Keeping the Faith

For three years, I co-facilitated a discussion group called “Engaging the Spirit” at a local cancer support community where cancer patients and survivors explored spiritual and faith questions as they traveled the cancer journey.

Those who came represented every faith, including Islam, Christianity, and other belief systems. We began each discussion with a simple question: “How’s your spirit?”

I learned from those who took part that no matter how someone defines his or her faith, in a group of cancer survivors there exists a common quest to understand existential questions about life and death.

Harold G. Koenig, MD, co-director of the Center for Spirituality, Theology and Health and professor of psychiatry and behavioral sciences at Duke University in Durham, North Carolina, describes the United States as one of the most spiritual countries in the world. Studies indicate that among the 89 percent of Americans who have a religious affiliation, 93 percent follow a form of Judeo-Christian philosophy that ascribes to a belief in a higher power such as God.

What does all this mean for cancer patients and survivors trying to make spiritual sense of cancer? And what about those whose lives are filled with meaning and purpose but not a faith tradition?

Researching, understanding, and making information available on faith and spirituality to help cancer survivors resolve their experience continues to challenge researchers and health care providers across the spectrum of cancer care.

Researchers who have undertaken the challenging task of trying to understand faith and its impact on health have discovered some basic information, such as the fact that belonging to a faith community is associated with positive emotions and higher quality of life.

They also agree that faith and spirituality play a role in how cancer survivors resolve their experience and the extent to which they experience mental health issues, such as depression and anxiety. What they have yet to determine is how to define the terms, which aspects result in what reactions, and how this information should be provided by health care professionals, if at all.

Koenig says more research on spirituality and health has been published since 2000 than in the preceding 140 years. Repeated studies have shown that people who follow a faith tradition “need and use fewer health care services because they are healthier, more likely to have intact families to care for them, and have greater social support,” Koenig says.

But is it faith in combination with a support community that makes the difference, or do spiritual individuals with a strong community benefit as well?

“The problem,” he says, “is that we don’t know what aspects of religion are particularly healthy or how these health benefits occur in terms of behavioral and physiological mechanisms.”

Andra Baker, 54, grew up embracing her mother’s approach to a higher power, which was, “Well, honey, there’s gotta be somethin’.”

“I believe there is ‘somethin’ and that our job in this lifetime is to seek that out—to seek the truth of our own existence, to find meaning in the face of ultimate uncertainty regarding basic truths,” explains Baker.

Baker, a former certified cognitive behavioral therapist and cancer survivor, has called her cancer journey a “wake-up call” that often left her out of touch with her spirituality as she struggled with pain and depression.

Cervical cancer, originally diagnosed when Baker was 24, was the probable result of being infected with human papillomavirus after being raped at age 11, she says, since she was not sexually active early and came out as a lesbian at 19. Her training as a cognitive behavioral therapist helped her resolve those issues, relying on the belief that, “it is not an event that creates despair but rather our view of the event,” she says.

When the cancer came back in 2004 when she was 49, Baker says her treatment of chemotherapy and radiation resulted in extensive damage to the vagina, rectum, colon, urethra, bladder, and external skin, leaving her with chronic pain and other long-term effects.

“Treatment was so fierce and painful and debilitating that I existed for months in what seemed like suspended animation. I couldn’t think or process well, and had only one simple prayer: ‘Your will be done.’ ”

Another survivor, Diane Phillips, MD, calls her diagnosis of endocervical adenocarcinoma, a rare cancer with no known cause, an inconvenience rather than a mortality issue.

As an internal medicine physician in Dallas, she knew her cancer was curable with a hysterectomy, and wanting no more children, the surgery was not a concern. And, she says, she and her husband, Bruce, also a physician, had a strong support system among the members of their Presbyterian church.

“I know that when something like that occurs in my life, I am going to learn something from it. I will have a better character for having gone through that.”

Koenig calls what Baker and Phillips share “the source of meaning and purpose,” and that is faith, or belief in a higher power.

“God has purpose for them and is in control and they don’t have to be. This is where mental health comes from,” Koenig says, adding that this belief frees them and reminds them that their illness can result in “something good.”

After a career of studying spirituality and illness, Koenig was forced to apply his research in a more personal way when he was diagnosed with prostate cancer in 2007 at age 57, undergoing a radical prostatectomy and partial dissection of the bladder. Koenig, who was raised a Catholic and is now a Protestant, says his diagnosis drove him closer to God.

Koenig recalls driving through the fall countryside after his diagnosis and feeling that the beauty of the sun and the changing leaves gave him a glimpse of what he would find in eternity.

“I guess that’s what I am talking about,” Koenig says, “a belief system that frames your diagnosis in the context of your life and what you believe happens after life. If you have no framework to place that in, all you have left is yourself and it isn’t enough. You can’t carry the full load—you weren’t meant to.”

Isabel Docampo, who holds a doctorate of ministry, had been in the ministry for 30 years when she was diagnosed with stage 3 cancer of the minor salivary gland in 2007 at age 49.

Docampo, associate professor of supervised ministry at Southern Methodist University’s Perkins School of Theology in Dallas, says her fear and depression came not from a crisis of faith, but from the pain and sadness that she felt from the idea she might leave her 21-year-old son, Ben, and her husband of 18 months, Scott Somers, also an ordained minister. It was a second marriage for both, which Docampo calls their second chance.

“The way I have always looked at life is that it is what it is,” Docampo says. “Life is a struggle and God has been there for all the blessings and all the bad stuff, and God is going to be here for the cancer.”

What Role Does Spirituality Play in the Cancer Journey?

Called to the ministry when she was 19, Docampo went straight to seminary after college and was ordained in the Baptist church in 1985.

When Docampo was referred to an oncologist after months of strange head and neck pain, she says it sank in that she was facing mortality, a feeling that was confirmed when her oncologist told her that the best treatment was surgery since an effective drug therapy had not been found. If it was found in her lymph nodes, as he suspected, she was facing a “shortened life span.”

The surgeons went in both through her mouth and neck to excise the tumor and surrounding lymph nodes, which were found to be clear of cancer. She had four additional surgeries before the end of 2007 for infection and to allow her to open her mouth enough to talk. She uses weekly acupuncture to deal with the ongoing pain and has decided not to undergo more surgery for a suspicious lump in the major salivary gland, which, for the present, is stable.

“I live with the fact that my life can turn in a minute, but I don’t focus on that because my life could turn in a minute from an accident.”

Docampo concedes that her spiritual journey continues.

“Last year the journey with God was, OK, it didn’t happen the first year, so I got a whole year of life, but it might happen this year.” This awareness, she says, helped her begin a personal assessment of what was important for her. “The first year was about family and the second year was about what I have accomplished and living faithfully—would I live differently.”

She reaffirmed that her job was exactly what she wanted to be doing and reassessed other parts of her life and where she wanted to put her energy. She has become the chair of the missions committee at her church and is active in a group called North Texas Jobs with Justice, which serves the unemployed and those who have no job security. She also facilitates an interfaith dialogue group that she began after 9/11.

She says the cancer has also given her a great awareness of the “brokenness of the body.”

Docampo couldn’t talk for 10 days after her surgery and then struggled to regain the ability while living with a feeding tube for eight more weeks. “As I sat in the hospital room, I felt this brokenness in my body that I had never felt before. I sat there and thought of all the stories I have heard working with battered women and women refugees who had been tortured. I realized that God is in the brokenness of the body in a way that I had never understood before.”

To view the full results of the CURE reader survey on spirituality and faith, go to www.curetoday.com/spirituality_survey.