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Objective: Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects. Methods: Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Results: Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [-0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size. Conclusions: Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.

OBJECTIVE Little is known about survivors' understanding of the cause of their cancer and of their recovery, nor how these ways of understanding relate to their well-being. No study has examined both secular and religious appraisals of the same event. The current study aimed to examine both religious (God) and secular (self) appraisals of both the cause (attributions) and course/cure of cancer in relation to multiple aspects of adjustment. METHODS Data were obtained from a sample of cancer survivors at Time 1 (n = 250) and 1 year later (Time 2, n = 167). RESULTS Cancer survivors endorsed higher appraisals relating to course/cure of their cancer than those relating to cause, and they endorsed both secular and religious appraisals. Appraisals of the cause and course/cure of cancer were differentially related to adjustment, such that self-attributions of cause and God-attributions of cause were related to negative aspects of adjustment (eg, negative affect and pessimism), while appraisals of self and God's control over the course/cure were related to positive aspects of adjustment (eg, perceived positive life and health changes since cancer). Religiosity did not moderate most of relationships between religious appraisals and adjustment outcomes. CONCLUSIONS Secular and religious appraisals of cancer are not mutually exclusive, and religious appraisals are associated with adjustment regardless of survivors' religiosity. Appraisals relating to cause and course/cure have differential relationships with well-being. Addressing cancer survivors' appraisals-religious or nonreligious-in a therapeutic setting may be beneficial regardless of their reported religiosity.

Objective Cancer poses unique challenges for the couple relationship. From a relational perspective, successful adaptation may be less dependent on the circumstances of being the "patient" or the "caregiver" than on how couples successfully integrate cancer into their relationship. In this article, we study posttraumatic growth through attachment theory, which provides a useful framework to explore the role of intimate processes dyadically. Method The sample comprised 84 heterosexual married and cohabitating couples. Women were in adjuvant treatment for breast cancer or in the posttreatment phase. Both members of the couple completed measures of attachment and posttraumatic growth. Path models were used to examine associations between the constructs through the application of the actor-partner interdependent model. Moreover, time since diagnosis was examined within the actor-partner interdependent model as a possible moderator affecting the attachment-posttraumatic growth associations. Results Partners' attachment security was an important predictor of individual posttraumatic growth for both members of the couple, while individuals' own attachment security was not associated with their posttraumatic growth for either member of the couple. The partner's effects were equal across gender. Additionally, time since breast cancer diagnosis did not affect the pattern of results. Conclusion Findings support the assessment of the couple dyadically and corroborate an attachment approach of the couple as an interdependent unit. Implications of the study for interventions assisting couples in oncological setting are discussed.

Objective Spirituality is related to many aspects of cancer survivors' physical and psychological adjustment. Given their unique developmental issues, spiritual issues may be especially important to adolescent and young adult (AYA) survivors, yet little research has been conducted on spirituality with AYA survivors. The present study examines how two aspects of spirituality, spiritual well-being (comprising faith and meaning/peace), and spiritual struggle relate to later post-cancer adjustment. Methods At Time 1 (T1), 120 AYA survivors completed questionnaires on spirituality and adjustment (fear of recurrence, post-traumatic stress symptoms, perceived post-traumatic growth, psychological distress, and health-related quality of life). Eighty-three of these participants also completed these questionnaires at Time 2 (T2), one year later. Results Our sample reported fairly low spiritual well-being (meaning/peace, faith) and spiritual struggle. As expected, T1 spiritual well-being was positively correlated with some aspects of psychological adjustment at T2, whereas T1 spiritual struggle was inversely correlated with T2 psychological adjustment. Both dimensions of T1 spiritual well-being, but not struggle, were positively associated with perceived T2 posttraumatic growth. In general, T1 spiritual well-being and struggle correlated with T2 psychological adjustment even when demographics and cancer-related variables were controlled. Conclusions These results suggest that while spirituality is not important to all AYA survivors, both spiritual well-being and struggle have important associations with adjustment and may warrant clinical attention. Future research is needed to more fully understand the role of spirituality in AYA survivors' adjustment in more depth. Copyright © 2016 John Wiley & Sons, Ltd.

OBJECTIVE Religiousness/spirituality (R/S) may influence cancer survivors' health through multiple pathways. We aimed to examine one potentially key pathway that has seldom been examined: relationships between survivors' R/S and their health behaviors. METHODS The present study investigated links between four core dimensions of R/S (beliefs, behaviors, identity, and coping) and three health behaviors (fruit/vegetable consumption, physical activity, and maintenance of a healthy weight) in 172 breast cancer survivors. RESULTS Both spiritual identity and use of religious coping were positively related to fruit and vegetable intake, while private prayer was marginally positively related. Both service attendance and religious identity (marginally) were related to engaging in less physical activity, while private prayer was positively related. Afterlife beliefs and private prayer were positively associated with BMI. CONCLUSIONS R/S has complex but meaningful associations with health behaviors in breast cancer survivors. More research is needed to understand these relationships and to determine whether different dimensions of R/S may play useful roles in lifestyle change interventions.

