Journal of Religion and Health

, Volume 53, Issue 6, pp 1717–1727 | Cite as

The Impact of Religiosity and Individual Prayer Activities on Advanced Cancer Patients’ Health: Is There Any Difference in Function of Whether or Not Receiving Palliative Anti-neoplastic Therapy?

  • Carlos Eduardo PaivaEmail author
  • Bianca Sakamoto Ribeiro Paiva
  • Sriram Yennurajalingam
  • David Hui
Original Paper


Consecutive patients (n = 221) presenting for initial consultation at a palliative care outpatient clinic were prospectively interviewed and then followed until death. Individual prayer activity (IPA) and global religion scores were associated with quality of life, symptoms, inflammatory markers, and survival. Analyses were adjusted for whether patients were still receiving anti-neoplastic therapies (ANTs) or not. Higher religion scores were associated with lower levels of inflammation in advanced cancer patients still undergoing ANTs. Additionally, higher IPA was an independent good prognostic factor in patients on active ANTs. Further studies are necessary to confirm these findings and to investigate possible biological mechanisms involved.


Religiosity Prayer Cancer Survival Chemotherapy 



The authors would like to thank the Learning and Research Institute of Barretos Cancer Hospital for revising the English text. We would like to thank the research nurses Camila Crovador and Camila Ito, and also Mr. André Vitor Spindola da Silva, from Researcher Support Center of Barretos Cancer Hospital for their help in data collection. Dr. Carlos Eduardo Paiva obtained his Masther (2006–2008) and PhD (2009–2011) degrees at the Faculty of Medicine of Botucatu (FMB), UNESP, Brazil. At this moment, Dr. Carlos is a post-doctoral fellow at FMB, working with the development of a new brief quality of life instrument directed to low educational patients. He is working at the Department of Medical Oncology and also at the Department of Palliative Care from Barretos Cancer Hospital (BCH, Barretos, SP, Brazil) since 2009. In addition, since 2011, he is one of the Professors from the Post-Graduation Program (MSc/PhD) from BCH. His research projects are focusing on palliative care and quality of life of cancer patients.

Conflit of Interest

The authors declare no conflict of interest.


