Spirituality and physical health status: a longitudinal examination of reciprocal effects in breast cancer survivors

Abstract

Purpose: This longitudinal study sought to examine the reciprocal relationship between spirituality and physical health status among breast cancer survivors.

Methods: Breast cancer survivors (N = 634) completed baseline assessments (T1) within 8 months of breast cancer diagnosis and 12 (T2) and 18 months (T3) after their baseline assessment. Spirituality was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale which consists of three subscales: meaning, peace, and faith. Physical health status was measured with the SF-36 Physical Component Summary (PCS). A cross-lagged structural equation model (SEM) was used to analyze the three-wave data to examine the reciprocal relationships between the observed variable, PCS, and the three subscales of the FACIT-Sp, treated as latent variables.

Results: The cross-lagged SEM yielded an adequate fit to the data: RMSEA = .036, CFI = 0.97, TLI = 0.96. After controlling for relevant sociodemographic and cancer-related variables, only higher PCS at T2 predicted greater meaning at T3. PCS at T1 did not predict meaning at T2 and the reciprocal relationship of meaning predicting PCS was not significant. Neither peace nor faith was reciprocally related to PCS.

Conclusions: Results provide evidence of a unidirectional relationship between self-reported physical health status and subsequent meaning among breast cancer survivors during the period of early to later survivorship. Additional studies are needed that examine the longitudinal and directional relationships between spirituality and physical health among diverse samples of cancer survivors.

Keywords: Breast cancer survivors; Longitudinal; Physical health; Spirituality.

Fig 1.

Cross-lagged structural equation model of the FACIT-Sp subscales (meaning, peace, and faith) and SF-36 PCS. Path coefficients are standardized. All models controlled for age, race, chemotherapy, time since diagnosis, radiation, surgery type, stage, and comorbidity. Dotted lines indicate non-significant paths, while solid lines represent significant paths. For clarity, indicators of the latent variables, error covariances, covariates, and cross-sectional associations are not depicted on the diagram. *p <.05; ***p < 0.001.