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Spirituality Improves Outcomes for Breast Cancer Survivors

Analysis  |  By Carol Davis  
   June 29, 2021

University of Missouri nurse's research links congregational support and forgiveness with neuroimmune biomarkers.

As a 20-year nurse practitioner, Jennifer Hulett, PhD, APRN, noticed breast cancer survivors often credited God or a divine being for being alive. Results from her new study suggest that may not be a coincidence.

Spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based psychoneuroimmunology (PNI) model of health, according to Hulett's study, which was published in Supportive Care in Cancer and funded in part by the National Institute of Nursing Research.

Hulett, now an assistant professor at the University of Missouri (MU) Sinclair School of Nursing, is researching the benefits of spirituality on improving immune health and reducing stress, as well as the chances of cancer reoccurrence, among breast cancer survivors, according to a press release.

Hulett collected and froze samples of saliva from 41 breast cancer survivors at MU’s Ellis Fischel Cancer Center.

She identified breast cancer survivors' reports of practicing forgiveness and receiving positive social support from their church congregation or other social support network and linked them with two specific biomarkers—alpha-amylase and interleukin-6.

The findings lay the foundation for further examining the role spirituality plays in the health and well-being of both cancer survivors and individuals managing chronic disease.

"Breast cancer survivors are often a highly spiritual group given the trauma they have been through, and we found they often have more positive spiritual beliefs in a loving God or higher power rather than a punitive, punishing God," Hulett says.

"This confirmed what I had previously experienced anecdotally as a nurse," she says. "Breast cancer survivors would often express gratitude and contribute their health and well-being to a higher power, and they tended to have better health outcomes as well."

Hulett’s research builds off previous findings indicating positive spiritual beliefs are associated with healthier levels of cortisol, a biomarker commonly associated with stress, among breast cancer survivors.

"Cortisol and stress suggest chronic inflammation, and anything we can do to lower levels of stress and inflammation will have a good effect on a patient’s longevity, health outcomes, and reduced risk of reoccurring disease," Hulett says. "We often hear about diet and exercise in promoting physical health, but we rarely hear about the importance of managing stress, and all three are connected with well-being."

One in eight women develop breast cancer, and previous studies show chronic stress in breast cancer survivors is linked with increased inflammation and risk for cancer reoccurrence.

"We know cortisol is linked with stress, and elevated levels of the immune biomarker interleukin 6 suggests inflammation," Hulett says. "By first finding out which biomarkers are meaningful to look at, we can then see how they are potentially influenced by various spiritual or mindfulness practices aimed at reducing inflammation."

Hulett’s research adds to the body of knowledge evaluating effectiveness of spiritual and mindfulness interventions, including daily prayer, mediation, yoga, and relaxation, on health outcomes among cancer survivors and individuals with chronic disease.

"We already know these interventions improve mental health, but they might also improve physical health as well, and we can try to prove it by looking at these physiological biomarkers," Hulett says.

"These spiritual interventions are what nurses can use at the bedside to quickly implement if they see patients struggling to cope with their illness," she says. "Any evidence-based solutions we can equip nurses with will help improve patient health outcomes, and that is where these mind-body interventions can play a role going forward."

“Breast cancer survivors would often express gratitude and contribute their health and well-being to a higher power, and they tended to have better health outcomes as well.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


Breast cancer survivors often express gratitude to God or a divine being for being alive.

Spiritual beliefs and religious practices are associated with neuroimmune activity.

Bedside nurses can use spiritual intervention to help patients struggling to cope with their illness.

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