Hope

Does a Prayer A Day Keep Illness at Bay?

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Research into the impact of religious and spiritual beliefs on our health continues.

By John Leifer

When we are sick, we rely on our physicians to heal us. And for good reason: they possess the knowledge, tools, drugs, and procedures to conquer many maladies. But not all illnesses respond to the ministrations of modern medicine, as many of us learn with the passage of time.

As we age, virtually all of us will be afflicted with one or more chronic diseases, some of which can be quite devastating. Cancer, once considered an acute disease, now often falls within this category. If good fortune prevails, medicine will control the progression of the disease. If not, we hope it will at least provide us with a modicum of comfort.

But medicine is not omnipotent, which is why, for some patients, healing is not the sole province of doctors. Those patients turn to their religious and spiritual beliefs in the hope that solace and, perhaps, healing will be found there. But do such beliefs—and the accompanying prayers, spiritual self-examination, and other practices—truly make a difference in the trajectory of our health?

If longevity and reduced mortality are the ultimate proxy for health, the jury may be out on that question. More than two dozen studies have revealed a correlation between how long we live and the degree to which we regularly attend religious services.1

According to researchers Doug Oman and Carl “One of the most thorough of these studies, an eight year follow-up of more than 20,000 adults representative of the US population, found a life expectancy gap of over seven years between persons never attending services and those attending more than once weekly.”1 The correlation between religious attendance and longevity is so strong that even the National Institutes of Health acknowledge it.2

But it is not just the length of our lives that may be affected by our spirituality or religious beliefs; it is also the quality of our lives. Researchers have found strong correlations between our beliefs and our ability to maintain hope, derive meaning and purpose, and maintain critically important relationships during times of great adversity.

It is important to note that our beliefs can also have an adverse effect on health, as was powerfully demonstrated in a study of HIV patients by Gail Ironson and colleagues. Ironson sought to determine the impact of both positive and negative views of God on the progression of this devastating disease.

Ironson’s results were tied to two clinical indicators of disease progression: CD4 cells (an important component of one’s immune system) and the viral load (the amount of active virus circulating in the patients’ bloodstreams). Ironson’s findings: “Those who viewed God as merciful/benevolent/forgiving had five times better preservation of CD4 cells than those who did not view God positively. Those who viewed God as harsh/judgmental/ punishing lost CD4 cells at more than twice the rate of those who did not view God negatively.”3

Such conclusions are powerful and provocative, yet many scientists remain skeptical about the relationship between religious beliefs/ spirituality and health. It’s not that they refute their colleagues’ findings, assuming that the research is methodologically sound; rather they raise important questions regarding the interpretation of those findings and the attribution of positive benefits to religion and spirituality.

Part of this skepticism comes from a well-founded distrust of the words religion and spirituality because there is no universally agreed upon definition of the terms. For some people these words communicate a profound and personal relationship with God, whereas for others they communicate a more agnostic outlook on life, where one’s sense of spirituality is derived from community. With such disparity it is understandably difficult to draw meaningful conclusions about the influence of religion and spirituality on health.

Beyond semantics looms another important issue: Are there discernible mechanisms at work, underlying religious and spiritual beliefs, that impact health outcomes? Oman and Thoresen offer four such mechanisms1 that may be responsible for improved health and well-being:

  • Health behaviors. Certain religious traditions foster the adoption of positive health habits while discouraging negative behaviors. When smoking, alcohol consumption, promiscuous sex, and other detrimental behaviors are shunned, adherents may benefit from such prohibitions.
  • Social support. There is vast evidence supporting the power of social connection in fostering health and well-being. Faith and religious organizations form the very heart of the social network for many people. Thus religion/spirituality brings social connectedness, which is essential to health.
  • Psychological states. Oman and Thoresen suggest that religious beliefs/spirituality may contribute to a heightened sense of emotional or psychological well-being—whether through elevated levels of positive affect, such as joy and hope, or reduced levels of negative emotional states, such as despair.
  • Psi influences. Psi in parapsychology refers to phenomena that cannot be explained using conventional rules of science. Mystical or transcendental experiences, synchronicity, and other phenomena fall into this category. Because we are unable to explain, measure, or replicate these phenomena, they remain largely outside the realm of scientific investigation.

So what should you take away from this research-oriented discussion?

Empirical research is important, but each of us will approach our health and well-being in a very personal way. Some of us will primarily turn inward, with our focus on how health issues change our sense of self and perhaps our direction in life. For others the journey will be more outwardly focused, emphasizing the importance of personal relationships in helping us cope with whatever health issues arise. Others will ultimately look upward, to God and their relationship with Him.

