹

Such a diagnosis challenges every dimension of a person's life: physical, emotional, and spiritual.

Meanwhile, researchers have found a strong relationship between patients' reliance on religious belief and practice and the effectiveness of their coping with cancer.² Faith can give a suffering person a framework for finding meaning and perspective through a source greater than self, and it can provide a sense of control over feelings of helplessness.

Religious practice also supplies the natural social support of community. In a study of 100 older adults diagnosed with cancer, a consistent positive relationship was discovered between the practice of faith, spiritual well-being, hope, and low anxiety and depression.³

Hope is particularly important for those suffering with cancer, and researchers have found a strong link between religious belief and hope.⁴ In a study of cancer patients at the University of Michigan Medical Center, 93 percent said that their faith had increased their capacity to be hopeful.⁵ Hope enables persons to actively cope with difficult and uncontrollable life situations.

Patients with a strong sense of hope report a high quality of life,⁶ and hopefulness is specifically linked to better adjustment by those receiving radiation therapy.⁷ Robust hope can provide strength and courage to face the stress of illness and treatment, while hopelessness brings passivity and resignation.

Quality of life has become increasingly important for patients as treatment advances extend the length of survival. Researchers studying a random sample of 296 breast cancer survivors in Southern California found that spiritual care was more important to the patients' quality of life than support groups, counseling sessions, or even peer or spouse support.⁸ Spiritual well-being among these patients often involved feelings of hopefulness, sense of purpose, participation in prayer or meditation, and attendance at religious services.

A second study of 1,337 cancer patients in the U.S. and Puerto Rico found that spiritual well-being influenced their quality of life as much as their emotional and physical well-being did.⁹ Spiritual well-being was associated with the ability to enjoy life, even when experiencing negative symptoms — and the relationship remained strong even after controlling for many other factors associated with quality of life.

Coping Strategies
Studies have found that the most common coping strategy for cancer patients is praying alone or with others, as well as having others pray for them.¹⁰ Fathers of children being treated for cancer in a hospital clinic were asked about various methods of coping. Among 29 separate strategies used, prayer was both the most common and most helpful for the men.¹¹

Patients also place a high value on interactions with clergy, noting that pastoral visits and prayers help them maintain hope and optimism.¹²

The frequent use of religion and spirituality when coping with illness or caregiver stress is no surprise, given how important religious community is to many Americans. There are nearly 500,000 places of worship with a presence in almost every community.¹³ According to one Gallup poll, approximately 70 percent of Americans claim membership in a church or synagogue, and about 40 percent attend worship at least weekly.¹⁴

Furthermore, the 353,000 Christian and Jewish clergy serving congregations in the United States (which includes 4,000 rabbis, 49,000 Catholic priests, and 300,000 Protestant ministers, according to the U.S. Department of Labor¹⁵) are among the most trusted professionals in society.¹⁶

Surveys by the National Institute of Mental Health found that clergy are more likely than psychologists and psychiatrists combined to have a person with a personal problem see them for assistance.¹⁷ More than 10,000 of these clergy serve as chaplains in hospitals and other health-care institutions working closely with medical professionals.¹⁸

Caregivers and Faith
Family caregivers of those with chronic illness often rely heavily on their religious faith to cope with the burden of providing care. Researchers at Johns Hopkins University surveyed caregivers of persons with end-stage cancer and Alzheimer's Disease. They discovered that successful coping was associated with only two variables: the number of social contacts and support received from religious faith.¹⁹

When these persons were followed for two years to determine what characteristics predicted faster adjustment to the caregiver role, again only the number of social contacts and support received from personal religious faith predicted better adaptation over time.²⁰ Thus, having support from one's faith appears to be one of the most important factors responsible for successful coping with the stress of caregiving.

Religious teachings can foster an ethos of care and responsibility that is an important resource for those facing the work of providing long-term care. Furthermore, those who have an active faith tend to have a better relationship with their care recipients than do non-religious caregivers, which reduces their risk of depression.²¹

Cancer patients tend to focus on religious issues increasingly as their illness advances. When 231 patients with end-stage cancer were asked what maintained their quality of life, their "relationship with God" was the most common response among 28 choices that included "how well I eat," "physical contact with those I care about," and "pain relief."²²

According to these findings, terminal patients maintained their relationship with God in spite of severe functional difficulties and serious physical symptoms.

In a study of 108 women in Michigan at various stages of cancer, about half felt they had become more religious since they were diagnosed, and none said they were less religious.²³

How Churches Can Help
African Americans are more likely to develop cancer and are 30 percent less likely to survive it than European-Americans. During the period from 1990-1996 the incidence rates per 100,000 were 442.9 among African-Americans, 402.9 for European-Americans, and 275.4 in Hispanic-Americans.²⁴ Early detection programs have resulted in a 35 percent improvement in five-year survival for colon and breast cancer patients nationwide.²⁵

Churches and other faith-based communities can play a vital role in preventing deaths through the use of screening. Research has found that the participation of clergy and key lay members in church-based cancer control programs can improve access to and participation in screening for cancer by African and Hispanic Americans.²⁶

For example, a recent study published in the American Journal of Public Health found that church-based telephone counseling in ethnic minority communities in Los Angeles significantly increased the regular use of mammography screening.²⁷ Such faith-based programs can have great impact in promoting regular cancer screening. Their support and implementation by religious communities will help ensure congregations that are healthy in both body and soul.

