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Cited by 384Religion, Spirituality, and PsychologyCancer survivorship and careWorkplace Spirituality and Leadership

Religion, spirituality, and physical health in cancer patients: A meta‐analysis

Open access
Jim, Heather S. L., Pustejovsky, James E., Park, Crystal L., Danhauer, Suzanne C., Sherman, Allen C., Fitchett, George, Merluzzi, Thomas V., Munoz, Alexis R. +3 more·2015·Cancer
DOI 10.1002/cncr.29353PMC PMC4618080
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Abstract

Although religion/spirituality (R/S) is important in its own right for many cancer patients, a large body of research has examined whether R/S is also associated with better physical health outcomes. This literature has been characterized by heterogeneity in sample composition, measures of R/S, and measures of physical health. In an effort to synthesize previous findings, a meta‐analysis of the relation between R/S and patient‐reported physical health in cancer patients was performed. A search of PubMed, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library yielded 2073 abstracts, which were independently evaluated by pairs of raters. The meta‐analysis was conducted for 497 effect sizes from 101 unique samples encompassing more than 32,000 adult cancer patients. R/S measures were categorized into affective, behavioral, cognitive, and ‘other’ dimensions. Physical health measures were categorized into physical well‐being, functional well‐being, and physical symptoms. Average estimated correlations (Fisher z scores) were calculated with generalized estimating equations with robust variance estimation. Overall R/S was associated with overall physical health ( z = 0.153, P < .001); this relation was not moderated by sociodemographic or clinical variables. Affective R/S was associated with physical well‐being ( z = 0.167, P < .001), functional well‐being ( z = 0.343, P < .001), and physical symptoms ( z = 0.282, P < .001). Cognitive R/S was associated with physical well‐being ( z = 0.079, P < .05) and functional well‐being ( z = 0.090, P < .01). ‘Other’ R/S was associated with functional well‐being ( z = 0.100, P < .05). In conclusion, the results of the current meta‐analysis suggest that greater R/S is associated with better patient‐reported physical health. These results underscore the importance of attending to patients' religious and spiritual needs as part of comprehensive cancer care. Cancer 2015;121:3760–3768. © 2015 American Cancer Society .

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis found that greater religion/spirituality (R/S) was significantly associated with better patient-reported physical health in cancer patients. Affective R/S showed the strongest and most consistent associations across physical well-being, functional well-being, and physical symptoms.

Key findings

  • Overall R/S was associated with overall physical health (z = .153, p < .001), and this relationship was not moderated by sociodemographic or clinical variables (p values > .08).
  • Affective R/S was associated with physical well-being (z = .167, p < .001), functional well-being (z = .343, p < .001), and physical symptoms (z = .282, p < .001).
  • Cognitive R/S was associated with physical well-being (z = .079, p < .05) and functional well-being (z = .090, p < .01); “other” R/S was associated with functional well-being (z = .100, p < .05).
  • Behavioral R/S was not significantly associated with physical health (p = .57).

Methods

  • Meta-analysis of 497 effect sizes from 101 unique samples encompassing over 32,000 adult cancer patients; searches of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 2,073 abstracts through December 20, 2013.
  • R/S measures were categorized a priori as affective, behavioral, cognitive, or “other”; physical health outcomes were categorized as physical well-being, functional well-being, and physical symptoms.
  • Average effect sizes were estimated on the Fisher z scale using generalized estimating equations with robust variance estimation; moderator analyses examined demographic and clinical variables.

Limitations

  • The paper states that included studies tended to use small convenience samples, with nearly half including fewer than 150 participants; methods sections were often incomplete, and R/S measures varied in quality.
  • The paper states that the meta-analysis relied mostly on bivariate correlations from cross-sectional studies, preventing causal or directional inferences; few longitudinal studies precluded analyzing study design as a moderator, and too few studies examined objective outcomes such as inflammation, recurrence, or survival.
  • The paper reports possible funnel-plot asymmetry for affective R/S, though a cluster-robust Egger’s test did not detect reporting bias (p = .08); evident from the text, physical health was patient-reported only, and some R/S sub-dimensions had too few samples for analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/cncr.29353

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Physical well-being and functional well-being effect sizes are significantly different from one another (p<.01).

    “Physical well-being and functional well-being were found to be significantly different from one another (p<.01).”
    Quote in the paperSubstantial claim
  • Findingown data

    Overall religion/spirituality (R/S) is significantly associated with overall physical health in adult cancer patients (z=.153, p<.001).

    “Overall R/S was associated with overall physical health (z=.153, p<.001)”
    • Also stated in: § Meta-Analysis · plain
      “R/S was significantly associated with physical health (z = .153, p<.001).”
    • Also stated in: § Discussion · plain
      “the current meta-analysis found statistically significant relationships between overall R/S and physical health.”
    Quote in the paperSubstantial claim
  • Findingown data

    'Other' R/S is significantly associated with functional well-being (z=.100, p<.05).