References

  1. Oman D, Thoresen CE. “Does religion cause health?”: Differing interpretations and diverse meanings. Journal of Health Psychology. 2002;7(4), 365-80.
  2. Hummer RA, Rogers RG, Nam CB, Ellison CG. Religious involvement and U.S. adult mortality. Demography. 1999;36(2):273-85.
  3. Ironson G, Stuetzle R, Ironson D, et al. View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression. Journal of Behavioral Medicine. 2011;34(6):414-25. doi: 10.1007/s10865-011- 9314-z.
  4. Swinton J, Bain V, Ingram S, Heys SD. Moving inwards, moving outwards, moving upwards: The role of spirituality during the early stages of breast cancer. European Journal of Cancer Care. 2011;20(5):640-52. doi: 10.1111/j.1365-2354.2011.01260.x.

 

Post-Traumatic Growth in Cancer Patients

By in Cancer, Healthcare, Hope, Post Traumatic Growth No Comments Tags:

Breaking the changes that bind us can result in unprecedented growth.

Breaking the changes that bind us can result in unprecedented growth.

The Transforming Power of Stress

There are few life events that can transform our daily reality more swiftly than a diagnosis of cancer. A once neatly planned future can seemingly evaporate in the wake of an overwhelming existential threat. The degree to which we remain mired in this nether-land of despair can be a function of the severity of our cancer, coupled with a myriad of variables – from our psychological health to our spirituality.

Fortunately, for most patients, the profound shock f cancer diminishes significantly over a relatively short period of time. For others, however, the distress associated with cancer may be a frequent or constant companion on the cancer journey, and it may even lead to post-traumatic stress disorder (PTSD).

There is yet another group, though, whose brush with mortality transforms them in a life-affirming direction. For these patients, the threat of cancer results not in PTSD, but in quite the opposite – post-traumatic growth (PTG).

PTG vs PTSD

The term post-traumatic growth was first coined by researchers Richard Calhoun and Lawrence Tedeschi more than two decades ago.[1] Calhoun and Tedeschi stated that two criteria must be met to satisfy their definition of post-traumatic growth: 1) The individual must struggle with a life-changing event; 2) that struggle then leads to profound growth and change.[2] Such growth may take many forms, including enhanced personal relationships, a deepened sense of spirituality, or an awareness of the transcendent meaning of life.[3]

It could be argued that scientists such as Calhoun and Tedeschi have simply formalized and named an idea that predates them by millennia: the indomitable spirit of human beings. It is a force that allows us not only to overcome seemingly insurmountable adversity, but to derive profound meaning from the experience. It has long been a topic of interest to philosophers and poets. Shakespeare eloquently stated: “Sweet are the uses of adversity which, like the toad, ugly and venomous, wears yet a precious jewel in his head.” [4]

The Illuminating Wisdom of Victor Frankl

One of the most profound examples of post-traumatic growth comes not from a cancer patient, but from Viktor Frankl, an Austrian psychiatrist deported to Auschwitz by the Nazis:

The dawn was grey around us; grey was the sky above; grey the snow in the pale light of dawn; grey the rags in which my fellow prisoners were clad, and grey their faces. I was again conversing silently with my wife, or perhaps I was struggling to find the reason for my sufferings, my slow dying. In a last violent protest against the hopelessness of imminent death, I sensed my spirit piercing through the enveloping gloom. I felt it transcend that hopeless, meaningless world, and from somewhere I heard a victorious “Yes” in answer to my question of the existence of an ultimate purpose. At that moment a light was lit in a distant farmhouse, which stood on the horizon as if painted there, in the midst of the miserable grey of a dawning morning in Bavaria. “Et lux in tenebris lucet” – and the light shineth in the darkness.

Frankl had endured unrelenting trauma – including the death of his family – and yet his indomitable spirit was able to rise above it – to be set free. Reflecting on his experiences, Frankl offered this guidance: “The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add a deeper meaning to his life.”[6]

Cancer has the power to inflict profound suffering, but only the human spirit has the power to transform that suffering into tremendous growth – growth that causes one to rise above an uncertain future, and find profound meaning in one’s relationships, faith, and the simple joys of life.

 

 

[1] Calhoun, L. G., & Tedeschi, R. G. (1995).Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.

 

[2] Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the Emerald City: Benefit finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487-497.

 

[3] Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research and practice (pp. 138-175). Mahwah, NJ: Erlbaum.

 

[4] Read more at: http://www.brainyquote.com/quotes/keywords/adversity_3.html

 

[5] Frankl, V. E. Man’s search for meaning. (1984). Boston, MA: Beacon Press, p. 60.

