Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship: A Pilot Study

What factors influence thriving in adolescent and young adult cancer patients? A focus on psychological health, biological markers, and quality of life

PURPOSE

This study explores the role of psychological health, biological markers, and quality of life (QoL) in influencing thriving - defined as resilience and enhanced well-being - among adolescent and young adult (AYA) cancer patients.

METHODS

A total of 148 AYA cancer patients were assessed for psychological health indicators (anxiety, depression, character strengths), physiological markers (cortisol awakening response [CAR], melatonin), and QoL. Thriving levels were evaluated using ordinary least squares regression and quantile regression to identify predictors across different thriving percentiles.

RESULTS

Psychological health was the strongest predictor of thriving. Depression negatively impacted thriving at lower levels, while inquisitiveness consistently enhanced it. CAR and melatonin played roles at higher and median thriving levels, respectively, and QoL was most influential at lower levels. These factors collectively explained 23.0% of the variance in thriving scores.

CONCLUSIONS

This study highlights depression, inquisitiveness, CAR, and QoL as key factors influencing thriving in AYA cancer patients. Depression affects thriving at lower levels, inquisitiveness enhances thriving consistently, CAR is significant at higher levels, and QoL is crucial at lower levels. These findings underscore the need for tailored interventions to support thriving across varying levels of adaptation.

Effect of Qigong exercise on quality of life and cortisol in patients with cancer: a non-randomized controlled trial

PURPOSE

The aim of this study was to investigate the effect of a 6-month Guolin Qigong on quality of life and serum cortisol among patients with cancer.

METHODS

This study was a two-arm and non-randomized controlled trial. Forty-nine patients with cancer who were over 18 years of age and diagnosed with cancer were enrolled in this study and assigned to either the Guolin Qigong intervention group (IG, n = 26) or the usual care group (UC, n = 23) for 6 months. During the Guolin Qigong exercise, the participants completed a training program consisting of five sessions per week and 40-60 min per session. The UC group maintained their usual lifestyle. The main outcomes included self-reported quality of life (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and well-being (General Well-Being Schedule, GWB). The second outcome was stress-related hormone serum cortisol measured by enzyme-linked immunosorbent assay. All measurements were assessed at baseline and 6 months.

RESULTS

Forty-nine participants (57.4% females, 26 in IG vs 23 in UC) were enrolled in the study, and forty-five participants completed all tests after the 6-month intervention (48.9% females, 25 in IG vs 20 in UC). Compared to the UC group, quality of life, physical function, and pain significantly improved in the IG (P < 0.05). Similarly, some sub-scales of GWB improved in the IG group compared to the UC group, especially for cheerful distracted and overall score (P < 0.05). However, there was no significant difference in serum cortisol between the two groups either at baseline or after intervention (P > 0.05).

CONCLUSIONS

Six-month Guolin Qigong could improve quality of life, physical function, and pain, and have a beneficial effect on the well-being of cancer patients. Further studies are warranted to confirm these results.

The associations of spirituality and Hispanic ethnicity with neuroendocrine biomarkers among patients with colorectal cancer

OBJECTIVE

Dealing with cancer evokes not only physical and emotional distress, but may also promote resilience through spirituality. Patients with cancer are vulnerable to neuroendocrine dysregulation. This longitudinal observational study examined the degree to which spirituality was associated with neuroendocrine biomarkers and the moderating role of Hispanic ethnicity.

METHODS

Participants were adults who were recently diagnosed with colorectal cancer (n = 81, 55 years old, 66% male, 63% Hispanic, 72% advanced cancer, 7 months post-diagnosis). The domains of spirituality (faith, meaning, and peace) and ethnicity (Hispanic vs. non-Hispanic) were self-reported. Cortisol and alpha amylase (sAA) were assayed from saliva samples collected at waking and bedtime on seven consecutive days. Mean levels at waking and bedtime, and diurnal slopes over seven days were calculated. Age and cancer stage were covariates.

RESULTS

Overall, patients reported moderate to high levels of spirituality. General linear modeling revealed that greater faith was associated with higher levels of sAA at waking and bedtime as well as more blunted diurnal pattern of sAA only among Hispanic patients (p ≤ .045). Greater peace was associated with steeper diurnal pattern of sAA, regardless of ethnicity (B = 0.021, p = .005). Meaning and cortisol were not significantly associated with study variables.

