title: Positive changes, increased spiritual importance, and complementary and alternative medicine (CAM) use among cancer survivors.
abstract: OBJECTIVE
  Spirituality is an important component of the cancer experience. This study aims to assess characteristics of spiritual health following a cancer diagnosis, and evaluate the relationship between spiritual change and the use of complementary and alternative medicine (CAM) among a population-based cohort of cancer survivors.
  
  
  METHODS
  A mailed, cross-sectional survey was completed by 614 cancer survivors identified through the Pennsylvania Cancer Registry. All subjects were 3 to 4.5 years postdiagnosis. Relationships between various characteristics of spiritual health and CAM use were examined, along with clinical and sociodemographic factors.
  
  
  RESULTS
  Although large proportions of individuals reported that having cancer had positively affected their spiritual well-being (eg, 40.3% experienced highly positive spiritual changes, 68% felt a high sense of purpose, 75.9% reported being very hopeful), some individuals experienced negative spiritual change (36.1%) and continued to experience high levels of uncertainty (27.2%). In multivariate analyses, those survivors who felt spiritual life became more important (adjusted odds ratio [AOR] = 1.92, 95% confidence interval (CI) = 1.21-3.04, P = .006), or experienced positive changes resulting from the cancer experience (AOR = 1.99, 95% CI = 1.26-3.15, P = .003), were more likely to use CAM than those who stated otherwise.
  
  
  CONCLUSIONS
  Having cancer affects many different aspects of spiritual well-being, both positively and negatively. Positive changes and increased spiritual importance appear to be associated with the use of CAM. Prospective research is needed to test whether integrating CAM into conventional cancer care systems will facilitate positive, spiritually transformative processes among diverse groups of cancer survivors.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA. maoj@uphs.upenn.edu
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
authors.forename: Peter F
authors.initials: PF
authors.lastname: Cronholm
authors.forename: Emma
authors.initials: E
authors.lastname: Stein
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Straton
authors.forename: Steven C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
mesh_terms: D000368:Aged; D000529:Complementary Therapies / Q000379:methods* / Q000523:psychology* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D010414:Pennsylvania / Q000453:epidemiology; D011788:Quality of Life; D012042:Registries; D029181:Spirituality; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*