Pain and Spirituality Among Women With Advanced Breast Cancer

Despite significant advancements in symptom management, a high proportion of women with advanced breast cancer report pain.1 The overall 5-year relative survival rate for women with metastatic breast cancer is low (15%–22%),2 making symptom management a critical concern. Inadequate management of pain inhibits comfort, impedes quality of life, and can be associated with reduced survival length for cancer patients.3 Pain is one of the most feared and burdensome symptoms of cancer,4 calling for additional research to guide comprehensive management. Pain has been defined as a distressing experience with interacting sensory, cognitive and emotional components, which may be associated with actual or perceived tissue damage.5–8 Being a complex, multidimensional phenomenon, the experience of pain is known to be modulated by alterations in thoughts and feelings.7,9 Pain in advanced cancer can be exacerbated by challenging thoughts and feelings associated with uncertainty about the future, lack of control, and fear of death.10 Novel approaches are needed to support patients who are experiencing these difficult thoughts and feelings, potentially improving the overall experience of pain. Spirituality is one area warranting further investigation.11 Women with advanced breast cancer have cited spirituality as an important resource for facing their disease experience, including their symptoms.12 Spirituality is most commonly defined as a dynamic process by which humans experience connection with self, others, nature or higher power, and a sense of meaning,13–15 thus serving as a resource when facing cancer and its associated symptoms.11,12 Spirituality can contribute to a broader cognitive understanding of the self and the universe,16 making a painful experience seem less significant overall. Additionally, spirituality promotes feelings of emotional safety and security in the face of difficulty.17,18 Due to these positive effects on thoughts and emotions, spirituality could feasibly be one avenue for altering the psychological aspects of pain, serving to modulate painful experiences.19 Additionally, there is evidence that spirituality increases the use of self-management interventions focused on relieving pain (such as exercise, relaxation, medication adherence complementary therapies, and activity cycling), thus indirectly improving this symptom.16,17 Michigan State University.