    “‘Other’ R/S was associated with functional well-being (z=.100, p<.05)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The association between overall R/S and overall physical health is not moderated by sociodemographic or clinical variables.

    “this relationship was not moderated by sociodemographic or clinical variables.”
    • Also stated in: § Moderator Analyses · plain
      “No moderators were statistically significant (p values >.08).”
    • Also stated in: § Discussion · plain
      “No sociodemographic or clinical variables moderated this association”
    Quote in the paperSubstantial claim
  • Findingown data

    Spiritual well-being (an affective R/S sub-dimension) is significantly associated with physical health.

    “Sub-dimensions significantly associated with physical health were spiritual well-being and spiritual distress in affective R/S and spiritual growth in cognitive R/S (p values <.05).”
    • Also stated in: § Discussion · plain
      “Both spiritual well-being and spiritual distress, affective sub-dimensions, were associated with overall physical health.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 12

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingreasoning

    R/S beliefs (a cognitive R/S sub-dimension) are not significantly associated with physical health.

    “spiritual growth but not R/S beliefs was significantly associated with physical health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The meta-analysis included 497 effect sizes from 101 unique samples encompassing over 32,000 adult cancer patients.

    “Meta-analysis was conducted on 497 effect sizes from 101 unique samples encompassing over 32,000 adult cancer patients.”
    • Also stated in: § Study Selection · plain
      “the current study examines 497 effect sizes from 101 unique samples.”
    • Also stated in: § Discussion · plain
      “Data were drawn from 101 unique samples encompassing over 32,000 patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    A generalized estimating equation (GEE) approach and robust variance estimation were used to estimate average effect sizes and meta-regressions, allowing valid inferences even when the covariance structure of effect sizes drawn from common studies is unknown or misspecified.

    “a generalized estimating equation (GEE) approach and robust variance estimation were used to estimate average effect sizes and meta-regressions, which allowed for valid inferences even when the covariance structure of effect sizes drawn from common studies is unknown or misspecified.26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Hedges LV Tipton E Johnson MC Robust Variance Estimation in Meta-Regression with Dependent Effect Size Estimates. Research synthesis methods 2010 1 39 65 26056092 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Four rater pairs independently reviewed the studies and entered data abstracted from the articles.

    “Four rater pairs independently reviewed the studies and entered data abstracted from the articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The meta-analysis was comprised of bivariate correlations drawn mostly from cross-sectional studies, which prevents making inferences regarding the strength or directionality of the causal relationship between R/S and physical health.

    “the current meta-analysis was comprised of bivariate correlations drawn mostly from cross-sectional studies, which prevents making inferences regarding the strength or directionality of the causal relationship between R/S and physical health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Threat of reporting bias was assessed through visual inspection of funnel plots; the plots did not display noticeable asymmetry indicating reporting bias, with the possible exception of the affective R/S dimension.

    “The plots did not display noticeable asymmetry that would indicate reporting bias, with the possible exception of the affective R/S dimension.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Studies included in the meta-analysis tended to collect data from small samples of convenience, with nearly half of the studies including less than 150 participants.

    “Studies included in the meta-analysis tended to collect data from small samples of convenience, with nearly half of the studies including less than 150 participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Spiritual distress is associated with increased depression and decreased adherence to medication and medical advice among cancer patients.

    “spiritual distress, or feelings of abandonment by God and/or one's religious community, is associated with increased depression and decreased adherence to medication and medical advice among cancer patients, suggesting a plausible pathway by which such an association could occur.16, 33, 34”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Park CL Edmondson D Hale-Smith A Blank TO Religiousness/Spirituality and Health Behaviors in Younger Adult Cancer Survivors: Does Faith Promote a Healthier Lifestyle? J Behav Med 2009 32 582 591 19639404 source

      Not checked in the free run.

    • cites [33] Sherman AC Simonton S Latif U Spohn R Tricot G Religious Struggle and Religious Comfort in Response to Illness: Health Outcomes among Stem Cell Transplant Patients. J Behav Med 2005 28 359 367 16049629 source

      Not checked in the free run.

    • cites [34] Sherman AC Plante TG Simonton S Latif U Anaissie EJ Prospective Study of Religious Coping among Patients Undergoing Autologous Stem Cell Transplantation. J Behav Med 2009 32 118 128 18855130 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A large literature has demonstrated the stress-buffering effects of R/S on physiological processes such as reduced cardiovascular reactivity, hypothalamic-pituitary-adrenal axis activation, and inflammation, which may improve health outcomes.

    “A large literature has demonstrated the stress-buffering effects of R/S on physiological processes such as reduced cardiovascular reactivity, hypothalamic-pituitary-adrenal axis activation, and inflammation, which may improve health outcomes.19”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Seeman TE Dubin LF Seeman M Religiosity/Spirituality and Health. A Critical Review of the Evidence for Biological Pathways. Am Psychol 2003 58 53 63 12674818 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Perceptions of growth can result from patients' denigration of their own pre-cancer attributes rather than true change.

    “some studies have found that perceptions of growth result from patients’ denigration of their own pre-cancer attributes rather than true change.36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Ransom S Sheldon KM Jacobsen PB Actual Change and Inaccurate Recall Contribute to Posttraumatic Growth Following Radiotherapy. J Consult Clin Psychol 2008 76 811 819 18837598 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Examination of dimensions of R/S was based on an a priori taxonomy.

    “examination of dimensions of R/S was based on an a priori taxonomy.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    R/S is theorized to affect physical health via two primary pathways: behavioral self-regulation and emotional self-regulation.

    “R/S is theorized to affect physical health via two primary pathways: behavioral self-regulation and emotional self-regulation.13, 14”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Aldwin CM Park CL Jeong Y Nath R Differing Pathways between Religousness, Spirituality, and Health: A Self-Regulation Perspective. Psychology of religion and spirituality 2014 6 9 21 source

      Not checked in the free run.

    • cites [14] Sapolsky R Why Don't Zebras Get Ulcers 2004 3 Henry Holt & Company New York, NY

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Available data suggest that spiritually-based interventions may improve quality of life and physical recovery in cancer patients.

    “Although few spiritually-based interventions have been tested in cancer patients, available data suggest that they may improve quality of life and physical recovery. 39-41”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [39] Breitbart W Poppito S Rosenfeld B Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients with Advanced Cancer. J Clin Oncol 2012 30 1304 1309 22370330 PMC3646315 source

      Not checked in the free run.

    • cites [40] Garlick M Wall K Corwin D Koopman C Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer. J Clin Psychol Med Settings 2011 18 78 90 21344265 source

      Not checked in the free run.

    • cites [41] Jafari N Zamani A Farajzadegan Z Bahrami F Emami H Loghmani A The Effect of Spiritual Therapy for Improving the Quality of Life of Women with Breast Cancer: A Randomized Controlled Trial. Psychol Health Med 2013 18 56 69 22533516 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Affective R/S is most strongly related to physical health, with cognitive and 'other' R/S related to physical health to a lesser extent.

    “Examination of dimensions of R/S indicated that affective R/S was most strongly related to physical health, with cognitive and ‘other’ R/S related to physical health to a lesser extent.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Positive mood results in reduced symptom reporting.

    “observational and experimental studies suggesting that positive mood results in reduced symptom reporting.29-32”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [29] Bruce J Thornton AJ Powell R Psychological, Surgical, and Sociodemographic Predictors of Pain Outcomes after Breast Cancer Surgery: A Population-Based Cohort Study. Pain 2014 155 232 243 24099954 source

      Not checked in the free run.

    • cites [30] Bruce J Thornton AJ Scott NW Chronic Preoperative Pain and Psychological Robustness Predict Acute Postoperative Pain Outcomes after Surgery for Breast Cancer. Br J Cancer 2012 107 937 946 22850552 PMC3464763 source

      Not checked in the free run.

    • cites [31] Kirwilliam SS Derbyshire SW Increased Bias to Report Heat or Pain Following Emotional Priming of Pain-Related Fear. Pain 2008 137 60 65 17881129 source

      Not checked in the free run.

    • cites [32] Lee JE Watson D Frey-Law LA Psychological Factors Predict Local and Referred Experimental Muscle Pain: A Cluster Analysis in Healthy Adults. Eur J Pain 2013 17 903 915 23165778 PMC3594074 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All abstracts were reviewed independently and discrepancies were resolved by consensus.

    “All abstracts were reviewed independently and discrepancies were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    R/S measures varied in quality; many effect sizes resulted from psychometrically-sound measures, while other studies used measures that were more obscure or investigator-derived.

    “R/S measures varied in quality; while many effect sizes resulted from psychometrically-sound measures such as the Functional Assessment of Cancer Therapy – Spirituality (FACIT-Sp),37 the Religious COPE,38 or the Post-Traumatic Growth Inventory,35 other studies used measures that were more obscure or investigator-derived.”
    Quote in the paperNot a substantial claim
17 of 17

  • The paper relies on this without support.

    The current study is the first meta-analysis of R/S and patient-reported physical health in cancer patients.

    “To our knowledge, the current study is the first meta-analysis of R/S and patient-reported physical health in cancer patients.”

  • The paper relies on this without support.

    Varying definitions of R/S have contributed to heterogeneous measures and, in turn, mixed results.

