These results indicated the necessity for providers to address the concerns of AYAs with cancer, including those of a spiritual nature.
Study results published in JAMA Network Open found that multiple aspects of religion and spirituality were associated with anxiety, depression, and fatigue among adolescent and young adults (AYAs) with cancer, all of which were indirectly associated with their sense of meaning and peace.
Researchers indicated that though these results do not establish a causal direction, future research based on this study should evaluate the extent to which religion and spirituality represent a novel and potentially efficacious focus for intervention development to improve quality of life for AYAs following a diagnosis of cancer.
“Meaningful conclusions can be drawn from this study, moving the state of the science of spirituality forward,” the authors wrote. “Meaning-making is a complex but modifiable process. Clinical application of these findings could facilitate further integration of religious considerations and meaning-making into pediatric palliative care, as has been demonstrated with adults.”
In this cross-sectional study, researchers used baseline data from an ongoing 5-year randomized clinical trial being conducted at 4 tertiary-referral pediatric medical centers in the US. Overall, 126 participants diagnosed with any form of cancer who were aged 14 to 21 years at enrollment were randomized.
Variables were obtained from the Brief Multidimensional Measurement of Religiousness/Spirituality, as well as the spiritual well-being subscales of the Functional Assessment of Chronic Illness Therapy. The predefined outcome variables were anxiety, depressive symptoms, fatigue, and pain interference from the Patient-Reported Outcomes Measurement Information System pediatric measures.
Structural equation modeling demonstrated that meaning and peace were inversely associated with anxiety (β = -7.94; 95% CI, -12.88 to -4.12), depressive symptoms (β = -10.49; 95%CI, -15.92 to -6.50), and fatigue (β = -8.90; 95% CI, -15.34 to -3.61). Moreover, feeling God’s presence daily was indirectly associated with anxiety (β = -3.37; 95% CI, -6.82 to -0.95), depressive symptoms (β = -4.50; 95% CI, -8.51 to -1.40), and fatigue (β = -3.73; 95% CI, -8.03 to -0.90) through meaning and peace.
Considering oneself to be very religious was also indirectly associated with anxiety (β = -2.81; 95% CI, -6.06 to -0.45), depressive symptoms (β = -3.787; 95% CI, -7.68 to -0.61), and fatigue (β = -3.11, 95% CI, -7.31 to -0.40) through meaning and peace. Even further, considering oneself to be very spiritual was indirectly associated with anxiety (β = 2.11; 95% CI, 0.05 to 4.95) and depression (β = 2.8, 95% CI, 0.07 to 6.29) through meaning and peace.
Notably, no associations were observed between spiritual scales and pain interference.
“We anticipated finding an association between spiritual constructs and [patient-reported outcomes; PROs] and did not find one. It is possible that no such association exists in this population. It may also be because of the way faith was operationalized,” the authors wrote. “Although comfort and strength of faith were not associated with the PROs measured, the actual importance of faith may be motivational, prohealthy behaviors that may relate to PROs. The current study also assessed how pain interferes with life and found no relationship with spiritual or religious variables.”
The investigators suggested that all pediatricians and adolescent medicine specialists practice primary palliative care to minimize the suffering of AYAs in any form. Though many providers may be reluctant to address these issues, the researchers indicated that AYAs want providers to address their concerns, including those of a spiritual nature.
“Specialty care addressing meaning and peace to improve outcomes may take several forms. Referrals to psychologists, who routinely deal with issues of spirituality, meaning, and health, may be appropriate,” the authors wrote. “Individual and group interventions addressing meaning for people with cancer have shown efficacy for increasing spiritual well-being and for decreasing anxiety, depression, and pain. Referrals for specialty spiritual care from clinically trained chaplains may also be beneficial.”
Grossoehme DH, Friebert S, Baker JN, et al. Association of Religious and Spiritual Factors With Patient-Reported Outcomes of Anxiety, Depressive Symptoms, Fatigue, and Pain Interference Among Adolescents and Young Adults With Cancer. JAMA Network Open. doi: 10.1001/jamanetworkopen.2020.6696.