Spirituality in coping with pain in oncological patients: systematic review

Oliveira, Sharon Shyrley Weyll; Vasconcelos, Rayzza Santos; Amaral, Verônica Rabelo Santana; Sá, Katia Nunes

doi:10.5935/2595-0118.20200028

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REVIEW ARTICLE • BrJP 3 (2) • Jan-Mar 2020 • https://doi.org/10.5935/2595-0118.20200028 copy

Spirituality in coping with pain in oncological patients: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The relationship between spirituality and cancer coping is still a challenge for comprehensive health care. Therefore, it is necessary to analyze whether the level of spirituality directly interferes with clinical markers, such as pain intensity in people with cancer. The present study aims to investigate the relationship between spirituality and pain coping and the strategies used in adult cancer patients.

This is a systematic review, registered in the International Prospective Register of Systematic Reviews: CRD42018108835. The search was performed in Pubmed, Medline, LILACS, Scielo, and ScienceDirect databases until May 2019, available in all languages. The search strategy was defined for the PubMed database as a parameter: (neoplasms or cancer) AND (spirituality) AND (pain). Adults patients with cancer of both genders who faced pain were studied. Studies that did not address the pain associated with spirituality were excluded. Of the 588 studies found, 13 were eligible. Among these, nine studies showed that spirituality contributes to positive pain coping. Regarding the level of spirituality, higher spiritual well-being was associated with lower pain intensity in three studies. The spiritual strategies used were mindfulness, meditation, relaxation, prayer, support from religious leaders and members.

CONCLUSION:

Despite the few studies found, the findings broaden the knowledge about the positive relationship between spirituality and pain coping and underline the spiritual strategies for the management of this health condition in cancer patients.

Keywords:
Cancer Pain; Neoplasms; Spirituality

Authors	Country	Population			Design	Sample selection location
Authors	Country	n	Average ages (years)	Gender	Design	Sample selection location
Edman et al.²⁰20 Edman JS, Roberts RS, Dusek JA, Dolor R, Wolever RQ, Abrams DI. Characteristics of cancer patients presenting to an integrative medicine practice-based research networn. Integr Cancer Ther. 2014;13(5):405-10.	USA	353	55	F-76.4% M-23.6%	Cohort	Integrative Medicine Center
Silva et al.²¹21 Silva JO, Araújo VM, Cardoso BG, Cardoso MG. Spiritual dimension of pain and suffering control of advanced cancer patient. Case report. Rev Dor. 2015;16(1):71-4.	Brazil	1	43	F-100%	Case report	Home
Jafari et al.²²22 Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et al. Spiritual therapy to improve the spiritual well-being of iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:353262.	Iran	65	47.9	F-100%	Randomized Controlled Clinical Trial	Cancer reference hospital
Rabow and Knish²³23 Rabow MW, Knish SJ. Spiritual well-being among outpatients with cancer receiving concurrent oncologic and palliative care. Support Care Cancer. 2015;23(4):919-23.	USA	883	65.6	F-54.1% M-45.8%	Cross-sectional	Cancer care center
Buck and Meghani²⁴24 Buck HG, Meghani SH. Spiritual expressions of African Americans and whites in cancer pain. J Holist Nurs. 2012;30(2):107-16.	USA	42	57.5	F-52% M-48.	Cross-sectional	-
Bai et al.²⁵25 Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and quality of life in black patients with cancer pain. J Pain Symptom Manage. 2018;56(3):390-8.	USA	102	55.2	F-90% M-100%	Cross-sectional	Cancer hospital and Medical Center
Zavala et al.²⁶26 Zavala MW, Maliski SL, Kwan L, Fink A, Litwin MS. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psychooncology. 2009;18(7):753-61.	USA	86	-.	M-100%	Cross-sectional	Support program
Ando et al.²⁷27 Ando M, Morita T, Akechi T, Ito S, Tanaka M, Ifuku Y, et al. The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med. 2009;12(12):1091-4.	Japan	28	60	F-85.7% M-14.3%	Non-randomized clinical trial	General Hospital
Visser, de Jager Meezenbroek and Garssen²⁸28 Visser A, de Jager Meezenbroek EC, Garssen B. Does spirituality reduce the impact of somatic symptoms on distress in cancer patients? cross-sectional and longitudinal findings. Soc Sci Med. 2018;214:57-66.	Netherlands	660	(S1^* * Study 1 59) (S2 ^ Study 2 59)	(S1^* * Study 1 F-78% M-22% S2^ Study 2 F-73% M-27%	S1 ^* * Study 1 cross-sectional S2 ^ Study 2 longitudinal	Hospital and Institution of Radiotherapy
Mystakidou et al.²⁹29 Mystakidou K, Tsilika E, Parpa E, Pathiaki M, Patiraki E, Galanos A, et al. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Arch Psychiatr Nurs. 2007;21(3):150-61.	Greece		63.3	F-42.7% M-57.3%	Cross-sectional	Hospital - Palliative Care Unit
Jagannathan and Juvva³⁰30 Jagannathan A, Juvva S. Life after cancer in India: coping with side effects and cancer pain. J Psychosoc Oncol. 2009;27(3):344-60.	India	80	-	F-16.7% M-83.3%	Cross-sectional	Cancer Hospital - Ward
Furlan et al.³¹31 Furlan M, Bernardi J, Vieira AM, Santos MCC, Marcon SS. Percepção de mulheres submetidas à mastectomia sobre o apoio social. Ciência Cuid e Saúde. 2012;11(1):66-73.	Brazil	3	55	F-100%	Cross-sectional	Manoel Ribas Municipality - PR
Gielen, Bhatnagar and Chaturvedi³²32 Gielen J, Bhatnagar S, Chaturvedi SK. Prevalence and nature of spiritual distress among palliative care patients in India. J Relig Health. 2017;56(2):530-44.	India	300	-	F-48.3% M-50.7%	Cross-sectional	Hospital - Pain Clinic