Andrew J. Weaver, a United Methodist pastor and clinical psychologist, is Director of Research for The HealthCare Chaplaincy in New York City. George F. Handzo, an ELCA pastor, is Director of Clinical Services at The HealthCare Chaplaincy, supervising 52 chaplains in 32 hospitals in the New York City area.

Endnotes
1. Cancer Facts and Figures 2000 (Atlanta, GA: American Cancer Society, 2000).
2. J. C. Holland, S. Passik, K. M. Kash, S. M. Russak, M. K. Gronert, A. Sison, M. Lederberg, B. Fox, and L Baider (1999). "The role of religious and spiritual beliefs in coping with malignant melanoma," Psycho-Oncology, 8, 14-26.
3. R. J. Ferhring, J. F. Miller, and C. Shaw (1997). "Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer," Oncology Nursing Forum, 24 (4), 663-671.
4. L. Koopmeiners, J. Post-White, S. Gutknecht, C. Ceronsky, K. Nickelson, D. Drew, W. Mackey, and J. J. Kreitzer (1997). "How healthcare professionals contribute to hope in patients with cancer." Oncology Nursing Forum, 24 (9), 1507-1513.
5. J. A. Roberts, D. Brown, T. Elkins, and D. B. Larson (1997). "Factors influencing views of patients with gynecological cancer about end-of-life decisions," American Journal of Obstetrics and Gynecology, 176 (1), 166-172.
6. B. R. Ferrell, M. M. Grant, B. M. Funk, S. A. Otis-Green, and N. J. Garcia (1998). "Quality of life in breast cancer survivors: implications for developing supportive services," Oncology Nursing Forum, 25(5), 887-895.
7. N. Christman (1990). "Uncertainty and adjustment during radiotherapy," Nursing Research, 39, 17-20.
8. B. R. Ferrel, et. al.
9. M. J. Brady, A. H. Peterman, G. Fichett, and D. Cella, D. (1999). "A case for including spirituality in quality of life measurements in oncology," Psycho-Oncology, 8, 417-428.
10. K. E. Soderstrom and I. M. Martison (1987). "Patients' spiritual coping strategies: A study of nurse and patient perspective," Oncology Nursing Forum, 14, 41-46.
11. L. N. Cayse (1994). "Fathers of children with cancer: A descriptive study of the stressors and coping strategies," Journal of Pediatric Oncology Nursing, 11(3), 102-108.
12. S. C. Johnson and B. Spilka (1991). "Coping with breast cancer: The role of clergy and faith," Journal of Religion and Health, 30, 21-33.
13. M. B. Bradley, N. M. Green, D. E. Jones, M. Lynn, and L. McNeil, L. Churches and Church Membership in the United States (Atlanta, GA: Glenmary Research Center, 1990).
14. G. H. Gallup and D. M. Lindsay, Surviving the Religious Landscape: Trends in U.S. Beliefs (Harrisburg, PA: Morehouse Publishing, 1999).
15. United States Department of Labor. Occupational Outlook Handbook (Washington, DC: Bureau of Labor Statistics, 1998).
16. G.H. Gallup, and D. M. Lindsay (see no. 14).
17. A. A. Hohmann and D. B. Larson, "Psychiatric factors predicting use of clergy," in Psychotherapy and Religious Values, ed. E.L. Worthington, Jr. (Grand Rapids, MI: Baker Book House, 1993), pp. 71-84.
18. L. VandeCreek and L. Burton (2001). "Professional chaplaincy: its role and importance in healthcare," Journal of Pastoral Care, 55(1), 81-97.
19. P.V. Rabins, M.D. Fitting, J. Eastham, and J. Zabora (1990). "Emotional adaptation over time in caregivers for chronically ill elderly people," Age and Aging, 19, 185-190.
20. Ibid.
21. B. Chang, A.E. Noonan, and S. L. Tennstedt (1998). "The role of religion/spirituality in coping with caregiving for disabled elders," The Gerontologist 38 (4), 463-470.
22. S. C. McMillian and M. Weitzner (2000). "How problematic are various aspects of quality of life in patients with cancer at the end of life?" Oncology Nursing Forum, 27(5), 817-823.
23. J. A. Roberts, et.al. (see no. 5).
24. American Cancer Society (see no. 1).
25. B. Levin, (1993). "Colorectoral cancer screening." Cancer, 72(3), 1056-1060.
26. D. T. Davis, A. Bustances, C. P. Brown, G. Wolde-Tsadik, E. W. Savage, X. Cheng, and L. Howland (1994). "The urban church and cancer control: A source of social influence in minority communities," Public Health Reports, 109(4), 500-508.
27. N. Duan, S. A. Fox, K. P. Derose, and S. Carson (2000). "Maintaining mammography adherence through telephone counseling in a church-based trial," American Journal of Public Health, 90(9), 1468-1471.

