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In many ways, VCU Massey Cancer Center is a technological wonder. Massey physicians have led recent national breast cancer studies that made great strides toward personalizing treatment based on the unique characteristics of each tumor. Another team of researchers developed a combination therapy that slowed the growth of cancer in a majority of clinical trial participants who had solid tumors. And a third team of scientists at Massey have had promising results in research that may result in a new, effective therapy to better manage neurological cancers. These technological advances are key reasons why people choose Massey as their cancer care provider.

Amazingly, patients undergoing treatment rarely mention the plethora of technology and research available at Massey.  Instead, they talk about the compassion and support that they receive from staff and others. This observation helps validate results from a patient survey conducted at Massey earlier this year in which spirituality the most-referenced integrative health practice. The increasing ability to prolong life and even to cure are of critical importance in cancer care. But modern oncology, in many ways, looks back to the days when much of healthcare was provided cooperatively with spiritual care; when spiritual care was seen as “compassionate care of the whole person – physical, emotional, social and spiritual.” 

A 2015 review of 54 studies comprising 12,327 patients examined the patient’s perspective of the role of doctors in the discussion of spirituality. In the majority of studies, over half the sample thought it was appropriate for a doctor to enquire about spiritual needs in at least some circumstances.

A challenge for many health care providers when addressing issues of spirituality is distinguishing between spirituality and religion. Though often used interchangeably, spirituality and religion are quite distinct. A 2015 article by the National Cancer Institute helped define the role of spirituality in cancer care:

“Religion may be defined as a specific set of beliefs and practices, usually within an organized group. Spirituality may be defined as an individual’s sense of peace, purpose, and connection to others, and beliefs about the meaning of life. Spirituality may be found and expressed through organized religion or in other ways. Patients may think of themselves as spiritual or religious or both.”

The choice of descriptor is extremely personal, unique to each individual and subject to change based on the circumstance. Regardless of how the patient self-identifies, the key descriptor for the health care provider has remained the same: compassion. The word compassion means “to suffer with.” Compassionate care calls for physicians to walk with people in the midst of their pain; to be partners with patients rather than experts dictating information.

Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp, wrote: “Man is not destroyed by suffering; he is destroyed by suffering without meaning.”  Harold Kushner, in his popular book When Bad Things Happen to Good People reiterates Frankl’s point:

“Pain is the price we pay for being alive. Dead cells—our hair, our fingernails—can’t feel pain; they cannot feel anything. When we understand that, our question will change from, ‘Why do we have to feel pain?’ to ‘What do we do with our pain so that it becomes meaningful and not just pointless empty suffering?’” 

Incorporating spiritualty into an interdisciplinary approach to cancer care allows the health care professional to move from a place of providing treatment to a place of meeting patients and families in their journey and walking alongside them as they wrestle in the quest for meaning and purpose in this experience. In his book Adam's Return: The Five Promises of Male Initiation, Richard Rohr states, “The soul needs meaning as much as the body needs food.” 

Meaning is critical.  Meaning allows us to navigate the “unthinkables” of our lives with some degree of sanity and grace.  Meaning is about finding answers to the “big” questions of life:

• Why me?
• Why now?
• Why not?
• When?
• How long?

These questions are bigger than we are, yet they often weigh heaviest on us.  Usually, there are no definitive answers to the “unthinkable” questions.  Each person must discern their own truth in their journey.

Cancer care, unfortunately, is full of ‘unthinkable’ questions. 

Spirituality refers to the tools that patients use to find a “truth” that feels good and right, or at least acceptable for them in the face of the unthinkable.  Spirituality is about the things that give patients meaning, which in turn allows for strength, courage and hope.  An organized religion with rituals and doctrine may play a role in this process.  Or, it may not.  Patients may use anything from prayer and readings from sacred text to long walks, yoga and listening to musicas spiritual tools.

