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

  • Neha G. Goyal
  • Edward H. Ip
  • John M. Salsman
  • Nancy E. AvisEmail author
Original Article



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


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.


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.


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.


Spirituality Physical health Breast cancer survivors Longitudinal 



National Cancer Institute R25 CA122061, Department of Defense grant DAMD17-01-1-0447, and the National Center for Advancing Translational Sciences UL1 TR001420-01.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”


  1. 1.
    Koenig HG (2015) Religion, spirituality, and health: a review and update. Adv Mind Body Med 29(3):19–26PubMedGoogle Scholar
  2. 2.
    Miller WR, Thoresen CE (2003) Spirituality, religion, and health. An emerging research field. Am Psychol 58(1):24–35CrossRefGoogle Scholar
  3. 3.
    Park CL, Masters KS, Salsman JM, Wachholtz A, Clements AD, Salmoirago-Blotcher E, Trevino K, Wischenka DM (2017) Advancing our understanding of religion and spirituality in the context of behavioral medicine. J Behav Med 40(1):39–51. CrossRefPubMedGoogle Scholar
  4. 4.
    Jim HS, Pustejovsky JE, Park CL, Danhauer SC, Sherman AC, Fitchett G, Merluzzi TV, Munoz AR, George L, Snyder MA, Salsman JM (2015) Religion, spirituality, and physical health in cancer patients: a meta-analysis. Cancer 121(21):3760–3768. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Oman D (2013) Defining religion and spirituality. In: Paloutzian R, Park C (eds) Handbook of the psychology of religion and spirituality, 2nd edn. Guilford Press, New York, pp 23–47Google Scholar
  6. 6.
    Salsman JM, Fitchett G, Merluzzi TV, Sherman AC, Park CL (2015) Religion, spirituality, and health outcomes in cancer: a case for a meta-analytic investigation. Cancer 121(21):3754–3759. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, Chochinov H, Handzo G, Nelson-Becker H, Prince-Paul M, Pugliese K, Sulmasy D (2009) Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med 12(10):885–904. CrossRefPubMedGoogle Scholar
  8. 8.
    Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D (2002) Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy--spiritual well-being scale (FACIT-Sp). Ann Behav Med 24(1):49–58CrossRefGoogle Scholar
  9. 9.
    Lipka M, Gecewicz C (2017) More Americans now say they're spiritual but not religious. Pew Research Center. Accessed 19 June 2018
  10. 10.
    Whitford HS, Olver IN, Peterson MJ (2008) Spirituality as a core domain in the assessment of quality of life in oncology. Psychooncology 17(11):1121–1128. CrossRefPubMedGoogle Scholar
  11. 11.
    Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS (2006) Spirituality influences health related quality of life in men with prostate cancer. Psychooncology 15(2):121–131. CrossRefPubMedGoogle Scholar
  12. 12.
    Bai M, Lazenby M (2015) A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 18(3):286–298. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Salsman JM, Yost KJ, West DW, Cella D (2011) Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning. Support Care Cancer 19(6):757–764. CrossRefPubMedGoogle Scholar
  14. 14.
    Edmondson D, Park CL, Blank TO, Fenster JR, Mills MA (2008) Deconstructing spiritual well-being: existential well-being and HRQOL in cancer survivors. Psychooncology 17(2):161–169. CrossRefPubMedGoogle Scholar
  15. 15.
    Bai M, Dixon JK (2014) Exploratory factor analysis of the 12-item functional assessment of chronic illness therapy-spiritual well-being scale in people newly diagnosed with advanced cancer. J Nurs Meas 22(3):404–420CrossRefGoogle Scholar
  16. 16.
    Canada AL, Murphy PE, Fitchett G, Peterman AH, Schover LR (2008) A 3-factor model for the FACIT-Sp. Psychooncology 17(9):908–916. CrossRefPubMedGoogle Scholar
  17. 17.
    Peterman AH, Reeve CL, Winford EC, Cotton S, Salsman JM, McQuellon R, Tsevat J, Campbell C (2014) Measuring meaning and peace with the FACIT-spiritual well-being scale: distinction without a difference? Psychol Assess 26(1):127–137. CrossRefPubMedGoogle Scholar
  18. 18.
    Whitford HS, Olver IN (2012) The multidimensionality of spiritual wellbeing: peace, meaning, and faith and their association with quality of life and coping in oncology. Psychooncology 21(6):602–610. CrossRefPubMedGoogle Scholar
  19. 19.
    Murphy PE, Canada AL, Fitchett G, Stein K, Portier K, Crammer C, Peterman AH (2010) An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society's study of Cancer survivors-II (SCS-II). Psychooncology 19(3):264–272. CrossRefPubMedGoogle Scholar
  20. 20.
    Avis NE, Levine B, Naughton MJ, Case LD, Naftalis E, Van Zee KJ (2013) Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment. Breast Cancer Res Treat 139(1):199–206. CrossRefPubMedGoogle Scholar
  21. 21.
    Ware JE, Kosinski M, Keller SD (1994) SF-36 physical and mental health summary scales: a User's manual. The Health Institute, BostonGoogle Scholar
  22. 22.
    Little TD (2013) The longitudinal CFA model. In: Longitudinal structural equation modeling. Guildford Publications, New York, pp 137–159Google Scholar
  23. 23.
    Selig JP, Little TD (2012) Autoregressive and cross-lagged panel analyis for longitudinal data. In: Laursen B, Little TD, Card NA (eds) Handbook of developmental research methods. The Guilford Press, New York, pp 265–278Google Scholar
  24. 24.
    Muthén L, Muthén B (2012) Mplus user's guide. Muthén & Muthén, Los AngelesGoogle Scholar
  25. 25.
    Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6(1):1–55. CrossRefGoogle Scholar
  26. 26.
    Bentler PM, Bonett DG (1980) Significance tests and goodness of fit in the analysis of covariance-structures. Psychol Bull 88(3):588–606. CrossRefGoogle Scholar
  27. 27.
    Munoz AR, Salsman JM, Stein KD, Cella D (2015) Reference values of the functional assessment of chronic illness therapy-spiritual well-being: a report from the American Cancer Society's studies of cancer survivors. Cancer 121(11):1838–1844. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12(Pt 3):363–381. CrossRefPubMedGoogle Scholar
  29. 29.
    Visser A, Garssen B, Vingerhoets A (2010) Spirituality and well-being in cancer patients: a review. Psychooncology 19(6):565–572. CrossRefPubMedGoogle Scholar
  30. 30.
    Park CL (2005) Religion as a meaning-making framework in coping with life stress. J Soc Issues 61(4):707–729. CrossRefGoogle Scholar
  31. 31.
    Canada AL, Fitchett G, Murphy PE, Stein K, Portier K, Crammer C, Peterman AH (2013) Racial/ethnic differences in spiritual well-being among cancer survivors. J Behav Med 36(5):441–453. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Neha G. Goyal
    • 1
  • Edward H. Ip
    • 2
  • John M. Salsman
    • 3
  • Nancy E. Avis
    • 3
    Email author
  1. 1.Helen Diller Family Comprehensive Cancer CenterUniversity of California - San FranciscoSan FranciscoUSA
  2. 2.Department of Biostatistical Sciences, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Social Sciences and Health Policy, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA

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