Religiosity, spirituality, and quality of life in cancer patients: a literature reviewAbstract
This study intends to investigate how cancer affects one’s quality of life in the context of religion and spirituality using bibliometric analysis. Keyword-specific publishing trends are analyzed based on a search on the Scopus database. In total, 406 documents were considered in the final analysis. The review of the available literature focused on six primary themes: religion, spirituality, coping, depression, quality of life, optimism. Following that, a thorough examination of these cancer-related topics was conducted. As a result, spirituality, religion, and optimism paved the way for cancer therapy.
Keywords
Quality of life; Happiness; Health
Resumen
Este estudio tiene como objetivo identificar cómo el cáncer afecta la calidad de vida de una persona en el contexto de la religión y la espiritualidad a partir de un análisis bibliométrico. Las tendencias de publicación específicas desde las palabras clave se analizan en función de una búsqueda en la base de datos Scopus. Para el análisis final se consideraron 406 documentos. La revisión de la literatura disponible se centró en seis temas principales: religión, espiritualidad, afrontamiento, depresión, calidad de vida y optimismo. Después, se realizó un análisis en profundidad de estos temas relacionados con el cáncer. Los resultados demuestran que la espiritualidad, la religión y el optimismo allanaron el camino para el tratamiento del cáncer.
Palabras clave
Calidad de vida; Felicidad; Salud
Resumo
Este estudo objetiva investigar como o câncer afecta a qualidade de vida de uma pessoa no contexto da religião e da espiritualidade, utilizando uma análise bibliométrica. As tendências de publicação específicas por palavra-chave são analisadas com base numa pesquisa na base de dados Scopus. No total, 406 documentos foram considerados na análise final. A revisão da literatura disponível centrou-se em seis temas principais: religião, espiritualidade, enfrentamento, depressão, qualidade de vida e otimismo. Em seguida, procedeu-se a uma análise aprofundada destes temas relacionados com o cancro. Como resultado, a espiritualidade, a religião e o otimismo abriram o caminho para a terapia do cancro.
Palavras-chave
Qualidade de vida; Felicidade; Saúde
Patients with cancer often experience discomfort, especially in more severe stages of the disease. Pain is frequently so intense that it interferes with a patient’s functional abilities 1,2. Coping resources for patients with cancer have been studied, emphasizing individualized methods, including positivity, combating negative attitudes, or personality attributes such as consistency and attachment feelings 3-5. In numerous cultural contexts, religion has been investigated as a possible adaptive resource for cancer patients and survivors 6-8.
The prevalence of cancer and death rate is quickly increasing as a result of causes including aging populations and global population expansion. With around 18 million new cases each year worldwide, cancer is one of the most common diseases 9. Receiving a cancer diagnosis can cause a lot of pain and suffering, in addition to the disease development and the dying phase 10. By 2030, the number of cancer-related deaths is expected to reach 13 million per year 11. Such people may suffer distress in all aspects, including psychological or mental (depression or anxiety), physical (pain), social (loneliness or sense of isolation), and spiritual (purpose, meaning, and connections) 12,13.
While religion is founded on a common set of rituals and beliefs inside a social organization or institution 14, spirituality is more personalized and connected with transcendence and in the connection with a higher being, and connections that bring meaning and purpose 15. Patients with cancer should receive the treatment depending on the biopsychosocial spiritual paradigm 16. According to research, people living with a life-threatening disease who embrace a spiritual perspective find purpose, strength, and comfort 17.
Cancer diagnoses are terrifying for both patients and their families, who frequently provide care for them. People in some cultures and ethnic groups might not fully comprehend the origins or progression of cancer, making them uncertain as to whether the disease or treatment poses a risk to others as well, especially those close to them. Although patients receive comprehensive information on their malignancies nowadays, this may not always happen 18.
The role of religion in connection to one’s health, illness, and medical practice is gaining more attention. Cancer frequently causes the faith of patients who are already devout believers to grow even stronger, while also causing patients who are not as devout to occasionally seek out spirituality and build a bond and connection to higher powers. By examining the role of religion, researchers demonstrated that spiritual options can be beneficial in coping with the illness in the first year after a breast cancer diagnosis and can also regulate anxiety and sadness 19.