CONCLUSIONS

Findings indicate that presence of peace facing a cancer diagnosis associated with neuroendocrine regulation, whereas drawing on one's faith, particularly among Hispanic patients, associated with neuroendocrine dysregulation during the first months after the diagnosis. Further investigations of psychobiobehavioral moderators and mediators for healthy neuroendocrine functioning among patients with cancer are warranted.

The impact of fear of cancer recurrence on the quality of life of breast cancer patients: A longitudinal study of the mediation effect of cortisol and hope

OBJECTIVE

This longitudinal study sought to explore the impact of cortisol and hope levels on Fear of Cancer Recurrence (FCR) and Quality of Life (QOL) in a cohort of 552 breast cancer patients from three centers in Wuhan City.

METHOD

A longitudinal study involving 552 breast cancer patients from three centers in Wuhan City utilized Chinese versions of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Herth Hope Index (HHI), and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Cortisol levels were measured thrice daily, and data was collected longitudinally three times. Data analysis was conducted using SPSS 26.0 and Mplus 8.3, employing a longitudinal path model constructed via the cross-lagged method.

RESULTS

The results showed there were significant correlations between FCR, cortisol levels, and QOL at different time points. A significant mediating model was found with outcomes related to hope levels. Specifically, FCR predicted a decrease in hope levels (β = -0.163, p < 0.001), which in turn led to a decrease in overall QOL (β = -0.078, p < 0.001), with a mediation effect accounting for 10.34%. Although there were correlations between FCR, cortisol levels, and QOL at different time points, further analysis revealed that cortisol levels did not exhibit a mediating effect between the two (95% confidence interval: -0.002 to 0.001).

CONCLUSION

This study demonstrated there were significant correlations among FCR, QOL, and hope levels. Considering hope as a crucial mediator between FCR and QOL, potential intervention strategies for optimizing the QOL of breast cancer patients are proposed.

Inflammatory Determinants and Associated Morbidity in Hemodialysis Patients

Hemodialysis deteriorates patients' physical, metabolic, and mental status. Clinical outcomes derived from inflammation determine a worse status but are less frequently identified. The objective of the study was to identify inflammatory determinants and the effect of SNP-related serum IL-6 and IL-10 levels on associated morbidity in hemodialysis. A sample of hemodialysis patients at IMSS Regional Hospital No.46 in Guadalajara (n = 85) were tested using the Malnutrition Inflammation Score (MIS) and Patient Health Questionnaire-9 (PHQ-9) to assess the associated morbidity. Serum cytokine levels were quantified by enzyme-linked immunosorbent assay (ELISA). The restriction fragment length polymorphism (RFLP) technique was used for analysis of IL-6-572C/G and IL-10-1082A/G. Using data visualization methods, we identified relevant determinants of inflammation. A simple regression model was constructed between predictors and targets with genotypes as covariates. Results showed malnutrition in 85.9% of patients and depressive symptoms in 50.6%. IL-10 was the most relevant inflammatory determinant, with regression coefficients (R2) between 0.05 and 0.11. The GG genotype of IL-10-1082 A/G evinced small effect on both clinical outcomes (δ of 0.35 and 0.37, respectively). Hemodialysis increases the associated morbidity, cytokines act as inflammatory determinants, and genetic variability contributes to the severity of clinical outcomes. Further studies need to refine the causal relationship between inflammation and CKD.

What Aspects of Religion and Spirituality Affect the Physical Health of Cancer Patients? A Systematic Review

In recent years, the literature on the relationship between religion and spirituality (R/S) and the health of cancer patients has been flourishing. Although most studies focus on mental health, many study the physical health of these individuals. In order to summarize the findings of these studies, we reviewed the most recent research on this subject using the PubMed and PsycInfo databases. The objective of this systematic review was to recognize the primary R/S variables studied in research on physical health in cancer contexts. We found that spiritual well-being was the most-researched variable in studies of these characteristics, followed by R/S struggles and other variables such as religious coping; religious commitment or practice; or self-rated R/S. In general, R/S seems to have a positive association with the physical health of cancer patients, although the results are quite heterogeneous, and occasionally there are no relationships or the association is negative. Our results may assist in improving interventions that include spirituality in clinical settings as well as the development of holistic approaches, which may have a positive impact on the quality of life and well-being of cancer patients.