 

[6] Ibid., p. 88

 

 

PROFILES IN COURAGE — Four People Discuss the Profound Impact That Cancer Had on Their Lives and the Lives of Loved Ones

By in After You Hear It's Cancer, Cancer, grace, Hope, survivorship No Comments Tags: , , , , , ,

Meet Mary Diagnosis: Breast Cancer

Meet Mary
Diagnosis: Breast Cancer

Meet Ali: Diagnosis: Head & Neck Cancer

Meet Ali:
Diagnosis: Head & Neck Cancer

Meet Diane Diagnosis: Leukemia and husband died of melanoma

Meet Diane
Diagnosis: Leukemia and husband died of melanoma

Meet Darrell Caregiver for wife over 20 year struggle w/lymphoma and leukemia

Meet Darrell
Caregiver for wife over 20 year struggle w/lymphoma and leukemia

 

PLEASE INVEST 7 MINUTES WATCHING THEIR POIGNANT VIDEO at: https://youtu.be/1Dy4kO7Zk70

 

When Initial Treatment Proves Insufficient… Searching for the Silver Lining

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shutterstock_252209614“Cancer is not a straight line. It’s up and down.”

—Elizabeth Edwards

When an initial treatment proves insufficient

Cancer treatments fail. It’s that simple. Though patients enter treatment with great hope, that hope may be dashed when either further evidence of disease or proof of recurrence is discovered. Sometimes the failure is apparent immediately, as was the case with my wife, Lori’s, lumpectomy. Other times the disease reappears months, years, even decades later. Evaluation of the effectiveness of your cancer treatment depends upon the modality used.

 Hitting the reset button

If your initial treatment failed to cure your cancer, than you have reached another critical signpost along your journey: The need to modify your treatment plan to include new modalities of care. It’s a bit like hitting the reset button and starting the game over. This can be a particularly difficult time for many patients because the preferred treatment option has proven unsuccessful, often triggering new waves of anxiety and doubt.

 The “middle stage” of cancer

Many patients enter a midpoint in their journey with cancer. It is what author and ovarian cancer survivor Susan Gubar defines as the “middle stage.” Writing in a June 5, 2014 article in the New York Times, Gubar stated:

“For some of us, there is a middle stage in this journey. Because of advances in cancer research and the efforts of dedicated oncologists, a large population today deals with disease kept in abeyance. The cancer has returned and has been controlled, but it will never go away completely. Like me, these people cope with cancer that is treatable for some unforeseeable amount of time. Chronic cancer means you will die from it—unless you are first hit by the proverbial bus—but not now, not necessarily soon.”

The word “chronic” resides between the category of cured and the category of terminal. It refers to disease that is not spreading, malignancy that can be arrested but not eradicated. At times, the term may seem incommensurate with repetitive and arduous regimens aimed at an (eventually) fatal disease. For unlike diabetes or asthma, cancer does not respond predictably to treatment.

Still, quite a few patients with some types of leukemia or lymphoma, prostate or ovarian cancer live for years. While in the 1970s, 10 percent of women with metastatic breast cancer survived five or more years, today up to 40 percent do. Chronic disease may lack the drama of diagnosis and early treatment; even friends can get bored by mounting details. Its evolution does not conform to the feel-good stories of recovery that most of us want to read. But neither does it adhere to the frightfully degenerative plot of quickly advancing tumors.[ii]

 Allowing for disappointment while not relinquishing hope

When you hit these milestones, it is time to be kind to yourself: a time to express your disappointment without relinquishing your hope. You will be traversing a new path on your journey, but first, you must understand how the additional knowledge acquired to date about your condition impacts your staging, prognosis, and recommended treatment options. Your physician should provide this information, as well as recommended modifications to the treatment plan.

Now’s the time to take out your compass and reassess the direction you are headed. It is essential that you go through an appropriate level of due diligence with your doctor regarding the next phase(s) of treatment. Just as you inquired about efficacy, side effects, treatment duration, and other factors prior to your first course of treatment, you need to repeat the process again now. Three very important questions to consider are:

  1. what are the goals of this treatment;
  2. what is the likelihood it will be successful; and
  3. what short-term and long-term effects may the treatment have on my quality of life? Only once you’ve completed this process can you truly provide your physician with informed consent to proceed.

 Due diligence déjà vu

Just as you asked many questions about your initial treatment, so, too, must you feel fully informed about the next steps in your journey. In addition to understanding the fundamental nature of the recommended treatment, you may also wish to ask your physicians the following questions:

  • Why might this treatment be effective when others have failed?
  • Are there other options for treatment that we should discuss?
  • What are the side effects or after-effects of treatment that I may experience?
  • Who will perform this treatment, and what are his or her qualifications for doing so?
  • Will my insurance cover the cost of this treatment?
  • Where I can learn more about this treatment before agreeing to it?

It may be helpful to then take a few days, do your own research, talk with your caregiver, and then come to the most informed decision possible. Regardless of the outcome, you will feel as though you entered this phase of treatment with a solid understanding of its probable outcome, side effects, and costs.

 The End of Active Treatment for Lori

Lori endured a second major surgery—bilateral mastectomies. The difficulty of the recovery was far more than Lori or I anticipated.

(IN LORI’S WORDS) Once I had a chance to digest the news about my initial pathology, I knew I needed more surgery—a mastectomy. I also knew that my type of cancer was also more likely to be present in the opposite breast and to evade early detection by imaging. So, I opted for bilateral mastectomies. It would take coordination between my breast surgeon and my reconstructive surgeon, which even under the most optimal circumstances can take several weeks. I decided to allow myself my hour of sadness, but then take that energy, become my own advocate, and push hard to get things done as soon as possible.

While waiting for my second surgery, I knew I needed to take care of my spiritual, psychological, and physical needs. I packed much of our house to get ready to move, took time to exercise, read my Bible, talk to friends. Mother’s Day was during that time, and all I wanted was to see my sons, so my husband arranged for them to fly home from California and Wisconsin for the weekend. We talked, went to church, and even took in a baseball game. My surgery was scheduled for early the next week.

The day of surgery was also the day before our scheduled move. My sister Janet, a nurse at Duke University Medical Center, came the night of surgery to help with my care and allow John to be with the movers the next day. She stayed with me those first few days when I felt so physically helpless. She brought me “home” to our new house (and new beginning for me) where we were greeted by a chaotic setting of John supervising the movers. Her calming presence, encouragement, and hands-on care were invaluable. I will always be grateful she was there by my side. My brother Chris and his wife Gail took the second watch and stayed for several days, helping me as I struggled to gain strength, as well as helping John unpack our new house. They all dropped their jobs, families, and plans to come and help. Having my strong support system was a tremendous blessing, and I strongly believe it was a key to my recovery.

The final pathology report came out. I held my breath, said a prayer for strength, and waited on the other end of the phone while Dr. V. read me her findings. There had proved to be many spots of cancer creeping through my breast—that was the scary news. But this time there was excellent clearance around the tumor—the margins were negative! A genetic test done to predict my recurrence was also low—so I was not going to need chemotherapy. My risk could be reduced by taking a pill each day to block estrogen.

I knew I had found a silver lining—and a new beginning. Three weeks later I was back at work, now armed with a personal story to complement those of my patients. We would help one another on this journey.

 

[i] Elizabeth Edwards, BrainyQuote, http://www.brainyquote.com/quotes/authors/e/elizabeth_edwards.html

[ii] Gubar, “Living with Cancer.”

Five Essential Things to Know if You are Diagnosed with Cancer

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shutterstock_210369577_1“When you hear the word ‘cancer,’ it’s as if someone took the game of Life and tossed it in the air. All the pieces go flying. The pieces land on a new board. Everything has shifted. You don’t know where to start.”  —Regina Brett[i]

A diagnosis of cancer can be overwhelming, but knowing a few basic things can help make the journey ahead far more manageable. Here are five key things you should know if you or a loved one has recently been diagnosed with cancer:

  1. It is normal to feel completely overwhelmed when you hear the word cancer. Despite the anxiety, and accompanying sense of urgency to begin treatment, you must slow down and be methodical about the next steps.
  2. Identify a caregiver who can be at your side throughout the journey ahead. Your caregiver will fill a number of important roles, including:
    • Serve as a scribe during your doctor appointments so that you have an accurate record of what transpires. This person can also be helpful in keeping other family members or loved ones informed.
    • Request copies of your records from all physicians seen related to your cancer. Be certain that the records include all imaging studies and pathology reports.
    • Help you navigate the complex health care system, while coordinating your care, as needed, across multiple physicians and treatment sites.
    • Provide essential emotional support.
    • Help you address basic functional needs at a time when many of your resources are consumed simply fighting your disease.
  3. Before you can proceed, it is essential that you understand your diagnosis, the goals of treatment, and treatment options based upon objective information presented by knowledgeable physicians.
  • Oftentimes this requires visiting multiple specialists – including surgeons, as well as medical and radiation oncologists. Since there often numerous methods for treating a disease, these specialists may render differing opinions regarding what is best for you.
  • It is important to keep in mind that specialists have an understandable predilection for the types of interventions they deliver – a surgeon may be biased towards surgical procedures just as a radiation oncologist is biased towards radiation therapy.
  • Such differing opinions can be confusing for the patient…particularly since you are now navigating in unfamiliar territory. Before making a decision about treatment, there are three things that you must know:
    • As a general rule, the treatment should be based upon a “standard of care” – meaning that there is a consensus in the medical community regarding the best method(s) for managing your disease. The National Comprehensive Cancer Network, or NCCN, publishes such standards of care, or evidence-based pathways, for many types of cancer. Consumer-friendly versions of such pathways are available for free on their web-site (nccn.org). You would be well-advised to review the NCCN recommendations for your disease (and stage of disease). If your doctor is recommending a treatment that appears to deviate from the standards of care, ask him or her why.
    • There are pros and cons for every treatment – both in terms of the relative effectiveness of the treatment, as well as the short-term and long-term potential side-effects. Only by understanding these nuances of treatment can you make a truly informed decision about what is right for you.
    • There may be substantial differences in the costs associated with different interventions. While we all want and deserve the best treatment available, two treatments may be virtually identical in terms of the outcomes produced, but vary dramatically in costs. Before your out-of-pocket expenses grow astronomically, you may wish to discuss the projected cost of care with your doctors. Your physician should also inform you if he or she has a financial conflict of interest whereby they will profit more from the delivery of certain types of treatment. A urologist, for example who treats prostate cancer with a linear accelerator owned by the group has an ethical obligation to disclose this conflict to the patient.
  1. Now that you are armed with far more information about the best course of treatment for your condition, you need to decide who will deliver your care and where you will receive it. Before you put blind trust in your doctors, you need to know that not all physicians (or facilities) are created equal – in fact, there’s tremendous variance in the relative quality of care delivered by different doctors at different hospitals/clinics. Unfortunately, sorting out the good apples is not the easiest task. Here are three suggestions for improving the odds of having a highly competent medical team:
  • Learn as much as you can about your physicians’ training, and experience treating your particular disease. There’s nothing wrong with interviewing your physicians! You should be sizing up your doctor, not only in terms of clinical training/experience/competency, but also how you feel at a gut-level about having them lead you through this difficult journey.
    • Keep in mind that practice does not make perfect, but when combined with the right training and certain inherent skills, it can make a huge difference. For instance, an oncologic surgeon who, after completing a fellowship in breast cancer surgery, has been practicing for ten years at a premier facility may produce different results than a general surgeon whose most frequent procedure is repairing a hernia. Unfortunately, there is no readily available data that allows us to compare the relative competency of our physicians.
  • Consider the depth and breadth of the cancer treatment resources available at your facility of choice. Do your best to separate out the marketing hyperbole from the cold, hard facts regarding the facility’s capabilities. It’s relatively easy to go to the hospitals’ websites within your community and compare capabilities. If there is an NCI-designated Comprehensive Cancer Center in your community (which differs from an NCI-designated Community Cancer Center), and have not selected it as your provider of choice, you may wish to get a second opinion at this facility. If you have an early stage, easily treated disease, this may be less of a concern than with more advanced or difficult to treat tumors.
  • Be careful about listening to the advice of your backdoor neighbor or cousin Martha about who the best doctor in town is for your cancer. Their intentions will undoubtedly be spot on, but their knowledge may be highly flawed. Author Marty Makary, M.D., a Johns Hopkins physician, talks about Dr. Hodad – a popular physician with a wonderful bedside manner whose patients think he walks on water (HODAD turns out to be an acronym for hands of death and destruction).
  1. Never under-estimate the power of hope in helping get you through the journey. Though no one welcomes cancer into their life, a great many people experience tremendous growth as a result. Hope can be the force that helps you emerge on the other side…stronger, more resilient, and with a unique appreciation for the wonderful life you’ve been given.

There are many more steps to transforming an arduous journey into a manageable one. What I’ve outlined here are five of the most basic. If you would like to read more, I would strongly encourage you to read: After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead.

The book is available at Amazon.com (http://www.amazon.com/After-You-Hear-Its-Cancer/dp/1442246251/ref=sr_1_3?ie=UTF8&qid=1423064996&sr=8-3&keywords=john+leifer#)  or through the publisher – Rowman & Littlefiel (https://rowman.com/ISBN/9781442246263).

 

 

I would welcome your questions or comments. 

 

 

 

[i] Regina Brett, BrainyQuote, http://www.brainyquote.com/quotes/quotes/r/reginabret586752.html.

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