Authors	Instruments		Methodological evaluation
	Pain	Spirituality
Edman et al.²⁰20 Edman JS, Roberts RS, Dusek JA, Dolor R, Wolever RQ, Abrams DI. Characteristics of cancer patients presenting to an integrative medicine practice-based research networn. Integr Cancer Ther. 2014;13(5):405-10.	Numeric scale	Guiding questions	5/9 - moderate
Silva et al.²¹21 Silva JO, Araújo VM, Cardoso BG, Cardoso MG. Spiritual dimension of pain and suffering control of advanced cancer patient. Case report. Rev Dor. 2015;16(1):71-4.	Visual analog scale	Not used	3/8 - low
Jafari et al.²²22 Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et al. Spiritual therapy to improve the spiritual well-being of iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:353262.	QLQ-C30	FACIT - Sp	15/28 - moderate
Rabow and Knish²³23 Rabow MW, Knish SJ. Spiritual well-being among outpatients with cancer receiving concurrent oncologic and palliative care. Support Care Cancer. 2015;23(4):919-23.	Assessment System	Are You at Peace?	3/8 - low
Buck and Meghani²⁴24 Buck HG, Meghani SH. Spiritual expressions of African Americans and whites in cancer pain. J Holist Nurs. 2012;30(2):107-16.	Semi-structured interview		2/8 - low
Bai et al.²⁵25 Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and quality of life in black patients with cancer pain. J Pain Symptom Manage. 2018;56(3):390-8.	Brief Pain Inventory	FACIT - Sp	3/8 - low
Zavala et al.²⁶26 Zavala MW, Maliski SL, Kwan L, Fink A, Litwin MS. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psychooncology. 2009;18(7):753-61.	SF-12	FACIT - Sp	5/8 - moderate
Ando et al.²⁷27 Ando M, Morita T, Akechi T, Ito S, Tanaka M, Ifuku Y, et al. The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med. 2009;12(12):1091-4.	Numeric scale	FACIT - Sp	13/28 - low
Visser, by Jager Meezenbroek and Garssen²⁸28 Visser A, de Jager Meezenbroek EC, Garssen B. Does spirituality reduce the impact of somatic symptoms on distress in cancer patients? cross-sectional and longitudinal findings. Soc Sci Med. 2018;214:57-66.	Visual analog scale and QLQ-30	SAIL	S1^* * Study 1 4/8 - moderate S2^ Study 2 5/9 - moderate
Mystakidou et al.²⁹29 Mystakidou K, Tsilika E, Parpa E, Pathiaki M, Patiraki E, Galanos A, et al. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Arch Psychiatr Nurs. 2007;21(3):150-61.	BPI	SIBS	4/8 - moderate
Jagannathan and Juvva³⁰30 Jagannathan A, Juvva S. Life after cancer in India: coping with side effects and cancer pain. J Psychosoc Oncol. 2009;27(3):344-60.	Semi-structured interview		1/8 - low
Furlan et al.³¹31 Furlan M, Bernardi J, Vieira AM, Santos MCC, Marcon SS. Percepção de mulheres submetidas à mastectomia sobre o apoio social. Ciência Cuid e Saúde. 2012;11(1):66-73.	Semi-structured interview		3/8 - low
Gielen, Bhatnagar and Chaturvedi³²32 Gielen J, Bhatnagar S, Chaturvedi SK. Prevalence and nature of spiritual distress among palliative care patients in India. J Relig Health. 2017;56(2):530-44.	Numeric scale	Spirituality quest. Indian Palliative. Care Patients	5/8 - moderate

