Relationship of spiritual constructs to mental health PROs in adolescents with cancer.

Abstract

136 Background: Global beliefs and goals form a meaning system, which plays a role in adjusting to stressors like cancer. Spirituality (search for the sacred) is a meaning system that can play a role in adolescent coping, and psychosocial adjustment to chronic disease. When malignancies occur during adolescence, there are long-term consequences to adjustment, functioning, and disease self-management. Methods: Data were obtained from 126 adolescents diagnosed with cancer at various stages and 4 sites in a longitudinal pediatric advance care planning intervention trial. Scales used: demographic; 2 spiritual scales (Brief-MMRS and FACIT-Sp v4); and 2 emotional PROMIS items (anxiety and depression). Bivariate relationships were analyzed. Structural equation modeling examined the relationship between spiritual and PROMIS items. Bootstrap with 1000 resamples was applied to due to sample size. Results: Mean age was 16.9 years (range: 14-20), with a mean time since diagnosis of 77 months (range: 1-232); 21% were on active treatment. The majority were female (57%) and white (79%). Most identified as spiritual (89%) and religious (83%). When asked if they believed they will be spiritually healed from cancer by a miracle, 49% reported “yes.” Adolescents viewing cancer as God’s punishment were more likely to have high depression (p = 0.03). Very or moderately spiritual teens were more likely to have high anxiety and high depression (p = 0.02). Meaning/peace (FACIT-Sp subscale) mediated feeling God’s presence on anxiety (β = -3.5; 95% CI: -9.2, -0.48) and depression (β = -4.6; 95%CI: -10.7, -1.1); and mediated religious identification on anxiety (β = -3.1; 95%CI:-6.9, -0.6) and depression (β = -4.1; 95%CI:-9.3,-0.24). Conclusions: Our findings are consistent with adult literature and a single longitudinal study of teens with cancer: spiritual distress (cancer is God’s punishment) is associated with poorer mental health outcomes, and meaning with positive outcomes. Adolescent anxiety and depression were inversely related to feeling God’s presence, and to identifying as religious; this effect was mediated by their sense of meaning/peace. Meaning-making is a modifiable process, opening a novel focus for intervention development. Clinical trial information: NCT02693665.