Spiritual distress is common in those with metastatic cancer. We evaluated the sustained effects of an empirically anchored 6-week psychoeducation program, Growing Resilience And CouragE (GRACE), on spiritual well-being, quality of life, and psychosocial symptoms.
Methods:
Primary and secondary outcomes were assessed at baseline (T0), immediately after GRACE (T1), 1 month after GRACE (T2), and 6 months later (T3). Intervention and waitlist control groups (from the randomized clinical trial) were combined for this analysis. A generalized additive model for location, scale, and shape was used.
Results:
Data from 54 women with metastatic breast cancer who received GRACE were analyzed. All outcomes (spiritual well-being, quality of life, and psychosocial symptoms) significantly improved at T1, T2, and T3 compared to baseline (p < 0.001).
Conclusion:
GRACE is beneficial for the spiritual well-being, quality of life, and psychosocial well-being of women with metastatic breast cancer, and these benefits appear to be sustained at 6 months post-intervention.
WalshLE, RosenfeldB, FeuerstahlerL, et al.Measuring hopelessness in advanced cancer: A secondary analysis of the hopelessness assessment in illness questionnaire (HAI). Psychol Health, 2023; 38(7):847–861.
2.
MosherCE, JohnsonC, DicklerM, et al.Living with metastatic breast cancer: A qualitative analysis of physical, psychological, and social sequelae. Breast J, 2013; 19(3):285–292.
3.
ZhengQ, XiongL, LiH, et al.Demoralization: Where it stands-and where we can take it: A bibliometric analysis. Front Psychol, 2022; 13:1016601.
4.
Survival rates for breast cancer. American Cancer Society; 2025.
5.
NolanTS, BrowningK, VoJB, et al.CE: Assessing and managing spiritual distress in cancer survivorship. Am J Nurs, 2020; 120(1):40–47.
KandasamyA, ChaturvediSK, DesaiG. Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer. Indian J Cancer, 2011; 48(1):55–59.
8.
Delgado-GuayMO, PalmaA, DuarteE, et al.Association between spirituality, religiosity, spiritual pain, symptom distress, and quality of life among Latin American patients with advanced cancer: A multicenter study. J Palliat Med, 2021; 24(11):1606–1615.
9.
DamenA, ExlineJ, PargamentK, et al.Prevalence, predictors and correlates of religious and spiritual struggles in palliative cancer patients. J Pain Symptom Manage, 2021; 62(3):e139–e47.
10.
BreitbartW, PessinH, RosenfeldB, et al.Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer, 2018; 124(15):3231–3239.
11.
PolettiS, RazziniG, FerrariR, et al.Mindfulness-based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study. Complement Ther Med, 2019; 47:102218.
12.
JohnsSA, Beck-CoonK, StutzPV, et al.Mindfulness training supports quality of life and advance care planning in adults with metastatic cancer and their caregivers: Results of a pilot study. Am J Hosp Palliat Care, 2020; 37(2):88–99.
13.
XiaW, ZhengY, GuoD, et al.Effects of cognitive behavioral therapy on anxiety and depressive symptoms in advanced cancer patients: A meta-analysis. Gen Hosp Psychiatry, 2024; 87:20–32.
14.
KissaneDW, GrabschB, ClarkeDM, et al.Supportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psychooncology, 2007; 16(4):277–286.
15.
ChaoulA, MilburyK, SoodAK, et al.Mind-body practices in cancer care. Curr Oncol Rep, 2014; 16(12):417.
16.
AsherA, ShirazipourCH, CapaldiJM, et al.A 6-week program to strengthen resiliency among women with metastatic cancer: A randomized clinical trial. Oncologist, 2023; 28(8):e669–e82.
17.
PetermanAH, FitchettG, BradyMJ, et al.Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy–spiritual well-being scale (FACIT-Sp). Ann Behav Med, 2002; 24(1):49–58.
18.
CellaDF, TulskyDS, GrayG, et al.The functional assessment of cancer therapy scale: Development and validation of the general measure. J Clin Oncol, 1993; 11(3):570–579.
19.
SteerRA, BrownGK, BeckAT, et al.Mean beck depression inventory-II scores by severity of major depressive episode. Psychol Rep, 2001; 88(3 Pt 2):1075–1076.
20.
BeckAT, EpsteinN, BrownG, et al.An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol, 1988; 56(6):893–897.
21.
BeckAT, RiskindJH, BrownG, et al.Levels of hopelessness in DSM-III disorders: A partial test of content specificity in depression. Cogn Ther Res, 1988; 12(5):459–469.
RigbyRA, StasinopoulosDM. Generalized additive models for location, scale and shape. Appl Stat, 2005; 54(3):507–554.
24.
RobinsJM, FinkelsteinDM. Correcting for noncompliance and dependent censoring in an AIDS clinical trial with inverse probability of censoring weighted (IPCW) log-rank tests. Biometrics, 2000; 56(3):779–788.
25.
YamashitaT, YamashitaK, KamimuraR. A stepwise AIC method for variable selection in linear regression. Commun Stat Theory Methods, 2007; 36(13):2395–2403.
26.
van BuurenS, FredriksM. Worm plot: A simple diagnostic device for modelling growth reference curves. Stat Med, 2001; 20(8):1259–1277.
27.
Team RC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2021.
28.
HolmS. A simple sequentially rejective multiple test procedure. Scandinavian J Stat, 1979; 6(2):65–70.
29.
ZimmermannC, SwamiN, KrzyzanowskaM, et al.Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 2014; 383(9930):1721–1730.
30.
NagyDS, IsaicA, MotofeleaAC, et al.The role of spirituality and religion in improving quality of life and coping mechanisms in cancer patients. Healthcare (Basel), 2024; 12(23):2349.
31.
BadaghiN, BuskbjergC, KwakkenbosL, et al.Positive health outcomes of mindfulness-based interventions for cancer patients and survivors: A systematic review and meta-analysis. Clin Psychol Rev, 2024; 114:102505.
