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Spirituality in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Modes of Intervention

Table 2. Exploring Spiritual/Religious Concerns in Adults With Cancera continued...

Support Groups

Support groups may provide a setting in which patients may explore spiritual concerns. If spiritual concerns are important to a patient, the health care provider may need to identify whether a locally available group addresses these issues. The published data on the specific effects of support groups on assisting with spiritual concerns is relatively sparse, partly because this aspect of adjustment has not been systematically evaluated. A randomized trial [13][Level of evidence: I] compared the effects of a mind-body-spirit group to a standard group support program for women with breast cancer. Both groups showed improvement in spiritual well-being, although there were appreciably more differential effects for the mind-body-spirit group in the area of spiritual integration.

A study of 97 lower-income women with breast cancer who were participating in an online support group examined the relationship between a variety of psychosocial outcomes and religious expression (as indicated by the use of religious words such as faith, God, pray, holy, or spirit). Results showed that women who communicated a deeper religiousness in their online writing to others were found to have lower levels of negative emotions, higher levels of perceived health self-efficacy, and higher functional well-being.[14] An exploratory study of a monthly spirituality-based support group program for African American women with breast cancer suggested high levels of satisfaction in a sample that already had high levels of engagement in the religious and spiritual aspects of their lives.[15][Level of evidence: III]

One author [16] presents a well-developed model of adjuvant psychological therapy that uses a large group format and addresses both basic coping issues and spiritual concerns and healing, using a combination of group exploration, meditation, prayer, and other spiritually oriented exercises. In a carefully conducted longitudinal qualitative study of 22 patients enrolled in this type of intervention,[17] researchers found that patients who were more psychologically engaged with the issues presented were more likely to survive longer. Other approaches are available but have yet to be systematically evaluated,[18,19] have not explicitly addressed religious and spiritual issues, or have failed to evaluate the effects of the intervention on spiritual well-being.[20]


Other therapies may also support spiritual growth and post-traumatic benefit finding. For example, in a nonrandomized comparison of mindfulness-based stress reduction (n = 60) and a healing arts program (n = 44) in cancer outpatients with a variety of diagnoses, both programs significantly improved facilitation of positive growth in participants, although improvement in spirituality, stress, depression, and anger was significantly larger for the mindfulness-based stress reduction group.[21][Level of evidence: II]


  1. Kristeller JL, Zumbrun CS, Schilling RF: 'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology 8 (5): 451-8, 1999 Sep-Oct.
  2. Ben-Arye E, Bar-Sela G, Frenkel M, et al.: Is a biopsychosocial-spiritual approach relevant to cancer treatment? A study of patients and oncology staff members on issues of complementary medicine and spirituality. Support Care Cancer 14 (2): 147-52, 2006.
  3. Lo B, Ruston D, Kates LW, et al.: Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA 287 (6): 749-54, 2002.
  4. Astrow AB, Wexler A, Texeira K, et al.: Is failure to meet spiritual needs associated with cancer patients' perceptions of quality of care and their satisfaction with care? J Clin Oncol 25 (36): 5753-7, 2007.
  5. Balboni TA, Paulk ME, Balboni MJ, et al.: Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 28 (3): 445-52, 2010.
  6. Kristeller JL, Rhodes M, Cripe LD, et al.: Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 35 (4): 329-47, 2005.
  7. King DE, Bushwick B: Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 39 (4): 349-52, 1994.
  8. Hebert RS, Jenckes MW, Ford DE, et al.: Patient perspectives on spirituality and the patient-physician relationship. J Gen Intern Med 16 (10): 685-92, 2001.
  9. Balboni MJ, Babar A, Dillinger J, et al.: "It depends": viewpoints of patients, physicians, and nurses on patient-practitioner prayer in the setting of advanced cancer. J Pain Symptom Manage 41 (5): 836-47, 2011.
  10. Fitchett G, Meyer PM, Burton LA: Spiritual care in the hospital: who requests it? Who needs it? J Pastoral Care 54 (2): 173-86, 2000 Summer.
  11. Handzo G: Where do chaplains fit in the world of cancer care? J Health Care Chaplain 4 (1-2): 29-44, 1992.
  12. Association of Professional Chaplains., Association for Clinical Pastoral Education., Canadian Association for Pastoral Practice and Education., et al.: A White Paper. Professional chaplaincy: its role and importance in healthcare. J Pastoral Care 55 (1): 81-97, 2001 Spring.
  13. Targ EF, Levine EG: The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psychiatry 24 (4): 238-48, 2002 Jul-Aug.
  14. Shaw B, Han JY, Kim E, et al.: Effects of prayer and religious expression within computer support groups on women with breast cancer. Psychooncology 16 (7): 676-87, 2007.
  15. Antle B, Collins WL: The impact of a spirituality-based support group on self-efficacy and well-being of African American breast cancer survivors: a mixed methods design. Social Work and Christianity 36 (3): 286-300, 2009.
  16. Cunningham AJ: Group psychological therapy: an integral part of care for cancer patients. Integrative Cancer Therapies 1(1): 67-75, 2002.
  17. Cunningham AJ, Edmonds CV, Phillips C, et al.: A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology 9 (4): 323-39, 2000 Jul-Aug.
  18. Breitbart W: Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10 (4): 272-80, 2002.
  19. Cole B, Pargament K: Re-creating your life: a spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psychooncology 8 (5): 395-407, 1999 Sep-Oct.
  20. Spiegel D, Bloom JR, Kraemer H, et al.: Psychological support for cancer patients. Lancet 2 (8677): 1447, 1989.
  21. Garland SN, Carlson LE, Cook S, et al.: A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients. Support Care Cancer 15 (8): 949-61, 2007.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
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