Resources on Cancer

1. American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329-4251 (800-ACS-2345, www.cancer.org ) is a nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing and diminishing suffering from cancer through research, education, advocacy, and service.

2. Candlelighters Childhood Cancer Foundation, 7910 Woodmont Avenue, Suite 460, Bethesda, MD 20814 (800-366-2223; www.candlelighters.org ) was founded in 1970 as an international foundation with more than 400 groups. It offers support for parents of children and adolescents with cancer, their family members, and adult survivors of childhood cancer. Health and education professionals are also welcomed as members.

3. Leukemia Society of America, Family Support Group Program, 600 Third Avenue, 4th floor, New York, NY 10016 (212-450-8834; www.leukemia.org ) is a national program of 125 professionally run groups, founded in 1949. It offers mutual support for patients, family members, and friends coping with leukemia, lymphoma, multiple myeloma, and Hodgkin's Disease.

4. Make Today Count, c/o Mid-America Cancer Center, 1235 East Cherokee Street, Springfield, MO 65804-2263 (800-432-2273) was founded in 1974 and provides self-help support groups in nearly 200 communities for persons facing a life-threatening illness. It is also open to relatives and friends.

5. National Coalition for Cancer Survivorship, 1010 Wayne Avenue, Suite 505, Silver Spring, MD 20910 (888-650-8868, www.cansearch.org ) was founded in 1986 as a national grassroots network that works on behalf of persons with all types of cancer. Its mission is to strengthen and empower cancer survivors and advocate for policy issues. It provides information on employment and insurance issues, referrals, and publications.

6. Y-ME National Breast Cancer Organization, 212 West Van Buren Street, Chicago, IL 60607-3908, (800-221-2141, 24 hrs., or Spanish, 800-986-9505, 24 hrs.; www.y-me.org ) is a national organization with 23 affiliated groups founded in 1978. It provides information and peer support for breast cancer patients and their families during all stages of the disease. It also offers community outreach to educate people on early detection.

7. Us Too, International, 930 North York Road, Suite 50, Hinsdale, IL 60521-2993 (800-808-7866; www.ustoo.com ) is an international organization founded in 1990 with more than 500 affiliated groups. It offers mutual support, information, and education for persons with prostate problems (including cancer) and their families and friends.

8. The Human Side of Cancer: Living with Hope, Coping with Uncertainty (Harper Collins, 2000) is a new book for those with cancer and their caregivers, by Sheldon Lewis and Jimmie Holland, a long-time chief of the Psychiatry Service at Memorial Sloan-Kettering Cancer Center. This very useful and complete volume gives straightforward advice gleaned from counseling patients for 30 years.

How Faith and Science-based Research Relate to One Another

The debate about the use of the scientific process in the practice of ministry has unfortunately often generated more heat than light in the faith community.

Those in ministry have often not understood that science and faith are different enterprises, that "science" and "art" are overlapping processes, and that both science and ministry are means and not ends in themselves.

It is impossible for science and faith to be antithetical because they are two completely different enterprises. The basic distinction is that faith is a set of beliefs, while science is a process. One could say that faith is knowledge, while science is a way to obtain knowledge. Faith is an end.

Science is a means in the same way that a theological education is a means. One can talk about doing science just as one can talk about doing theology. On the other hand, a person would not talk about doing faith.

An example of misunderstanding these concepts occurs when the scientific process that is used to show that religious belief or practice helps people is confused with using a scientific process to challenge the existence of God. Whether or not God exists is a matter of faith, not subject to scientific proof. The effect of faith or religious practice on people's lives can be described by science, irrespective of one's faith claims.

The reality is that we all do science every day. It is a part of the way we are taught to approach our world and to communicate with one another. When we think or talk about lengths or weights or anything else where individual words have concrete equivalents, we are doing science.

Science has been and continues to be a major tool of the religious enterprise. We use science and the knowledge it has produced to build houses of worship and to determine how best to communicate our faith to our children in age-appropriate ways.

More recently, the scientific process has helped us understand disease, especially psychological disease, in ways that have helped clergy counsel congregants.

Scientific language is a universally understood means of communication in our culture. To ignore the scientific process as a way to communicate what we are about or even as a way to maximize the effectiveness of what we do is to surrender a major tool available for achieving the goals of ministry.

To enter the world of health care and not be able to speak in the language of science is like undertaking missionary work in a foreign country without speaking the language. There will be a few who understand, but the work will largely be ineffective because of the language barrier.