Authors	Outcomes	Spiritual strategies
Edman et al.²⁰20 Edman JS, Roberts RS, Dusek JA, Dolor R, Wolever RQ, Abrams DI. Characteristics of cancer patients presenting to an integrative medicine practice-based research networn. Integr Cancer Ther. 2014;13(5):405-10.	Average pain was found more in cancer patients who sought spirituality than those who did not seek this care.	---
Silva et al.²¹21 Silva JO, Araújo VM, Cardoso BG, Cardoso MG. Spiritual dimension of pain and suffering control of advanced cancer patient. Case report. Rev Dor. 2015;16(1):71-4.	Spirituality was essential for the positive coping of pain.	Shared reading of the word of God (Bible), worship, and hymns of praise.
Jafari et al.²²22 Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et al. Spiritual therapy to improve the spiritual well-being of iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:353262.	Participation in a spiritual therapy program is associated with better coping with pain.	Relaxation and meditation, performed by spiritual healers.
Rabow and Knish²³23 Rabow MW, Knish SJ. Spiritual well-being among outpatients with cancer receiving concurrent oncologic and palliative care. Support Care Cancer. 2015;23(4):919-23.	High spiritual well-being helps in coping with pain.	Guidelines for spiritual well-being.
Buck and Meghani²⁴24 Buck HG, Meghani SH. Spiritual expressions of African Americans and whites in cancer pain. J Holist Nurs. 2012;30(2):107-16.	The use of spirituality in coping with pain is prevalent in African American and white ethnicities.	---
Bai et al.²⁵25 Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and quality of life in black patients with cancer pain. J Pain Symptom Manage. 2018;56(3):390-8.	Spirituality is associated with better coping with pain.	---
Zavala et al.²⁶26 Zavala MW, Maliski SL, Kwan L, Fink A, Litwin MS. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psychooncology. 2009;18(7):753-61.	High levels of faith, combined with a high sense of peace and meaning, have resulted in better coping with pain.	---
Ando et al.²⁷27 Ando M, Morita T, Akechi T, Ito S, Tanaka M, Ifuku Y, et al. The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med. 2009;12(12):1091-4.	Spiritual well-being is associated with coping with pain.	Meditation (mindfulness).
Visser, de Jager Meezenbroek and Garssen²⁸28 Visser A, de Jager Meezenbroek EC, Garssen B. Does spirituality reduce the impact of somatic symptoms on distress in cancer patients? cross-sectional and longitudinal findings. Soc Sci Med. 2018;214:57-66.	Patients coped with pain through spirituality in a moderate way.	---
Mystakidou et al.²⁹29 Mystakidou K, Tsilika E, Parpa E, Pathiaki M, Patiraki E, Galanos A, et al. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Arch Psychiatr Nurs. 2007;21(3):150-61.	There was no correlation between spirituality and pain.	---
Jagannathan and Juvva³⁰30 Jagannathan A, Juvva S. Life after cancer in India: coping with side effects and cancer pain. J Psychosoc Oncol. 2009;27(3):344-60.	The patients had a firm faith in the doctor, and the population with the lowest income used prayer and meditation strategies.	Prayer, meditation, and keeping faith in the doctor.
Furlan et al.³¹31 Furlan M, Bernardi J, Vieira AM, Santos MCC, Marcon SS. Percepção de mulheres submetidas à mastectomia sobre o apoio social. Ciência Cuid e Saúde. 2012;11(1):66-73.	Patients used spirituality to cope positively with pain.	Advice from members and religious leaders and prayer.
Gielen, Bhatnagar and Chaturvedi³²32 Gielen J, Bhatnagar S, Chaturvedi SK. Prevalence and nature of spiritual distress among palliative care patients in India. J Relig Health. 2017;56(2):530-44.	Spirituality is a good mechanism for coping with pain.	---

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[1] Correspondence to: Sharon Shyrley Weyll Oliveira, Univ. Estadual de Santa Cruz - Departamento de Ciências da Saúde-Campus Soane Nazaré de Andrade, Rod. Jorge Amado, Km 16 - Salobrinho, 45662-900 Ilhéus, BA, Brasil. E-mail: sharonweyll@gmail.com

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Spirituality in coping with pain in oncological patients: systematic review

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: