At a professional meeting not long ago, I got into a casual conversation with a colleague about religion. He said, “I’m not religious but I see myself as spiritual.” It’s not the first time I’ve heard similar statements, so I told him he’s not alone.

In fact, since 1990 there’s been a growing U.S. population shift. Based on census data, a September 13, 2022 national report describes it: “Only a few decades ago, a Christian identity was so common among Americans that it could almost be taken for granted. … The change in America’s religious composition is largely the result of large numbers of adults switching out of the religion in which they were raised to become religiously unaffiliated.”^[i] As of 2020, religiously unaffiliated Americans make up 23% of the U.S. population. Just because they are switching out doesn’t mean they’re shutting the door on spiritual values or practice. According to the Fetzer Study of Spirituality in the U.S., The more spiritual than religious group rose from 18.5% of American adults in 1998 to 33.6% in 2020.

As I wondered about the difference between religion and spirituality, I found this description helpful: “Religion is a specific set of organised beliefs and practices, usually shared by a community or group. Spirituality is more of an individual practice and has to do with having a sense of peace and purpose. It also relates to the process of developing beliefs around the meaning of life and connection with others.”

Then, in keeping with my work diagnosing and treating prostate cancer (PCa), I became curious about what peer-reviewed journals contain when it comes to role of spirituality among prostate cancer patients. I found more than I expected, and thought the following ideas are worth sharing.

1. One study explored the part spirituality might play in making treatment decisions. The study group was comprised of 1114 men who had been diagnosed with localized PCa and recently made a treatment decision but had not yet gone through treatment. The authors found “… that greater spirituality was associated with greater decision-making satisfaction, less decisional conflict, and less decision-making difficulty.”^[ii]
2. A second study from the same research institutions took it a step further, asking about the relationship between spirituality and treatment regret. This time, 1093 PCa patients completed measures of spirituality, any decision conflict after diagnosis, and any decision regret 6 months out from treatment. The authors report that stronger spiritual beliefs were associated with less regret, and they concluded, “Spirituality may help men feel less conflicted about their cancer treatment decisions and ultimately experience less decisional regret.”^[iii]
3. Another paper described a study of 222 PCa patients who were receiving treatment and care through a state-funded program. The authors report that those lacking spiritual resources tended to do less well overall. “We found a consistent relationship between spirituality and the outcomes assessed. Low spirituality was associated with significantly worse physical and mental health, sexual function and more urinary bother after controlling for covariates. All of the psychosocial variables studied reflected worse adjustment in the men with low spirituality.”^[iv]
4. An Australian author interviewed 9 men with advanced PCa who felt that spirituality had a positive role in transcending the daily challenges they faced. It was a “holistic” experience integrating physical, psychosocial and spiritual matters. “Through their spirituality they obtained greater comfort and peace of mind during what was for many of them a very traumatic time. The central theme in the men’s stories was that of connectedness-to themselves, to their partners, sometimes to a higher being, to other people such as their family and friends, and to other aspects of their lives.”^[v]

From this small sample of articles, I see that a patient’s spirituality can be a support at any stage of his personal journey with PCa. Choosing a treatment, going through it, being at peace with the outcome, dealing with side effects, and coming to terms with more possibly life-threatening advanced disease—at all these points along the pathway, spirituality seems to afford perspective, meaning and comfort. I have met many PCa patients in my practice who appear uplifted by their religion or spirituality, and it can be very inspiring.

A final thought: I do not mean to imply that nonbelievers (agnostics, atheists) or those who don’t identify in any way as spiritual have fewer resources than those who embrace a spiritual connection with something larger than themselves. Every cancer patient brings a unique toolkit of inner and outer beliefs and relationships to the challenging journey that starts with the words, “You have cancer.” As a doctor and fellow human being, I respect the often intangible attributes that help cancer patients and their loved ones on the cancer road.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Pew Research Center. “How U.S. religious composition has changed in recent decades.” Sep. 13, 2022. https://www.pewresearch.org/religion/2022/09/13/how-u-s-religious-composition-has-changed-in-recent-decades/
[ii] Mollica MA, Underwood W 3rd, Homish GG, Homish DL, Orom H. Spirituality is associated with better prostate cancer treatment decision making experiences. J Behav Med. 2016 Feb;39(1):161-9.
[iii] Mollica MA, Underwood W 3rd, Homish GG, Homish DL, Orom H. Spirituality is associated with less treatment regret in men with localized prostate cancer.
[iv] Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality influences health related quality of life in men with prostate cancer. Psychooncology. 2006 Feb;15(2):121-31.
[v] Lepherd L. Spirituality in men with advanced prostate cancer: “it’s a holistic thing…it’s a package”. J Holist Nurs.
2014 Jun;32(2):89-101; quiz 102-3.