Study examines the role of spirituality in health, well-being of breast cancer survivors

Reviewed by Emily Henderson, B.Sc.Jun 23 2021

Throughout her 20-year career as a nurse practitioner, Jennifer Hulett noticed survivors of breast cancer would often express gratitude for being alive and mention God or a divine acknowledgement that had improved their health and well-being.

Now an assistant professor at the University of Missouri Sinclair School of Nursing, Hulett is researching the benefits of spirituality on improving immune health and reducing stress, as well as the chances of cancer reoccurrence, among breast cancer survivors.

In a recent study, Hulett collected and froze samples of saliva from 41 breast cancer survivors at MU's Ellis Fischel Cancer Center. She identified breast cancer survivors' reports of practicing forgiveness and receiving positive social support from their congregation or other social support network were linked with two specific biomarkers, alpha-amylase and interleukin-6. The findings lay the foundation for further examining the role spirituality plays in the health and well-being of both cancer survivors and individuals managing chronic disease.

"Breast cancer survivors are often a highly spiritual group given the trauma they have been through, and we found they often have more positive spiritual beliefs in a loving God or higher power rather than a punitive, punishing God," Hulett said. "This confirmed what I had previously experienced anecdotally as a nurse. Breast cancer survivors would often express gratitude and contribute their health and well-being to a higher power, and they tended to have better health outcomes as well."

Hulett's research builds off previous findings indicating positive spiritual beliefs are associated with healthier levels of cortisol, a biomarker commonly associated with stress, among breast cancer survivors.

Cortisol and stress suggest chronic inflammation, and anything we can do to lower levels of stress and inflammation will have a good effect on a patient's longevity, health outcomes and reduced risk of reoccurring disease. We often hear about diet and exercise in promoting physical health, but we rarely hear about the importance of managing stress, and all three are connected with well-being."

Jennifer Hulett, Assistant Professor, University of Missouri Sinclair School of Nursing

One in eight women develop breast cancer at some point in their lives, and previous studies show chronic stress in breast cancer survivors is linked with increased inflammation and risk for cancer reoccurrence.

"We know cortisol is linked with stress, and elevated levels of the immune biomarker interleukin 6 suggests inflammation," Hulett said. "By first finding out which biomarkers are meaningful to look at, we can then see how they are potentially influenced by various spiritual or mindfulness practices aimed at reducing inflammation."

Hulett's research sets the foundation for future research that evaluates the effectiveness of spiritual and mindfulness interventions, including daily prayer, mediation, yoga and relaxation, on health outcomes among cancer survivors and individuals with chronic disease.

"We already know these interventions improve mental health, but they might also improve physical health as well, and we can try to prove it by looking at these physiological biomarkers," Hulett said. "These spiritual interventions are what nurses can use at the bedside to quickly implement if they see patients struggling to cope with their illness. Any evidence-based solutions we can equip nurses with will help improve patient health outcomes, and that is where these mind-body interventions can play a role going forward."

"Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study" was recently published in Supportive Care in Cancer. Funding for the study was provided by the National Institute of Nursing Research and the Ellis Fischel Cancer Center Donor Fund.