Loneliness, Spirituality and Quality of Life Among Cancer Survivors and Their Caregivers

Abstract

BACKGROUND: Cancer is the second leading cause of death in the United States (US). Hispanic women carry a disparate burden in terms of younger age of onset and poorer outcomes. Studies have demonstrated that psychosocial symptoms among cancer survivors persist after cancer treatment and can affect the health-related quality of life (HRQoL) for cancer patients and their caregivers. Loneliness is one common symptom reported by patients with cancer and their caregivers that may be modifiable, particularly in relation to one’s spirituality. Additional research is needed in survivorship to advance our understanding of these issues. PURPOSE: The purpose of this dissertation was to advance our knowledge and understanding of loneliness and spirituality and HRQoL in Hispanic survivors of cancer and their caregivers. METHODS: The first study consisted of conducting a systematic review and meta-analysis that evaluated studies that offered loneliness intervention among cancer survivors. The second study used structural equational modeling to conduct mediation and conditional process analysis (moderated mediation) to examine the role of loneliness, spirituality and HRQoL among participants of the Support for Latinas with Breast Cancer study. The third study utilized a qualitative descriptive approach using semi-structured interviews among Hispanic cancer caregivers having participated in the Improving Informal Caregivers’ and Cancer Survivors Psychological Distress, Symptom Management and Health Care Use study. RESULTS: In total, 6503 studies were initially evaluated; eight studies met inclusion criteria. The meta-analysis and a narrative synthesis indicate a paucity of interventions to address loneliness in cancer survivors, generally of lower quality. Interventions were feasible and acceptable with cultural modifications more likely to demonstrate effectiveness. Quantitative analysis suggested that higher self-reported spirituality is associated with higher HRQoL in Hispanic caregivers of breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers. Qualitative findings identified five themes and four major categories emerged from the descriptive thematic analysis. Caregiver experience (173) and coping strategy (188) were the two most referred themes in the interviews, followed by religion to gain strength or support (110) and loneliness (69). CONCLUSION: Collectively, this research demonstrated the importance of addressing loneliness and spirituality as well as religion, when developing needed culturally sensitive programs to improve HRQoL for Hispanic cancer survivors and caregivers.