Nursing care based on the Support-Based Spiritual Care Model increases hope among women with breast cancer in Iran

PURPOSE

Taking care of cancer patients and treating them are among major challenges in the field of health. Several studies have shown that promotion of hope is an efficient strategy for effectively treating this group of patients, reducing their symptoms, and improving the quality of their life. It seems that spiritual care can boost hope in these patients. This study aims to determine the effects of nursing care based on the Support-Based Spiritual Care Model on boosting hope among women with breast cancer.

METHODS

In this controlled clinical trial, 72 patients with breast cancer were selected through consecutive sampling and randomly assigned to two control and intervention groups (n = 36 in each group) based on four randomized blocks. The intervention was carried out based on the Support-Based Spiritual Care Model for the patients and their main caregivers in six sessions. Besides, the Snyder's hope scale was completed before and 1 month after the intervention by the participants in the intervention and control groups.

RESULTS

The results of the independent samples t-test showed no significant difference in the mean scores of hope between the intervention and control groups before the intervention (P > 0.05). However, after the intervention, the mean scores of hope for the intervention and control groups were 46.71 ± 4.61 and 40.40 ± 5.42, respectively, showing a significant intergroup difference as verified by the independent samples t-test (P < 0.05).

CONCLUSION

According to the results of this study, providing nursing care based on the Support-Based Spiritual Care Model can raise hope in patients with breast cancer.

CLINICAL IMPLICATIONS

Healthcare professionals can boost hope in cancer patients through proper planning and adequate support in providing nursing care based on the proposed model.

Expanding Application of the Long-Term Quality of Life Instrument to the Population of Women Undergoing Treatment of Advanced Breast Cancer

BACKGROUND

The Long-Term Quality of Life (LTQL) instrument was designed for female cancer survivors who have completed treatment and includes an existential spirituality subscale that is omitted in many other quality of life scales. Women with advanced breast cancer are now living longer, while also expressing greater spiritual concerns.

OBJECTIVE

The objective of this analysis was to test the psychometric properties of the LTQL among women undergoing treatment of advanced breast cancer.

METHODS

This secondary analysis was based on a sample of 385 women. Validity was evaluated using a confirmatory factor analysis and associations with Functional Assessment of Cancer Therapy-Breast Cancer. Internal consistency reliability was assessed using Cronbach's α for each subscale of the LTQL.

RESULTS

The mean age was 56 years, 84% of participants were white, and 69% had metastasis. Model fit indices for the confirmatory factor analysis were acceptable, with the root mean square error of approximation of 0.076 (90% confidence interval, 0.071-0.081) and a comparative fit index of 0.91. The LTQL subscale scores were significantly correlated with the subscales of the Functional Assessment of Cancer Therapy-Breast Cancer of similar conceptual content. Internal consistency reliability for the subscales ranged from 0.80 to 0.86.

CONCLUSIONS

The factor structure of the LTQL was consistent with previous findings in long-term female cancer survivors. The instrument has adequate psychometric properties for use among women with advanced breast cancer.

IMPLICATIONS FOR PRACTICE

The LTQL can be used to assess the physical, psychosocial, and existential spiritual domains of quality of life among women with advanced breast cancer as well as in long-term female cancer survivors.

Rural-Urban Differences in Neuroimmune Biomarkers and Health Status Among Women Living With Breast Cancer

BACKGROUND

Because of chronic emotional and psychosocial stressors following breast cancer (BC) treatment, BC survivors are at risk of neuroimmune dysfunction in survivorship. Rural BC survivors experience more health disparities than urban BC survivors. Rural-urban residence as a variable on neuroimmune activity in extended BC survivorship continuum has not been explored.

OBJECTIVE

To report the feasibility of studying relationships between neuroimmune activity and perceived health in rural and urban BC survivors.

METHODS

Data from a pilot study of BC survivors (n = 41) were analyzed. Participants were rural (n = 16) and urban (n = 25). Participants completed Medical Outcomes Study Short-Form Version 2 Health Survey questionnaires and provided salivary specimens for analysis of salivary α-amylase (sAA), cortisol, and interleukin 6 (IL-6). Rural-Urban Commuting Area Codes were used to determine rural or urban residence.

RESULTS

Differences in immune activity were observed between rural and urban BC survivors (U = 34, P < .05). No rural-urban group differences in neuroendocrine activity were observed. Relationships were observed between perceptions of mental health and sAA (P < .05) in rural BC survivors and between perceptions of mental health and IL-6 (P < .05) in urban BC survivors. Interleukin 6 was positively associated with perceptions of physical health (P < .05) in rural BC survivors.

CONCLUSION

Pilot data suggest rural-urban residence may be a factor in relationships between neuroimmune function (ie, sAA and IL-6) and perceived health status, particularly social functioning in women with BC. Additional studies with powered designs are indicated.

IMPLICATIONS FOR PRACTICE

Although evidence is limited, data support the feasibility of studying relationships between sAA and IL-6 and perceptions of health in women with BC.

Religion, spirituality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women

Background

Religion and spirituality (R/S) are important resources for coping with stress and are hypothesized to influence health outcomes via modulation of the hypothalamic-pituitary-adrenal (HPA) axis, though this has not been evaluated extensively. In this study, we examined associations between several measures of religiosity or spirituality (R/S) and three HPA axis biomarkers: cortisol, dehydroepiandrosterone (DHEA), and cortisol:DHEA ratio.

Methods

Sample included 216 female postmenopausal Nurses’ Health Study II participants who provided up to five timed saliva samples: immediately upon awakening, 45 min, 4 h, and 10 h after waking, and prior to going to sleep during a single day in 2013. Multivariable-adjusted linear mixed models with piecewise cubic spline functions and adjustment for potential covariates were used to estimate the cross-sectional associations of eight R/S measures with diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio.

Results

There was little evidence of association between the eight R/S measures analyzed and diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio. Women who reported that R/S was very involved in understanding or dealing with stressful situations had slower night rise in cortisol than those who did not. Greater levels of religious struggles were associated with higher cortisol levels throughout the day. Higher non-theistic daily spiritual experiences scores were associated with slower DHEA night rise, and a higher cortisol/DHEA ratio upon waking and at night. However, these associations were significantly attenuated when we excluded women reporting bedtimes at least 30 min later than usual.

Conclusion

Observed associations were driven by those with late sleep schedules, and given the number of comparisons made, could be due to chance. Future research using larger, more diverse samples of individuals is needed to better understand the relationship between R/S and HPA axis biomarkers.

•

We examined the influence of religion and spirituality on HPA-axis diurnal rhythms of cortisol, DHEA, and their ratio.

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Religious coping, religious struggles, and non-theistic DSES were associated with modest alterations in HPA axis rhythms.

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Observed associations were driven by those with late sleep schedules.

Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study

PURPOSE

Chronic stress is associated with neuroimmune inflammation and adverse outcomes in breast cancer survivors. Some breast cancer survivors rely on religious and spiritual (R/S) variables to manage stress after breast cancer treatment. A spiritually based psychoneuroimmunological (PNI) model of health suggests that R/S variables influence neuroimmune activity; however, these associations are not well-established. A pilot study was conducted to assess the feasibility of studying associations between R/S variables and neuroimmune biomarkers in breast cancer survivors.

METHOD

Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) were sampled among women previously treated for breast cancer. The primary aim was to assess feasibility and acceptability of the sampling protocol. A secondary aim explored associations between sAA, IL-6, R/S variables, and health outcomes.

RESULT

Forty-one women completed the study. Biomarker sampling yielded 246 acceptable specimens used for analysis. SAA was detectable in 96% of specimens and IL-6 was detectable in 44% of specimens. The R/S variables with the strongest associations to sAA were spiritual self-rank (rs = .39; p < .05) and forgiveness (rs = .40; p < .05). The R/S variable with the strongest association to salivary IL-6 was positive congregational support (rs = .42; p < .05).

CONCLUSION

Feasibility and acceptability of the sampling protocol were confirmed. Reference ranges for sAA and IL-6 for female breast cancer survivors are presented. Results suggest that spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based PNI model of health. Findings lay the foundations for future R/S-based interventions to promote health and well-being in breast cancer survivors.

