Journal of Cancer Survivorship

, Volume 1, Issue 3, pp 212–225 | Cite as

Ethnicity and spirituality in breast cancer survivors

  • Ellen G. Levine
  • Grace Yoo
  • Caryn Aviv
  • Cheryl Ewing
  • Alfred Au



Many women are incorporating spirituality as a way of coping with cancer. However, few studies have examined the role of spirituality in mood and quality of life among breast cancer survivors from different ethnic groups.


One hundred and seventy-five women who had completed treatment for breast cancer participated in in-depth interviews about their experiences. Transcripts were available for 161 women.


The majority (83%) of the women talked about their spirituality. The main themes were: (1) God as a Comforting Presence; (2) Questioning Faith; (3) Anger at God; (4) Spiritual Transformation of Self and Attitude Towards Others/Recognition of Own Mortality; (5) Deepening of Faith; (6) Acceptance; and (7) Prayer by Self. A higher percentage of African-Americans, Latinas, and Christians felt comforted by God than the other groups.


These results are consistent with the common assumption that more African-American and Latinas engage in spiritual activities and that African-Americans are more fatalistic than the other groups. Implications for Cancer Survivors: The present findings suggest that there are several dimensions of spirituality experienced among cancer survivors. For many the trauma of a cancer diagnosis might deepen their faith and appreciation of life as well as changing the way they view at themselves, their lives, and how they relate to those around them, including God.