  1. Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.PubMedCrossRefGoogle Scholar
  2. Alcorn, S. R., Balboni, M. J., Prigerson, H. G., Reynolds, A., Phelps, A. C., Wright, A. A., et al. (2010). “If God wanted me yesterday, I wouldn’t be here today”: Religious and spiritual themes in patients’ experiences of advanced cancer. Journal of Palliative Medicine, 13(5), 581–588.PubMedCrossRefGoogle Scholar
  3. Aquino, T. A. A., Correia, A. P. M., Marques, A. L. C., Souza, C. G., Fritas, H. C. A., Araújo, I. F., et al. (2009). Atitude religiosa e sentido da vida: Um estudo correlacional. Psicologia: ciência e profissão., 29, 15.Google Scholar
  4. Balboni, T. A., Vanderwerker, L. C., Block, S. D., Paulk, M. E., Lathan, C. S., Peteet, J. R., et al. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25(5), 555–560.PubMedCrossRefPubMedCentralGoogle Scholar
  5. Beasley, J. M., Newcomb, P. A., Trentham-Dietz, A., Hampton, J. M., Ceballos, R. M., Titus-Ernstoff, L., et al. (2010). Social networks and survival after breast cancer diagnosis. Journal of Cancer Survivorship, 4(4), 372–380.PubMedCrossRefPubMedCentralGoogle Scholar
  6. Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6–9.PubMedGoogle Scholar
  7. Campbell, J. D., Yoon, D. P., & Johnstone, B. (2010). Determining relationships between physical health and spiritual experience, religious practices, and congregational support in a heterogeneous medical sample. Journal of Religion and Health, 49(1), 3–17.PubMedCrossRefGoogle Scholar
  8. Chen, H., Cheal, K., McDonel Herr, E. C., Zubritsky, C., & Levkoff, S. E. (2007). Religious participation as a predictor of mental health status and treatment outcomes in older persons. International Journal of Geriatric Psychiatry, 22(2), 144–153.PubMedCrossRefGoogle Scholar
  9. Clinical practice guidelines for quality palliative care, second edition. (2009). Retrieved October 30, 2012, from
  10. Dezutter, J., Wachholtz, A., & Corveleyn, J. (2011). Prayer and pain: The mediating role of positive re-appraisal. Journal of Behavioral Medicine, 34(6), 542–549.PubMedCrossRefGoogle Scholar
  11. Gillum, R. F., King, D. E., Obisesan, T. O., & Koenig, H. G. (2008). Frequency of attendance at religious services and mortality in a U.S. national cohort. Annals of Epidemiology, 18(2), 124–129.PubMedCrossRefPubMedCentralGoogle Scholar
  12. Holt-Lunstad, J., Steffen, P. R., Sandberg, J., & Jensen, B. (2011). Understanding the connection between spiritual well-being and physical health: An examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose. Journal of Behavioral Medicine, 34(6), 477–488.PubMedCrossRefGoogle Scholar
  13. Hui, D., de la Cruz, M., Thorney, S., Parsons, H. A., Delgado-Guay, M., & Bruera, E. (2011). The frequency and correlates of spiritual distress among patients with advanced cancer admitted to an acute palliative care unit. The American Journal of Hospice and Palliative Care, 28(4), 264–270.PubMedCrossRefGoogle Scholar
  14. Johnson, K. S., Tulsky, J. A., Hays, J. C., Arnold, R. M., Olsen, M. K., Lindquist, J. H., et al. (2011). Which domains of spirituality are associated with anxiety and depression in patients with advanced illness? Journal of General Internal Medicine, 26(7), 751–758.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Koenig, H. G., George, L. K., & Peterson, B. L. (1998). Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry, 155(4), 536–542.PubMedGoogle Scholar
  16. Lagman, R., & Walsh, D. (2005). Integration of palliative medicine into comprehensive cancer care. Seminars in Oncology, 32(2), 134–138.PubMedCrossRefGoogle Scholar
  17. Lissoni, P., Messina, G., Parolini, D., Balestra, A., Brivio, F., et al. (2008). A spiritual approach in the treatment of cancer: Relation between faith score and response to chemotherapy in advanced non-small cell lung cancer patients. In Vivo, 22(5), 577–581.Google Scholar
  18. Lucchetti, G., Lucchetti, A. L., & Koenig, H. G. (2011). Impact of spirituality/religiosity on mortality: Comparison with other health interventions. Explore (NY), 7(4), 234–238.CrossRefGoogle Scholar
  19. McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19(3), 211–222.PubMedCrossRefGoogle Scholar
  20. Meraviglia, M. G. (2002). Prayer in people with cancer. Cancer Nursing, 25(4), 326–331.PubMedCrossRefGoogle Scholar
  21. Messina, G., Lissoni, P., Marchiori, P., Bartolacelli, E., Brivio, F., & Magotti, L. (2010). Enhancement of the efficacy of cancer chemotherapy by the pineal hormone melatonin and its relation with the psychospiritual status of cancer patients. Journal of Research in Medical Science, 15(4), 225–228.Google Scholar
  22. Naing, A., Stephen, S. K., Frenkel, M., Chandhasin, C., Hong, D. S., Lei, X., et al. (2011). Prevalence of complementary medicine use in a phase 1 clinical trials program: The MD Anderson Cancer Center Experience. Cancer, 117(22), 5142–5150.PubMedCrossRefGoogle Scholar
  23. Nelson, C., Jacobson, C. M., Weinberger, M. I., Bhaskaran, V., Rosenfeld, B., Breitbart, W., et al. (2009). The role of spirituality in the relationship between religiosity and depression in prostate cancer patients. Annals of Behavioral Medicine, 38(2), 105–114.PubMedCrossRefPubMedCentralGoogle Scholar
  24. Nelson, C. J., Rosenfeld, B., Breitbart, W., & Galietta, M. (2002). Spirituality, religion, and depression in the terminally ill. Psychosomatics, 43(3), 213–220.PubMedCrossRefGoogle Scholar
  25. O’Connor, P. J., Pronk, N. P., Tan, A., & Whitebird, R. R. (2005). Characteristics of adults who use prayer as an alternative therapy. American Journal of Health Promotion, 19(5), 369–375.PubMedCrossRefGoogle Scholar
  26. Oh, B., Butow, P. N., Mullan, B. A., Clarke, S. J., Beale, P. J., Pavlakis, N., et al. (2012). Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: A randomized controlled trial. Supportive Care in Cancer, 20(6), 1235–1242.PubMedCrossRefGoogle Scholar
  27. Purnell, J. Q., Andersen, B. L., & Wilmot, J. P. (2009). Religious practice and spirituality in the psychological adjustment of survivors of breast cancer. Counseling and Values, 53(3), 165.PubMedCrossRefPubMedCentralGoogle Scholar
  28. Schnall, E., Wassertheil-Smoller, S., Swencionis, C., Zemon, V., Tinker, L., O’Sullivan, M. J., et al. (2010). The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women’s Health Initiative Observational Study. Health Psycholgy, 25(2), 249–263.CrossRefGoogle Scholar
  29. Seeman, T. E., Dubin, L. F., & Seeman, M. (2003). Religiosity/spirituality and health. A critical review of the evidence for biological pathways. American Psychologist, 58(1), 53–63.PubMedCrossRefGoogle Scholar
  30. Stefanek, M., McDonald, P. G., & Hess, S. A. (2005). Religion, spirituality and cancer: Current status and methodological challenges. Psychooncology, 14(6), 450–463.PubMedCrossRefGoogle Scholar
  31. Stewart, D. E., & Yuen, T. (2011). A systematic review of resilience in the physically ill. Psychosomatics, 52(3), 199–209.PubMedCrossRefGoogle Scholar
  32. Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V., & Prigerson, H. G. (2006). Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine, 9(3), 646–657.PubMedCrossRefPubMedCentralGoogle Scholar
  33. Zhang, B., Nilsson, M. E., & Prigerson, H. G. (2012). Factors important to patients’ quality of life at the end of life. Archives of Internal Medicine, 172(15), 1133–1142.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Carlos Eduardo Paiva
    • 1
    • 2
    Email author
  • Bianca Sakamoto Ribeiro Paiva
    • 2
  • Sriram Yennurajalingam
    • 3
  • David Hui
    • 3
  1. 1.Department of Clinical OncologyBarretos Cancer HospitalBarretosBrazil
  2. 2.Post Graduation ProgramBarretos Cancer HospitalBarretosBrazil
  3. 3.Department of Palliative Care and Rehabilitation MedicineThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations