title: The relationship of spiritual concerns to the quality of life of advanced cancer patients: preliminary findings.
abstract: OBJECTIVE
  Religion and/or spirituality (R/S) have increasingly been recognized as key elements in patients' experience of advanced illness. This study examines the relationship of spiritual concerns (SCs) to quality of life (QOL) in patients with advanced cancer.
  
  
  METHODS
  Patients were recruited between March 3, 2006 and April 14, 2008 as part of a survey-based study of 69 cancer patients receiving palliative radiotherapy. Sixteen SCs were assessed, including 11 items assessing spiritual struggles (e.g., feeling abandoned by God) and 5 items assessing spiritual seeking (e.g., seeking forgiveness, thinking about what gives meaning in life). The relationship of SCs to patient QOL domains was examined using univariable and multivariable regression analysis.
  
  
  RESULTS
  Most patients (86%) endorsed one or more SCs, with a median of 4 per patient. Younger age was associated with a greater burden of SCs (β = -0.01, p = 0.006). Total spiritual struggles, spiritual seeking, and SCs were each associated with worse psychological QOL (β = -1.11, p = 0.01; β = -1.67, p < 0.05; and β = -1.06, p < 0.001). One of the most common forms of spiritual seeking (endorsed by 54%)--thinking about what gives meaning to life--was associated with worse psychological and overall QOL (β = - 5.75, p = 0.02; β = -12.94, p = 0.02). Most patients (86%) believed it was important for health care professionals to consider patient SCs within the medical setting.
  
  
  CONCLUSIONS
  SCs are associated with poorer QOL among advanced cancer patients. Furthermore, most patients view attention to SCs as an important part of medical care. These findings underscore the important role of spiritual care in palliative cancer management.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Winkelman
authors.forename: Katharine
authors.initials: K
authors.lastname: Lauderdale
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Phelps
authors.forename: John R
authors.initials: JR
authors.lastname: Peteet
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: VanderWeele
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
mesh_terms: D000368:Aged; D001900:Boston; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D029181:Spirituality