Quality of life Spirituality Ethnic differences Breast cancer survivors 


  1. 1.
    American Cancer Society. Facts & Figures. Oakland, Calif: American Cancer Society, Inc.; 2005 Accessed: October 2005.
  2. 2.
    American Cancer Society. Breast Cancer Facts & Figures 2005–2006. Atlanta: American Cancer Society, Inc.; 2005 Accessed: October 2005.
  3. 3.
    Cella D, Zagari M, Vandoros C, Gagnon D, Hurtz H, et al. Epoetin Alfa treatment results in clinically significant improvements in quality of life in anemic cancer patients when referenced to the general population. J Clin Oncol. 2002;21:366–73.CrossRefGoogle Scholar
  4. 4.
    Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ EF. Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncol. 1999;8:429–38.CrossRefGoogle Scholar
  5. 5.
    Greer S, Morris P, Pettingale KW. Psychological response to breast cancer: effect on outcome. Lancet. 1979:785.Google Scholar
  6. 6.
    Levine EG, Raczynski JM, Carpenter JT. Psychological factors, weight gain and recurrence of breast cancer: two and five year follow-up. Presented at the Second International Congress of Behavioral Medicine, July; Hamburg, Germany; 1992.Google Scholar
  7. 7.
    Levy SM. Behavior and Cancer. San Francisco: Jossey-Bass; 1992.Google Scholar
  8. 8.
    Levy SM, Lee J, Bagby C, Lippman M. Survival hazards analysis and first recurrent breast cancer patients: Seven year follow-up. Psychosom Med. 1988;50:520–8.PubMedGoogle Scholar
  9. 9.
    Morris T, Pettingale K, Haybittle J. Psychological response to cancer diagnosis and disease outcome in patients with breast cancer and lymphoma. Psycho-Oncol. 1998;1:105–14.CrossRefGoogle Scholar
  10. 10.
    Northouse LL, Caffey M, Deichelbohrer L, Schmidt L, Guziatek-Trojniak L, et al. The quality of life of African American women with breast cancer. Res Nurs Health. 2000;22(6):35–448.Google Scholar
  11. 11.
    Northouse LL, Mood D, Kershaw T, Schafenacker A, Mellon S, et al. Quality of life of women with recurrent breast cancer and their family members. A J Clin Oncol. 2002;20:4050–64.CrossRefGoogle Scholar
  12. 12.
    Pettingale KW. Coping and cancer prognosis. J Psychosom Res. 1984;28:363–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Pettingale KW, Morris T, Greer S, Haybittle JL. Mental attitudes to cancer: an additional prognostic factor. Lancet. 1985:750.Google Scholar
  14. 14.
    Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol. 2005;23:4945–4953. DOI 10.1200/JCO.2005.03.475.PubMedCrossRefGoogle Scholar
  15. 15.
    Ferrell BR, Dow KH, Leigh S, Ly J, Gulasekaram P. Quality of life in long-term cancer survivors. Oncol Nurs Forum. 1995;22:915–22.PubMedGoogle Scholar
  16. 16.
    Ransom S, Jacobsen PB, Schmidt JF, Andrykowski MA. Relationship of problem-focused coping strategies in quality of life following treatment for early stage breast cancer. Journal of Pain and Symptom Management. 2005;30:243–253. DOI 10.1016/j.jpainsymman.2005.03.013.PubMedCrossRefGoogle Scholar
  17. 17.
    Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality. Am Psychol. 2003;58:64–74. DOI 10.1037/0003-066X.58.1.64.PubMedCrossRefGoogle Scholar
  18. 18.
    Hiatt JF. Spirituality, medicine and healing. South Med J. 1986;79:736–743.PubMedCrossRefGoogle Scholar
  19. 19.
    Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. Gen Hosp Psych. 2002a;24:238–48.CrossRefGoogle Scholar
  20. 20.
    Targ EF, Levine EG. A mind-body-spirit model for cancer support groups. In: Tripathy D, Tripathy M, eds. Breast Cancer: Beyond Convention, the World’s Foremost Authorities on Alternative and Complementary Medicine. New York: Pocket Books; 2002b.Google Scholar
  21. 21.
    Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: Implications for clinical practice. Mayo Clin Proc. 2001;76:1225–35.PubMedGoogle Scholar
  22. 22.
    Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. Religious struggle as a predictor of mortality among medically ill elderly patients. Arch Intern Med. 2001;161:1881–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Dulin PL. Social support as a moderator of the relationship between religious participation and psychological distress in a sample of community dwelling older adults. Ment Health Relig Cult. 2005;8:81–6.CrossRefGoogle Scholar
  24. 24.
