Editor's Commentary - Spirituality and end-of-life care in disadvantaged men dying of prostate cancer

BERKELEY, CA (UroToday.com) - In the World Journal of Urology, the group of Dr. Mark Litwin at UCLA discusses spirituality in disadvantaged men dying from prostate cancer (CaP). Spirituality and religion are coping resources for many with cancer, with 90% reporting it as important and many having higher levels of spirituality after receiving a cancer diagnosis. Interestingly, higher spirituality is reportedly associated with less end of life planning and higher use of intensity care, such as mechanical ventilation, CPR and hospitalization at the end of life. These investigators hypothesized that prostate cancer patients with higher spirituality would utilize hospice care less than men with lower spirituality and use chemotherapy, palliative radiotherapy or zolendroic acid more often.

The study included 35 low-income, uninsured men (who had died since 2001) in IMPACT, a state of California funded public assistance program They had completed a spirituality questionnaire at program enrollment. These men were assigned medical care and access to advanced disease therapies as indicated. The Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being questionnaire measured spirituality and religiosity. Higher scores indicated greater spirituality. The questionnaire had two subscales; a peace subscale assessing the existential impact of spirituality and a faith subscale measuring the strength and comfort derived from faith and religious beliefs.

Most of the 35 patients were minorities with a partner. At diagnosis, 31 of the 35 men had high-risk CaP and androgen deprivation therapy was the most commonly employed therapeutic modality. For advanced therapies, one-quarter enrolled in hospice, one-third received palliative radiotherapy, one-half received zolendoic acid and most received chemotherapy. Partnership status was significantly associated with spirituality and ethnicity. Patient age, area of residency, and clinical stage at diagnosis were not associated with spirituality. Regarding hospice enrollment, 33% of those with high spirituality enrolled compared with 13% having low spirituality scores. There was a trend for men of higher spirituality to use more palliative radiotherapy, and differences in end of life care received did not differ much by the peace and faith subscales. Thus, the authors were surprised to find higher hospice utilization among more spiritual CaP patients. The pattern of end of life care was similar to other reports of higher income, insured patients for men with both higher and lower spirituality. The associations between spirituality and end of life care did not change in the peace or faith subscale analyses.

Bergman J, Fink A, Kwan L, Maliski S, Litwin MS

World J Urol. 2011 Feb;29(1):43-9

PubMed Abstract
PMID: 21170717

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