Effectiveness of Best Possible Self and Gratitude Writing Intervention on Mental Health Among Parents of Troubled Children

The current study was conducted to determine if journaling focused on best possible self and gratitude could improve physiological and mental health outcomes in a sample of affected parents who have teenagers or adult children with emotional and/or behavioral problems. A quasi-experimental, pretest/posttest design was used with blood pressure measure and saliva collection at baseline, after a first journal entry, and after a 6-week journaling intervention. Among 42 parents who completed the pretest, 37 (88.1%) completed the 6-week guided journal and posttest. Findings of paired t tests indicated a statistically significant decrease in stress level (p < 0.001), anxiety (p < 0.001), somatic symptoms (p = 0.001), and depression (p = 0.01), as well as increased gratitude (p = 0.012) among participants. Repeated measures analysis of variance indicated the journaling intervention showed a statistically significant reduction in systolic blood pressure (p = 0.016), but not diastolic blood pressure, or cortisol level at the three testing times. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 31-39.].

The Use of Prayer During Life-Threatening Illness: A Connectedness to God, Inner-Self, and Others

To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.

Rigor and Reproducibility: A Systematic Review of Salivary Cortisol Sampling and Reporting Parameters Used in Cancer Survivorship Research

Salivary cortisol is a commonly used biomarker in cancer survivorship research; however, variations in sampling protocols and parameter reporting limit comparisons across studies. Standardized practices to provide rigor and reproducibility of diurnal salivary cortisol sampling and reporting are not well established. Previous systematic reviews examining relationships between diurnal salivary cortisol and clinical outcomes have resulted in mixed findings. It remains unclear which sampling protocols and reporting parameters offer the greatest utility for clinical research. This review examines diurnal salivary cortisol sampling protocols and reporting parameters to evaluate whether a standardized approach is recommended. A comprehensive search of intervention studies among adult cancer survivors including diurnal salivary cortisol resulted in 30 articles for review. Sampling protocols ranged from 1 to 4 days with the majority of studies sampling cortisol for 2 days. Sampling instances ranged from 2 to 7 times per day, with the majority collecting at 4 time points per day. Diurnal cortisol slope and cortisol awakening response (CAR) were the most commonly reported parameters associated with clinical outcomes. Flattened cortisol slopes, blunted CARs, and elevated evening cortisol concentrations were associated with poorer psychosocial and physiological outcomes. Based on our review, we propose that a rigorous, standardized diurnal salivary cortisol sampling protocol should include sampling at key diurnal times across ≥3 consecutive days to report diurnal cortisol parameters (i.e., CAR and slope) and objective measures of participant protocol adherence. Diminishing budgetary resources and efforts to minimize participant burden dictate the importance of standardized cortisol sampling protocols and reporting parameters.

Health belief about adjuvant endocrine therapy in premenopausal breast cancer survivors: a qualitative study

OBJECTIVE

The aim of this study is to describe the connotations of health beliefs about adjuvant endocrine therapy (AET) in premenopausal breast cancer survivors in Northeast China and to explore the reasons underlying bad behaviours and influential factors of AET adherence and persistence.

METHODS

Semi-structured interviews were conducted using a qualitative description research method with 30 premenopausal breast cancer survivors who had undergone surgery and AET for more than half a year. The researcher collected and coded the interview transcripts and extracted the concepts and themes.

RESULTS

Two main categories of themes regarding the health beliefs of survivors who were undergoing AET were formed in the conceptual framework: connotations and modifiable factors. Subcategories of the first category included perceptions of the survivors regarding the risks and effects of recurrence or metastasis of breast cancer; the methods, benefits and barriers of AET; behavioural clues; and self-efficacy. Subcategories of the second category included religious belief, disposition, matrimony and other demographic factors as well as traditional Chinese female characteristics, gender role and other socio-cultural factors.

CONCLUSION

Demographic, socio-cultural and other factors play an important role in the health beliefs of breast cancer survivors. Health beliefs such as related knowledge of AET, related cognition of recurrence or metastasis of breast cancer directly affect adherence to and persistence with AET. Therefore, implementing interventions with respect to health beliefs may enhance adherence to AET.

Of These, Faith, Hope, and Love: Assessing and Providing for the Psychosocial and Spiritual Needs of Burn Patients

Burn treatment has grown increasingly advanced and technologically capable. Clinicians must take into account, however, multidimensional patient needs that factor into long-term burn recovery. Important psychosocial factors associated with burn care include psychiatric comorbidities, such as anxiety and depression, healthy family relationships, social support, and community involvement. Spiritual factors and resources, such as time spent praying and/or meditating and access to pastoral services, are also important to consider. Further study is needed to identify specific psychosocial and spiritual needs of patients and to develop interventions or therapies that specifically provide for these needs.