Given this context, this systematic review used bibliometric analysis to evaluate and identify the impact of religiosity and spirituality on the quality of life among patients with cancer.
Method
This systematic review followed the standard Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), namely: 1) identification; 2) screening; 3) eligibility using the inclusion criteria; and 4) assessment of the quality of the studies and detection of any possible bias.
The Scopus database was used for the search of articles published between 1996 and January 2023. The inclusion criteria included articles in English language only, articles that included patients with cancer in the general population, and that considered the role of spirituality or religiosity in the quality of life of the study population.
The search resulted in 486 documents, of which 80 were excluded due to not meeting the criteria, for 406 documents (358 articles; 40 reviews; four book chapters; and three conference papers) being included in the final study. Figure 1 provides the flowchart for the selection of studies.
Bias that may have occurred in the study since it might include the non-reporting of the studies that may not depict the positive pathway of spirituality in reducing the negative symptoms that may be caused by cancer (selective non-reporting bias).
Bibliometric analysis was used to evaluate the connections and effects of publications within the particular topic chosen using mathematical and statistical techniques.
The findings led to a detailed analysis of the search outcomes, in which a maximum number of article papers was found, followed by review papers and other different types of documents such as editorials, conference papers, short surveys, notes, etc.
Figure 2 shows the clusters and association of co-occurrence between keywords identified in the search. The visual representation shows 6 clusters corresponding to 6 contrasting colors, with important keywords being “religion,” “spirituality,” and “quality of life,” together with a link of curved lines that reveals an enumerator’s interest in the indicated themes regarding the already stated keywords. The author keywords tally is represented by the size of the node.
Discussion
Spirituality and religiosity are highly studied in relation to cancer, as many patients find a path to meaning and purpose in their lives with the help of such aspects. This bibliometric analysis may help researchers to understand the various other variables studied in relation to cancer, keeping in mind the major impact of religion and spirituality. The articles and reviews were thoroughly read, resulting in the six themes discussed below.
Theme 1: religiosity
Religion is a structured system of values, rituals, practices, and symbols intended to promote a feeling of closeness to something holy or transcendent, such as God, a higher power, or the truest reality/truth 20. Like religion, religiosity may be viewed as a relationship with the entire community, as well as a person’s solitary conduct. Fundamentally, the choice will be based on a person’s spiritual requirements, including the desire to belong to a group, the desire to advance society, and the need for social and emotional support 21. Religiosity can be a supplemental technique used by those who feel unwell and experience severe suffering and pain 22, assisting individuals and families when dealing with serious or protracted diseases 23.
Given that cancer frequently raises feelings connected to pain, terminality, and especially since we have little control or no control over such conditions 24, even people who do not have or reject religious and spiritual views or principles desire to talk about this dimension during their treatment. By offering emotional support, optimism, and a sense of meaning and purpose, positive religious coping, by far the most prevalent construct 25, may affect one’s long-term adaptation to sickness 26.
Theme 2: spirituality
Spirituality is the search for one’s unique knowledge of the answers to basic issues about life, including its purpose and connection to the holy or transcendental 20. Studies 27-29 demonstrate the usage of spiritual practices to grow, feel comfort, and get nearer to God in difficult times, which helps to promote a sense of calmness and tranquility when one experiences pain 30,31, a way to ask God for help to have strength and comfort in the situations that are being experienced 32; religiosity is a technique that enhances one’s psychological well-being 27, and that is used to try to deal with the grief that manifests during illness 33.
Hill and Pargament 34 argue that spirituality is the individualized and sentimental component of religion, which might include “an inner strength or an inside characteristic of a person,” which is also used to deal with significant stressors like breast cancer 35,36. Spirituality aids patients in adopting an optimistic outlook while dealing with a diagnosis 37. Incorporating spiritual care into clinical practice may have positive emotional effects on patients, as well as positive interpersonal effects on patient satisfaction and the patient-health provider relationship 38,39.
Enhancing coping, adjusting psychosocially to a cancer diagnosis, and positively changing behavior following a cancer diagnosis are some examples of positive psychosocial benefits and consequences of spirituality 37,40.