Dr. Marvin Guay, M.D., from MD Anderson Cancer Center, offers six ways for people to improve their spiritual life and foster a healing environment:

1. Live one day at a time, with people you love
2. Make time for yourself – to heal as well as to love
3. Cultivate gratefulness by writing down three things or people you’re grateful for each day
4. Share your emotions (good or bad) with the people who support and love you the most
5. Remember to grow your relationship with a higher power
6. Grow your relationship with yourself and others

The list of activities that may be considered spiritual is as exhaustive as the list of different people who may be diagnosed with cancer.  Spirituality is, in fact, not a thing that you do but a way of being, which is enhanced by certain activities.  So the best response to the question, “Is this spiritual?” is best answered by considering another question: “Does this activity connect you to your ‘best self?’” If the answer is yes, then the answer to the first question is a resounding “yes, this activity is most likely spiritual.”  Spirituality is more about “feeling” the result of an activity than it is about the activity itself. 

Research on spirituality and health care show that people who describe themselves as spiritual tend to be more resilient and they tend to have better coping skills.  Research has shown that spirituality can contribute to improved physical health and have a positive impact on your quality of life by:

• Lessening feelings of anxiety, depression, and anger;
• Decreasing loneliness;
• Improving blood pressure;          
• Helping adjust to the side effects of cancer treatments;              
• Improving management of pain, nausea, and discomfort;
• Experiencing a sense of inner peace;
• Increasing hope and optimism; and
• Increasing enjoyment of life following treatment.

Spiritual distress, on the other hand, negatively affects health and may make it more difficult to deal with the diagnosis of cancer or its treatment. Spiritual distress could include doubts about religious beliefs or values, the feeling that you are being punished by God (by having cancer), or even a loss of faith. Feeling this way is not abnormal; a cancer diagnosis can cause some people to experience anger and shaken beliefs. But this distress can have a negative effect on attitude, health and progress. Talking about these feelings can be therapeutic and chaplains are available at Massey and throughout VCU Health help people work through spiritual issues.

Christina Puchalski, M.D., from the GW Institute for Spirituality and Health at George Washington University, reminds us that a cure is not possible for many illnesses, but healing—defined as finding peace in one’s life and acceptance of one’s illness—is always a possibility. Patients struggle to find their own truth in their reality.  In that struggle, patients long to have their families and their health care team be present with them in the struggle. 

• As compassionate healers, we must strive to:
• Be fully present with patients and family
• Listen with our whole selves
• Do the work to be aware of our spiritual strengths and biases
• Know the resources in our system who can help patients and families in their journey
• Be gentle with ourselves
• Feel our own pain
• Create places of meaning in our own lives

Each of us—patient, loved one, health care professional—we are all healing and being healed at once.  Being intentional about compassionately caring for all those around us opens the door to having VCU Massey Cancer Center  transition from a facility of technological excellence where a cure is possible to being a spiritual space where true healing can take place.

 If you are interested in speaking to a chaplain or staff member in VCU Health’s Pastoral Care Department, talk to your care team or call (804) 828-0928.

References:

Best, M., Butow, P., & Olver, I. (2015). Do patients want doctors to talk about spirituality? A systematic literature review. Patient Education and Counseling, 98(11), 1320-1328. doi:10.1016/j.pec.2015.04.017

Frankl, V. E. (1963). Man's search for meaning: An introduction to logotherapy. New York: Pocket Books

Guay, M. (2016). Spirituality and religiosity and living with cancer. Retrieved from www.mdanderson.org/integrativemedcenter

Kushner, H. S. (1981). When bad things happen to good people. New York: Schocken Books

National Cancer Institute (2015). Spirituality in cancer care. Retrieved from www.cancer.gov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-hp-pdq/

National Comprehensive Cancer Network (2016). Finding comfort in spirituality. Retrieved from www.nccn.org/patients/resources/life_with_cancer/spirituality.aspx

Puchalski, C. (2004). Spirituality in health: The role of spirituality in critical care. Critical Care Clinics, 20(3), 487-504. doi:10.1016/j.ccc.2004.03.007

Written by: Massey Communications Office