Objective: We investigated predictors of emotional (worry) and cognitive (perceived risk) dimensions of fear of recurrence (FOR) and their relationships with psychological well-being in a sample of young and middle-aged adult cancer survivors. Methods: Eligible participants were survivors between 18 and 55 years old and diagnosed from 1 to 3 years prior. A total of 250 participants were recruited, and 167 responded to a 1-year follow-up. Demographic and psychosocial variables were assessed at baseline, and FOR and psychological well-being were assessed at follow-up. Results: Race was associated with the cognitive dimension of FOR (such that minority race perceived less risk of recurrence), but no demographics were associated with the emotional dimension. Hierarchical regression analyses showed that spirituality was the only predictor of perceived risk independent of the effect of race, even when worry about general health was controlled. For the emotional dimension of FOR, avoidance coping predicted higher worry, but when controlling for a general tendency to worryabout one’s health, noneof the psychosocialvariables predictedworries about cancer’s return. In addition, only worry about cancer’s return predicted negative affect and intrusive thoughts. Conclusions: These results suggest that FOR comprises distinct dimensions, each of which has different implications for adjustment. These findings may have important clinical implications in developing interventions to deal with both FOR and more general health anxieties in cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.

Objective: We examined whether post-traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well-being in a sample of younger adult survivors of various types of cancer. Methods: 167 participants completed questionnaires regarding intrusive thoughts, post-traumatic growth, mental and physical health-related quality of life, positive and negative affect, life satisfaction, and spiritual well-being. Multiple regression analyses controlling for relevant background and cancer-related variables tested the interaction effects of post-traumatic growth and intrusive thoughts. Results: Intrusive thoughts were related to poorer adjustment on all indices except physical health-related quality of life. However, post-traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well-being in a protective fashion. That is, for those higher in post-traumatic growth, higher levels of intrusive thoughts were related to better adjustment. Conclusions: The positive meaning that individuals assign to their cancer experience as reflected in their reports of post-traumatic growth appears to be important in determining the impact of intrusive thoughts on post-cancer adjustment. Copyright © 2009 John Wiley & Sons, Ltd.

We demonstrate the utility of partitioning the spiritual well-being (SpWB) construct into spiritual and religious components using results from a study of the relationship of existential well-being to health-related quality of life (HRQOL) in a sample of 237 cancer survivors. Existential and religious well-being were measured using the FACIT-Sp-12 and HRQOL was measured using the mental and physical component scores of the SF-12. In hierarchical linear regression analyses, existential well-being fully mediated religious well-being's effect on HRQOL and explained unique variance in both the mental and physical HRQOL domains, controlling for demographic, disease, and psychosocial variables previously shown to impact HRQOL. Religious well-being was not predictive of HRQOL.

Spirituality is related to many aspects of cancer survivors' physical and psychological adjustment. Given their unique developmental issues, spiritual issues may be especially important to adolescent and young adult (AYA) survivors, yet little research has been conducted on spirituality with AYA survivors. The present study examines how two aspects of spirituality, spiritual well-being (comprising faith and meaning/peace), and spiritual struggle relate to later post-cancer adjustment.At Time 1 (T1), 120 AYA survivors completed questionnaires on spirituality and adjustment (fear of recurrence, post-traumatic stress symptoms, perceived post-traumatic growth, psychological distress, and health-related quality of life). Eighty-three of these participants also completed these questionnaires at Time 2 (T2), one year later.Our sample reported fairly low spiritual well-being (meaning/peace, faith) and spiritual struggle. As expected, T1 spiritual well-being was positively correlated with some aspects of psychological adjustment at T2, whereas T1 spiritual struggle was inversely correlated with T2 psychological adjustment. Both dimensions of T1 spiritual well-being, but not struggle, were positively associated with perceived T2 posttraumatic growth. In general, T1 spiritual well-being and struggle correlated with T2 psychological adjustment even when demographics and cancer-related variables were controlled.These results suggest that while spirituality is not important to all AYA survivors, both spiritual well-being and struggle have important associations with adjustment and may warrant clinical attention. Future research is needed to more fully understand the role of spirituality in AYA survivors' adjustment in more depth. Copyright © 2016 John WileySons, Ltd.

We examined whether post-traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well-being in a sample of younger adult survivors of various types of cancer.167 participants completed questionnaires regarding intrusive thoughts, post-traumatic growth, mental and physical health-related quality of life, positive and negative affect, life satisfaction, and spiritual well-being. Multiple regression analyses controlling for relevant background and cancer-related variables tested the interaction effects of post-traumatic growth and intrusive thoughts.Intrusive thoughts were related to poorer adjustment on all indices except physical health-related quality of life. However, post-traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well-being in a protective fashion. That is, for those higher in post-traumatic growth, higher levels of intrusive thoughts were related to better adjustment.The positive meaning that individuals assign to their cancer experience as reflected in their reports of post-traumatic growth appears to be important in determining the impact of intrusive thoughts on post-cancer adjustment.