Theme 3: coping
Coping is another crucial element for the quality of life of people facing cancer. It is understood as the attitudes, beliefs, and actions that patients employ to deal with the demanding situations, conflicts, and issues encountered throughout cancer treatment progression. Coping techniques can be categorized into many categories such as problem-focused coping (which deals with problem-solving techniques, including planning, active coping, looking for supportive assistance, or suppressing emotions), and emotion-focused coping (which deals with adjustments in one’s emotional responses to circumstances and a variety of avoidant and defensive tactics, including turning to social or emotional support, religious guidance, or denial) 41.
Coping techniques play a key role in deciding how adaptive mechanisms are put into action after receiving a cancer diagnosis 42. Active coping is evident in non-cancer patients 43, and problem-focused coping mechanisms are more commonly seen in cancer patients 44.
According to research on specific coping techniques used by patients with cancer and their relationship to mental health outcomes, more active coping techniques (such as active problem-focused coping, positive reframing, and seeking support) are more beneficial to outcomes than the more passive techniques (such as denial and avoidance) 45,46.
Theme 4: quality of life
Quality of life is multifaceted and includes aspects of social, physical, and psychological function, as well as areas of health and well-being that contribute to a fulfilling and worthwhile life 47,48. Negative affect, positive affect, and life satisfaction are the three distinct elements of an individual’s subjective well-being 49. Life satisfaction relates to the cognitive-judgmental parts of quality of life, whereas positive and negative affect refer to its emotional aspects. Throughout their cancer journey, many women deal with some degree of psychosocial anguish, which may have a long-lasting effects on their ability to make wise treatment decisions and adhere to it, as well as on their psychosocial adjustment to cancer and their quality of life 35.
The presence of sorrow, despair, and anxiety is a significant risk factor for poor overall and domain-specific quality of life among patients with breast cancer 50-52. Patients who depend on God but are always involved in active coping cite improved health outcomes as a benefit more often, including quality of life 53,54. Lower quality of life levels haven been related to decreased levels of spiritual well-being 55.
Theme 5: depression
The cancer continuum is a time of potentially upsetting occurrences, where patients experience difficulties with adjusting to new lives during treatment 56. An especially disproportionate burden of spiritual obligations affect patients with cancer due to constant worry, despair, dread, and uncertainty feelings 57. Between 20% and 30% of cancer patients may, at any given moment, suffer clinically severe depression symptoms 58.
Worse clinical outcomes, such as greater depression rates, worse quality of life, and a heightened risk of mortality, have been linked to negative religious coping (e.g., battling with disbelief in spiritual/religious principles) 59. Female breast cancer patients have a significant prevalence of mental health issues, with anxiety and depression prevalence rates reaching 40% 60,61. A patient’s quality of life, perception of pain, adherence to therapy, self-care ability, duration of hospital stay, and even the course of the illness itself, are all negatively impacted by depression 62.
Theme 6: optimism
Along with spirituality, other advantageous traits that have been linked to improved health outcomes in recent years include optimism and social support 63. As a personal resource, optimism helps individuals stay upbeat and see the good in difficult situations. It also provides a more adaptable coping mechanism for situations in which it is impossible to manage unpleasant stimuli and shields people from the potential side effects of cancer therapy 64. More spiritually advanced patients with cancer are likely to seem more optimistic 19,65.
Study limitations
The literature search was constrained to a single database, namely Scopus. Alternative databases such as WOS and PubMed were not considered for the extraction of data.
Final considerations
This research aims to explore the impact of cancer on an individual’s quality of life within the realms of religion and spirituality, employing bibliometric analysis. The examination of existing literature delved into six key themes: religion, spirituality, coping, depression, quality of life, and optimism. The findings of this investigation revealed that individuals facing cancer encounter diverse mental health challenges, including anxiety and depression, coupled with certain physiological issues. Notably, spirituality, religiosity, and optimism emerged as crucial factors in addressing these challenges, contributing to treatment effectiveness and enhancing overall quality of life for cancer patients.
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Publication Dates
-
Publication in this collection
23 Sept 2024 -
Date of issue
2024
History
-
Received
17 Mar 2023 -
Reviewed
13 Oct 2023 -
Accepted
17 Oct 2023
