Matters of Faith After a Cancer Diagnosis

After rising prostate-specific antigen (PSA) levels led to a positive biopsy in July 2014, Jock Dyer, who lives in New Hampshire, received a diagnosis of prostate cancer at age 72. After laboring over treatment options with his wife, they decided on a prostatectomy (a procedure to surgically remove some or all the prostate), which he underwent that September.

However, Dyer’s PSA levels were not zero, where they should have been after the procedure. In January 2015, he received a diagnosis of metastatic prostate cancer.

Since then, Dyer, now 81, has been receiving hormone therapy at Dana-Farber Cancer Institute in Boston.

Although he does not experience pain or discomfort, he says he loses a couple pounds of muscle per month. So, he advocates for himself and tells his doctors when he needs a break from treatment to regain some of the lost muscle.

Despite the nuisance of losing muscle because of treatment, he doesn’t let his diagnosis control his life.

“I don’t refer to it as my cancer. I refer to it as my diagnosis, but cancer is what it is,” Dyer tells CURE. “I’m still me, cancer doesn’t change me. That’s been my mantra.”

Instead, he leans on his Christian faith, which has guided him for more than 45 years, he says.

“When I received the diagnosis, it was like a punch in the gut,” he says. “I was a fish out of water for a few months. One day I was at the YMCA trying to stay in shape, but I couldn’t keep up with the routine. I ended up just giving up trying to do push-ups and putting my nose on the floor, and I started to cry.”

Yet, Dyer stopped himself and realized that thinking about the possibility of death after the diagnosis was distracting him from precious life presently.

“I would pray to God, not so much make this go away or wake me up, but rather, asking [him] to help me accept the reality right in front of me by exploring helpful areas that I could control, such as nutrition, exercise, stress reduction, close friendships and prayer,” Dyer explains.

“I credit God for showing me that mortality is not so much connected to time, since I’m already standing off to the side, observing from a position of eternity,” he says. “It became clear to me that birth, life on earth and death are just three parts of one much larger life, I could let the past go, live in the present and plan for the future without worry, because God created me for eternal life.”

So, Dyer emphasizes that “the dreaded diagnosis I received in 2014 turned out to be an enormous improvement in my being.”

The Meaning of Faith

Faith can relate to both spirituality and religion, explains Dr. John Peteet, a psychiatrist at Brigham and Women’s Hospital and Dana-Faber Cancer Institute in Boston. He notes that spirituality can connect the self and a larger entity that may offer meaning in individuals’ lives. Religion, however, is typically seen as an institutionalized and organized form of spirituality that a community may share.

Patients with cancer who were spiritually faithful before cancer tended to have a stronger connection to their faith after receiving their diagnoses, Peteet notes.

“There was a study a few years ago, and I think they surveyed over 2,000 people, the majority of whom, 70%, said that their faith had gotten stronger as a result of their cancer diagnosis,” he says. “Only about 17% said that they experienced a negative effect on their faith. So, I think it can go in either direction.”

Having a combination of reactions is also “very common” for patients with cancer shortly after receiving a diagnosis, agrees Julie Exline, a psychology professor at Case Western Reserve University in Cleveland.

Exline says people may “turn to their faith for help coping with [their diagnosis]. Saying, ‘I’m trusting God will bring good from this,’ or ‘I’m leaning on God for help,’ or ‘My religious community can help me.’”

On the opposite end, she explains that people may also question their faith.

“There is also often a sense of struggle, maybe fear. ‘Is God still going to take care of me? Have I done something wrong? Is God going to let something terrible happen to me?’

“A key message here is that lots of people have had these feelings, including people who would say they have a strong faith,” says Exline. “Devout believers lean on God but have also had this belief that maybe if I’m good or if I’m a faithful person, if my life is surrendered to God, then bad things won’t happen to me. So often, their faith could be shaken by this.”

Quality of Life and Spirituality

Spiritual distress is seen through different themes, such as beliefs, practices and community, says Peteet. These themes together may change the experiences patients could face during cancer.

“When people feel as though they’re not sure if their original faith still holds, it can cause them to question deeply held beliefs,” he adds. “If they feel that they can no longer depend on them, that can get pretty distressing.”

However, an individual’s spiritual distress can also affect their physical health, says Jamila Kwarteng, an assistant professor of community health at the Medical College of Wisconsin in Milwaukee.

“If a person has more distress, then that can lead to worsened outcomes,” she explains, referring to outcomes as the aspects of quality of life. “They could question the meaning of life, and the [additional] distress they have can lower their quality of life.”

Different dimensions of quality of life include physical, social, emotional, functional and spiritual aspects for some, Kwarteng notes. But when one element of quality of life is worsened, then it can impact patient outcomes, she says.

“If a person has improved quality of life, then that will lead to improved patient outcomes, as well,” Kwarteng explains. “Something we will want to try to achieve is to help someone to have an improved quality of life, whether it’s through providing spiritual support or some other type of support. Many studies have found that quality of life is so important in terms of patient outcomes. Those with a higher quality of life can have better survival after a cancer diagnosis as well.”