    Koenig HG. Religion, spirituality, and medicine: Research findings and implications for clinical practice. South Med J. 2004;97:1194–200.PubMedCrossRefGoogle Scholar
  25. 25.
    Lengacher CA, Bennett MP, Kip KE, Gonzalez L, Jacobsen P, Cox CE. Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer. Oncol Nurs Forum. 2006;33:97–104. DOI 10.1188/06.ONF.97-104.PubMedCrossRefGoogle Scholar
  26. 26.
    VandeCreek L, Rogers E, Lester J. Use of alternative therapies among breast cancer out patients compared with the general population. Altern Ther Health Med. 1999;5:71–6.PubMedGoogle Scholar
  27. 27.
    Shaw A, Joseph S, Linley PA. Religion, spirituality, and posttraumatic growth: a systematic review. Ment Health Relig Cult. 2005;8:1–11.CrossRefGoogle Scholar
  28. 28.
    Levine EG, Targ E. Spiritual correlates of functional well-being in women with breast cancer. Integrative Cancer Therapy. 2002;1:166–74. DOI 10.1177/1534735402001002008.CrossRefGoogle Scholar
  29. 29.
    Brady M, Peterman AH, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psycho-Oncol. 1999;8:417–28.CrossRefGoogle Scholar
  30. 30.
    Yates JS, Mustian KM, Morrow GR, Gillies LJ, Padmanaban D, et al. Prevalence of complementary and alternative medicine use in cancer patients during treatment. Supportive Care Cancer. 2005;13:806–11. DOI 10.1007/s00520-004-0770-7.CrossRefGoogle Scholar
  31. 31.
    Stefanek M, McDonald PG, Hess SA. Religion, spirituality and cancer: Current status and methodological challenges. Psycho-Oncol. 2005;14:450–63. DOI 10.1002/pon.861.CrossRefGoogle Scholar
  32. 32.
    Johnson SC, Spilka B. Coping with breast cancer: the roles of clergy and faith. J Relig Health. 1991;30:21–33.CrossRefGoogle Scholar
  33. 33.
    Feher S, Maly RC. Coping with breast cancer in later life: The role of religious faith. Psycho-Oncol. 1999;8:408–16.CrossRefGoogle Scholar
  34. 34.
    Gall TL, Cornblat MW. Breast cancer survivors give voice: A qualitative analysis of spiritual factors in long-term adjustment. Psycho-Oncol. 2002;11:524–35.CrossRefGoogle Scholar
  35. 35.
    Levin J. God, Faith and Health. New York: John Wiley and Sons; 2001.Google Scholar
  36. 36.
    Meraviglia M. Effects of spirituality in breast cancer survivors. Oncol Nurs Forum. 2006;33:E1–7. DOI 10.1188/06.ONF.E1-E7.0.Google Scholar
  37. 37.
    Gall TL, de Renart RMM, Boonstra B. Religious resources in long-term adjustment to breast cancer. J Psychosoc Oncol. 2000;18:21–37. DOI 10.1300/J077v18n02_02.CrossRefGoogle Scholar
  38. 38.
    Stanton AL, Danoff-Burg S, Huggins ME. The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncol. 2002;11:93–102.CrossRefGoogle Scholar
  39. 39.
    Cella DF, Hernandez L, Bonomi A, Corona M, Vaquero M, Shiomoto G, et al. Spanish language translation and initial validation of the functional assessment of cancer therapy quality of life instrument. Med Care. 1998;36:1407–18.PubMedCrossRefGoogle Scholar
  40. 40.
    Kleinman A, Eisenberg J, Good B. Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251.PubMedGoogle Scholar
  41. 41.
    Aziz NM, Rowland JH. Cancer survivorship research among ethnic minority and medically underserved groups. Oncol Nurs Forum. 2002;29:789–801. DOI 10.1188/02.ONF.789-801.PubMedCrossRefGoogle Scholar
  42. 42.
    Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp). Annals Behav Med. 2002;24:49–58.CrossRefGoogle Scholar
  43. 43.
    Mickley J, Soeken K. Religiousness and hope in Hispanic- and Anglo-American women with breast cancer. Oncol Nurs Forum. 1993;20:1171–7.PubMedGoogle Scholar
  44. 44.
    Erwin DO, Spatz TS, Stotts RC, Hollenberg JA. Increasing mammography practice by African-American women. Cancer Pract. 1999;7:78–85.PubMedCrossRefGoogle Scholar
  45. 45.
    Phillips JM. Breast cancer and African American women: Moving beyond fear, fatalism, and silence. Oncol Nurs Forum. 1999;26:1001–7.PubMedGoogle Scholar
  46. 46.
    Pettaway L, Frank D. Health promoting behaviors of urban African American female heads of households. ABNFJ. 1999 (Jan–Feb):14–9.Google Scholar
  47. 47.
    Hoffman-Goetz L. Cancer experiences of African-American women as portrayed in popular mass magazines. Psycho-Oncol. 1999;8:36–45. DOI 10.1002/(SICI)1099-1611(199901/02) 8:1<36::AID-PON330>3.0.CO;2-8.CrossRefGoogle Scholar
  48. 48.