    “Varying definitions of R/S have also likely contributed to heterogeneous measures and, in turn, mixed results.”

  • The paper relies on this without support.

    Religious communities can provide tangible support, such as transportation to medical appointments and provision of meals and other basic care needs.

    “Religious communities can also provide tangible support, such as transportation to medical appointments and provision of meals and other basic care needs.”

  • The paper relies on this without support.

    Some religious sects proscribe health behaviors such as immunization and receipt of blood products.

    “while some religious sects proscribe health behaviors such as immunization and receipt of blood products.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The strongest relationships were found between affective dimensions of RS and mental health outcomes, whereas behavioral RS constructs showed few significant associations with health, except for a modest positive relationship with social health outcomes.

    “The strongest relationships were found between affective dimensions of RS (e.g., sense of meaning, purpose, or connection to a source larger than oneself) and mental health outcomes, whereas behavioral RS constructs (e.g., service attendance, prayer and meditation) showed few significant associations with health, except for a modest positive relationship with social health outcomes.”

    From Advancing our understanding of religion and spirituality in the context of behavioral medicine (2017) · cites this paper as Jim et al., 2015

  • Recent meta-analyses of 1341 effects drawn from over 44,000 patients with cancer demonstrated an overall positive relationship between RS and self-reported measures of health outcomes, but the strength varied as a function of RS dimension and physical, mental, and social outcomes assessed.

    “Recent meta-analyses of 1341 effects drawn from over 44,000 patients with cancer demonstrated an overall positive relationship between RS and self-reported measures of health outcomes (Park et al., 2015) but the strength of that relationship varied as a function of both the RS dimension and the physical (Jim et al., 2015), mental (Salsman et al., 2015), and social (Sherman et al., 2015) outcomes”

    From Advancing our understanding of religion and spirituality in the context of behavioral medicine (2017) · cites this paper as Jim et al., 2015

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Not confirmedz = 0.153reported p < .001 · recomputed p = .878

    “(z=.153, p < .001”

  • Not confirmedz = 0.167reported p < .001 · recomputed p = .867

    “(z=.167, p < .001”

  • Not confirmedz = 0.343reported p < .001 · recomputed p = .732

    “(z=.343, p < .001”

  • Not confirmedz = 0.282reported p < .001 · recomputed p = .778

    “(z=.282, p < .001”

  • Not confirmedz = 0.079reported p < .05 · recomputed p = .937

    “(z=.079, p < .05”

  • Not confirmedz = 0.09reported p < .01 · recomputed p = .928

    “(z=.090, p < .01”

  • Not confirmedz = 0.1reported p < .05 · recomputed p = .920

    “(z=.100, p < .05”

  • Not confirmedz = 0.153reported p < .001 · recomputed p = .878

    “(z = .153, p < .001”

8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

1 of the 41 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Sapolsky R, 2004, Why Don't Zebras Get Ulcers

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Related

Authors
Jim, H. S. L., Pustejovsky, J. E., Park, C. L., Danhauer, S. C., Sherman, A. C., Fitchett, G., Merluzzi, T. V., Munoz, A. R., George, L., Snyder, M. A., & Salsman, J. M.
Affiliations
  • Moffitt Cancer Center (US)
  • The University of Texas at Austin (US)
  • University of Connecticut (US)
  • Wake Forest University Health Sciences (US)
  • University of Arkansas for Medical Sciences (US)
  • Rush University Medical Center (US)
  • University of Notre Dame (US)
  • Northwestern University (US)
Corresponding author
Jim, Heather S. L.
ORCID
Venue
Cancer
Publisher
Wiley
Published
2015-08-10
Volume
121
Issue
21
Pages
3760-3768
ISSN
  • 0008-543X (ISSN-L)
  • 1097-0142
DOI
10.1002/cncr.29353
PMC
PMC4618080
OpenAlex
W2142895878
Semantic Scholar
0a9023f9cca36bd67abd818498887270da460e66
Cited by
373
References
41
Citations by year
2026: 20 · 2025: 30 · 2024: 30 · 2023: 34 · 2022: 44 · 2021: 54 · 2020: 44 · 2019: 37 · 2018: 34 · 2017: 27 · 2016: 11 · 2015: 7
FWCI
5.19
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (K07CA158008, K07CA138499)
Topics
  • Social Sciences › Health › Religion, Spirituality, and Psychology
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Demography › Workplace Spirituality and Leadership
Keywords
religion, spirituality, cancer patients, physical health, physical well-being, functional well-being, somatic symptoms, patient-reported outcomes, comprehensive cancer care
MeSH terms
Adaptation, Psychological, Behavior, Cognition, Health Status, Humans, Neoplasms, Quality of Life, Religion and Medicine, Treatment Outcome, Outcome Assessment, Health Care, Spiritual Therapies, Spirituality

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