A review co-authored by Peteet and published in CA: A Cancer Journal for Clinicians emphasizes that lack of spiritual support and negative religious coping — such as anger toward God — is associated with lower quality of life.

To mitigate this, Peteet says that receiving assistance with spiritual concerns may help.

“When people have worse quality of life, their spiritual distress can be heightened,” he says. “When someone is in pain, they may be questioning their faith. If they get help with their spiritual concerns, there’s research that shows this can improve their quality of life.

“A diagnosis itself still raises the issue of dying for most people, even though cancer is more treatable now,” Peteet says. “It raises these existential concerns about one’s mortality, what the larger meaning of life is and what happens after death.”

'Cancer Made Me Human'

Cancer wasn’t what made Roberta Codemo wonder what the meaning of life is. Rather, cancer helped her understand her life’s purpose.

In 2008, Codemo went to the emergency room, thinking she had a case of appendicitis. She was initially told that she had a mass on an ovary and a twisted fallopian tube.

A follow-up appointment with her doctor revealed that she had complex endometrial hyperplasia without atypia (when the uterus lining becomes too thick but has normal-looking cells) at 44 years old. At the time, her doctor didn’t want to proceed with a hysterectomy (a surgical procedure to remove the uterus and cervix), because she hadn’t had children, and gave her progesterone instead, a medication to prevent changes in the uterus.

After, Codemo’s doctor told her she would eventually develop endometrial cancer, leaving her with, in her words, a “ticking time bomb.”

Starting around 2012, Codemo started experiencing abnormal vaginal bleeding and passed blood clots the size of her fist. She received a diagnosis of stage 1C endometrial cancer and ovarian cancer in 2014.

As a Buddhist for nearly 30 years, Codemo did not perceive her diagnosis as good or bad. Instead, she viewed cancer as “burning off” her negative karma.

“My parents had both been diagnosed with cancer and now I had my own battle to fight, but it was also seeing it as a way of burning off karma,” Codemo, of Camp Point, Illinois, explains. “Getting cancer was the best thing that happened to me.”

Her diagnosis allowed her to open herself up and “understand what suffering really is.”

“My Buddhism has deepened because I’ve gotten to know other women who have been diagnosed with gynecologic cancer,” Codemo says. “No woman should have to go through this, and that is why I advocate and continue to advocate.

“Buddhism sees illness and sickness as a means of eliminating negative karma. It gives you guidance to reach Buddhahood, if you meditate, study and follow the Eightfold Path.”

According to Britannica, the Eightfold Path in Buddhism is described as the path to enlightenment via eight elements that include having “correct” actions and choices in life, including “correct effort,” “correct speech” and “correct mindfulness.”

However, she admits her faith wasn’t always this strong. It wasn’t until she had met fellow patients with gynecologic cancers that shifted her entire view on compassion and companionship.

“I called myself Buddhist, but I didn’t practice. After my diagnosis, I met Melanie Chasen during my first day in the [chemotherapy] room, and I have her to thank for the person I’ve become.”

Her friend, who was also Codemo’s cancer mentor, always told Codemo that the reason her cancer was caught at such an early stage was so that she could “be a voice for other women who were so sick, they didn’t have a voice.”

“Getting cancer made me human,” Codemo says. “It taught me the meaning of the word compassion, which is the touchstone of Buddhism. I’m no longer cold-hearted and now advocate, speak out and do interviews like this.

“After I was declared NED [no evidence of disease], I had too much invested and had met so many wonderful women. I couldn’t turn my back and walk away.”

Now 60 years old, Codemo has been cancer-free for 10 years and continues to advocate for women with gynecologic cancers, and would like to become a patient navigator.

“I still am not fully practicing, but I understand more of what Buddhism is,” she says. “I still continue to feel that connection because I will probably continue advocating until the day I die.”

Advice for Patients Regarding Faith

Although stories like Dyer’s and Codemo’s are common, so are other experiences with faith regarding spiritual distress.

Leaning into faith support networks can be important for patients, Kwarteng notes. She explains that patients may open up about their diagnoses with trusted leaders or others within their network.

“They might not want to share with everyone, but if they can find a few trusted people, then they may be able to get more support that can help them through their cancer journey,” she says.

Peteet agrees that patients having a spiritual community or spiritual authority in their lives may be helpful.

“It’s interesting that in the research that’s been done on providing spiritual care to people with spiritual concerns, the care that was provided through the medical team seemed to lead to less aggressive care at the end of life, as compared with the kind of support that people got from outside,” he explains. “Most cancer hospitals have cancer-experienced chaplains who can be pretty helpful.”

Still, for patients who may feel that it’s morally wrong to be angry at God or temporarily lose faith, Exline emphasizes that experiencing feelings like these is common.

“A very big take-home message is that feelings of anger and disappointment related to God or worrying that God is going to punish you [and] doubting whether you can trust God is extraordinarily common,” she says. “The counterintuitive thing about it is that once [patients] are willing to go there and acknowledge it, that is often a really huge step toward healing one’s relationship with God. If patients can address it, [then] at least they can get somewhere.”

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