    Lee MM, Lin SS, Wrensch MZR, Adler SR, Eisenberg D. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst. 2000;92:42–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Ashing-Giwa KT, Padilla G, Tejero J, Kraemer J, Wright K, Coscarelli A, et al. Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncol. 2004;13:408–28. DOI 10.1002/pon.750.CrossRefGoogle Scholar
  50. 50.
    Chiu L. Spiritual resources of Chinese immigrants with breast cancer in the USA. Int J Nurs Stud. 2001;38:175–84.PubMedCrossRefGoogle Scholar
  51. 51.
    Strauss A, Corbin J. Basics of Qualitative Research. Thousand Oaks: Sage Press; 1990.Google Scholar
  52. 52.
    Charmaz K. Good Days, Bad Days: The Self in Chronic Illness and Time. New Brunswick, NJ: Rutgers University Press; 1993.Google Scholar
  53. 53.
    Kearney MH. Understanding Women’s Recovery from Illness and Trauma. Thousand Oaks, CA.: Sage Publications; 1999.Google Scholar
  54. 54.
    Walton J, Sullivan N. Men of prayer: Spirituality of men with prostate cancer: A grounded theory study. J Holist Nurs. 2004;22:133–51.PubMedCrossRefGoogle Scholar
  55. 55.
    Halstead MT, Hull M. Struggling with paradoxes: the process of spiritual development in women with cancer. Oncol Nurs Forum. 2001;28:1534–44.PubMedGoogle Scholar
  56. 56.
    Strauss AL. Qualitative Analysis for Social Scientists. Cambridge University Press; 1987.Google Scholar
  57. 57.
    Kushner H. When Bad Things Happen to Good People. New York: Schocken Books, Inc.; 2001.Google Scholar
  58. 58.
    Pargament KI, Murray-Swank NA, Tarakeshwar N. An empirically-based rationale for a spiritually-integrated psychotherapy. Ment Health, Relig Cult. 2005;8:155–65. DOI 10.1080/13694670500138940.CrossRefGoogle Scholar
  59. 59.
    Dalai Lama. Transforming the Mind: Teachings on Generating Compassion. Thorsons/Element; 2003.Google Scholar
  60. 60.
    Fitzpatrick CM, Levine EG, Heide F, Zelman D, Targ E. Re-examining the construct of fatalism in women with breast cancer: Stoic resignation versus spiritually focused acceptance. Psycho-Oncol. 2000;9(5 Supplement):90.Google Scholar
  61. 61.
    Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, et al. Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psycho-Oncol. 1999;8:378–85.CrossRefGoogle Scholar
  62. 62.
    Musgrave CF, Allen CE, Allen GJ. Spirituality and Health for Women of Color. Am J Public Health. 2002;92:557–60.PubMedCrossRefGoogle Scholar
  63. 63.
    Bloom JR, Stewart SL, Chang S, Banks PJ. Then and now: Quality of life of young breast cancer survivors. Psycho-Oncol. 2004;13:147–60. DOI 10.1002/pon.794.CrossRefGoogle Scholar
  64. 64.
    Sarkisian CA, Hays RD, Mangione CM. Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults. J Am Geriatr Soc. 2002;50:1837–43.PubMedCrossRefGoogle Scholar
  65. 65.
    Broeckel JA, Jacobsen PB, Balducci L, Horton J, Lyman GH. Quality of life after adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat. 2000;62:141–50.PubMedCrossRefGoogle Scholar
  66. 66.
    Thewes B, Butow P, Girgis A, Pendlebury S. The psychosocial needs of breast cancer survivors: A qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncol. 2004;13:177–89. DOI 10.1002/pon.710.CrossRefGoogle Scholar
  67. 67.
    Culver JL, Arena PL, Antoni MH, Carver CS. Coping and distress among women under treatment for early stage breast cancer: Comparing African Americans, Hispanics, and non-Hispanic Whites. Psycho-Oncol. 2002;11:495–504.CrossRefGoogle Scholar
  68. 68.
    Strang S, Strang P. Spiritual thoughts, coping, and ‘sense of coherence’ in brain tumour patients and their spouses. Palliat Med. 2001;15:127–34.PubMedCrossRefGoogle Scholar
  69. 69.
    Cole B, Pargament K. Re-creating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psycho-Oncol. 1999;8:395–407.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ellen G. Levine
    • 1
  • Grace Yoo
    • 2
  • Caryn Aviv
    • 3
  • Cheryl Ewing
    • 4
  • Alfred Au
    • 5
  1. 1.BioBehavioral Research CenterSan Francisco State UniversitySan FranciscoUSA
  2. 2.Asian-American StudiesSan Francisco State UniversitySan FranciscoUSA
  3. 3.Center for Judaic StudiesUniversity of DenverDenverUSA
  4. 4.Department of SurgeryUniversity of California San Francisco Comprehensive Cancer CenterSan FranciscoUSA
  5. 5.University of California San Francisco Comprehensive Cancer CenterSan FranciscoUSA

Personalised recommendations