Spiritual well-being and health-related quality of life in colorectal cancer: A multi-site examination of the role of personal meaning

Purpose Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model. Methods Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis,M=19). Participants completed measures of SpWB (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp)) and HRQL (Functional Assessment of Cancer Therapy-Colorectal) in both studies. Measures of general distress (Profile of Mood States-Short Form) and cancer-specific distress were also completed in study 1 and study 2, respectively. Results After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace. Conclusions This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACITSp separately and explore the viability of meaning-based interventions for cancer survivors.