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A New Look at Spirituality

Addressing the spiritual health of cancer patients is now recognized as an essential aspect of quality care. By Sue Rochman

Katherine Piderman has a voice that encourages 
conversation. It is gentle and gracious, receptive and reassuring. After listening to Piderman talk, your reaction to learning that she has spent the past 18 years providing bedside ministry as a staff chaplain at the Mayo Clinic in Rochester, Minn., is likely to be “of course.”

Learn More About Spirituality and Cancer Care
Check out these websites to find out more about spiritual development.

Assessing Spiritual Distress

The Commission on Cancer has mandated a screening test for psychosocial distress, including spiritual distress. 

As you might expect, Piderman is often called upon to pray with cancer patients and their family members or perform religious rituals. But she also spends time walking the hospital’s halls and visiting outpatient clinics, looking for those she might be able to assist.

There is nothing novel about clergy members providing solace. What is new is the growing 
recognition of the need to acknowledge and address cancer patients’ spiritual needs. Research on spirituality in cancer, especially at the end of life, is burgeoning. (Type “spirituality and cancer” into PubMed, an online database of medical journals, and you’ll find more than 1,000 research articles.) A 2010 survey of U.S. medical school deans found that 90 percent of the respondents’ programs included classes that addressed the spiritual needs of patients. And at some cancer centers, chaplains are considered part of the treatment team, providing spiritual care to patients and caregivers of all cultures and faiths.

Spirituality and Quality of Life
The research on cancer and spirituality has been buoyed by efforts to move quality of life from the fringes of cancer care into the mainstream. When “we focus on a quality-of-life model of care,” says Betty Ferrell, an oncology nurse and research scientist at the City of Hope National Medical Center in Duarte, Calif., “everything that we do involves thinking about the whole person.” This includes not only the physical and psychosocial well-being of cancer patients and their caregivers, she says, but their spiritual health, too.

“When I was new in oncology,” says Ferrell, who has worked in the field for 25 years, “spirituality had a limited definition. We would only think of it in terms of religion. We would ask patients if they were religious or part of a church community, and you’d note if they were Catholic, Jewish, Buddhist or Protestant or not religious at all—and that is where it ended.” Now, she says, “we’ve come to understand that spirituality is a broad concept. For some people, there is a religious aspect to their spirituality. But we think of all people as spiritual beings who are seeking meaning and purpose.” And for people facing an often life-threatening illness like cancer, she notes, it’s common for questions about meaning and purpose to come to the fore.

The Rev. Stephen King, the manager of chaplaincy care at the Seattle Cancer Care Alliance, helps patients and their loved ones as they wrestle with these types of questions. Some cancer patients, says King, may experience a crisis in faith, whereas others may find that a cancer diagnosis leads to a new or renewed interest in religious or spiritual practices. And for still others, cancer may affirm their decision to have followed a more agnostic path. This religious questioning, he says, can lead to strain among family members. It can also cause internal struggles that result in feelings of shame, guilt or moral distress, especially when people feel abandoned by God. “This struggle and conflict can be a source of spiritual pain” that has a negative impact on quality of life, King says.

This type of spiritual pain is more common than people may realize. King and his colleagues presented preliminary study results at the 2013 American Society of Clinical Oncology annual meeting showing that 28 percent of the more than 1,500 blood and bone marrow transplant patients they surveyed, including many cancer patients, reported experiencing a spiritual or religious struggle. Spirituality may play an even larger role for people with advanced cancer. A study led by Michael Balboni—a theologian and social scientist at the Dana-Farber Cancer Institute in Boston—published last year in the Journal of Clinical Oncology, found that most of the patients with advanced cancer he and his colleagues had interviewed said spiritual care played an important role in their cancer experience.

Even those who don’t think they need spiritual care may still be struggling spiritually. Balboni says his research shows that when you ask patients follow-up questions, those who say spiritual care isn’t important also frequently say they are feeling anger at God or punished by God or wondering why this is happening to them.


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