title: Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning.
abstract: OBJECTIVE
  Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model.
  
  
  METHODS
  Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis, M=19). Participants completed measures of SpWB (functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp)) and HRQL (functional assessment of cancer therapy-colorectal) in both studies. Measures of general distress (profile of mood states-short form) and cancer-specific distress were also completed in study 1 and study 2, respectively.
  
  
  RESULTS
  After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace.
  
  
  CONCLUSIONS
  This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.
authors.affiliation: Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, 625 North Michigan Ave., 27th Floor, Chicago, IL 60611, USA. j-salsman@northwestern.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Salsman
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Yost
authors.forename: Dee W
authors.initials: DW
authors.lastname: West
authors.forename: David
authors.initials: D
authors.lastname: Cella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015179:Colorectal Neoplasms / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D029181:Spirituality; D013315:Stress, Psychological / Q000209:etiology; D017741:Survivors
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