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The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

African Americans with chronic conditions have reported the importance of spirituality in their lives. Aspects of spirituality have been shown to be related to physical activity (PA) and sleep, and PA and sleep affect quality of life (QOL). This study examined the association between spirituality, PA, and sleep in long-term African American breast cancer survivors.

Methods

This cross-sectional study included 323 breast cancer survivors who previously participated in a case-only study. During 2015–2016, participants completed a questionnaire focused on survivorship that used validated measures for spirituality, PA, and sleep. Adjusted binary and multinomial logistic regression models estimated odds ratios (aORs) and 95% confidence intervals (CIs) for the associations of spirituality with total PA, meeting PA guidelines, sleep duration, and sleep medication.

Results

The mean age at diagnosis was 54.8 (SD = 9.89) years. The range of spirituality scores was 7–48 (median = 44). Among participants who had a score ≥ 44, 59% had high total PA, 61% met PA guidelines, 59% had high sleep duration, and 55% did not use sleep medication. Higher spirituality score was associated with higher total PA (aOR for ≥ 681 min/week: 1.90, 95% CI: 1.03–3.50), meeting PA guidelines (aOR: 1.78, 95% CI: 1.06–2.98), sleep duration > 7 h/night (aOR: 1.72, 95% CI 1.05–2.83), and lack of sleep medication use (aOR: 0.45, 95% CI: 0.24–0.84).

Conclusion

In African American long-term breast cancer survivors, a higher spirituality score increased the likelihood of greater PA and high sleep duration. These results indicate that interventions surrounding spirituality may benefit the QOL of African American breast cancer survivors.

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Data Availability

The data used for this research study are not available to external researchers at this time.

Code Availability

Available upon request.

Abbreviations

SF-36:

36-item short form survey

AABL:

African American Breast Cancer Long-Term Survivorship Study

BMI:

Body mass index

FACIT-Sp-12:

Functional Assessment of Chronic Illness Therapy Spiritual Well-Being 12

HR-QOL:

Health-related quality of life

PA:

Physical activity

PSQI:

Pittsburg Sleep Quality Index

QOL:

Quality of life

References

  1. American Cancer Society. Breast Cancer Facts & Figures 2022-2024. Atlanta: American Cancer Society, Inc.; 2022. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/2022-2024-breast-cancer-fact-figures-acs.pdf. Accessed 27 Aug 2023.

  2. American Cancer Society. Cancer treatment & survivorship facts & figures 2022–2024. 2022. https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html. Accessed 27 Aug 2023.

  3. Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022;128(24):4251–84.

    Article  PubMed  Google Scholar 

  4. Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC. Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA Cancer J Clin. 2020;70(1):31–46.

    Article  PubMed  Google Scholar 

  5. Coughlin SS, Yoo W, Whitehead MS, Smith SA. Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat. 2015;153(2):253–61.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Palmer NR, Weaver KE, Hauser SP, et al. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer. 2015;23(11):3201–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Menashe I, Anderson WF, Jatoi I, Rosenberg PS. Underlying causes of the black-white racial disparity in breast cancer mortality: a population-based analysis. J Natl Cancer Inst. 2009;101(14):993–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  8. DeSantis CE, Siegel RL, Sauer AG, et al. Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin. 2016;66(4):290–308.

    Article  PubMed  Google Scholar 

  9. Sun YS, Zhao Z, Yang ZN, et al. Risk factors and preventions of breast cancer. Int J Biol Sci. 2017;13(11):1387–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Goyal NG, Ip EH, Salsman JM, Avis NE. Spirituality and physical health status: a longitudinal examination of reciprocal effects in breast cancer survivors. Support Care Cancer. 2019;27(6):2229–35.

    Article  PubMed  Google Scholar 

  11. Siler S, Arora K, Doyon K, Fischer SM. Spirituality and the illness experience: perspectives of African American older adults. Am J Hosp Palliat Care. 2021;38(6):618–25.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and quality of life in Black patients with cancer pain. J Pain Symptom Manage. 2018;56(3):390–8.

    Article  PubMed  Google Scholar 

  13. Schreiber JA, Brockopp DY. Twenty-five years later--what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review. J Cancer Surviv. 2012;6(1):82–94.

    Article  PubMed  Google Scholar 

  14. Henderson PD, Gore SV, Davis BL, Condon EH. African American women coping with breast cancer: a qualitative analysis. Oncol Nurs Forum. 2003;30(4):641–7.

    Article  PubMed  Google Scholar 

  15. Leak A, Hu J, King CR. Symptom distress, spirituality, and quality of life in African American breast cancer survivors. Cancer Nurs. 2008;31(1):E15–21.

    Article  PubMed  Google Scholar 

  16. Hurtado-de-Mendoza A, Gonzales F, Song M, et al. Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors. J Cancer Surviv. 2022;16(6):1379–89.

    Article  PubMed  Google Scholar 

  17. Mkuu RS, Harvey IS, Brown E, et al. “I Struggle with breast cancer and I struggle with God”: insights from African American breast cancer survivors. J Racial Ethn Health Disparities. 2022;9(2):566–75.

    Article  PubMed  Google Scholar 

  18. Fong DY, Ho JW, Hui BP, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012;344:e70.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Busen K, Sanderson M, Banks AD, Wallace H, Nechuta S. Patterns of physical activity and the role of obesity and comorbidities among long-term African American breast cancer survivors. J Racial Ethn Health Disparities. 2022;10:2261–72.

    Article  PubMed  Google Scholar 

  21. Park CL, Waddington E, Abraham R. Different dimensions of religiousness/spirituality are associated with health behaviors in breast cancer survivors. Psychooncology. 2018;27(10):2466–72.

    Article  PubMed  Google Scholar 

  22. Gonzalez BD, Eisel SL, Qin B, et al. Prevalence, risk factors, and trajectories of sleep disturbance in a cohort of African-American breast cancer survivors. Support Care Cancer. 2021;29(5):2761–70.

    Article  PubMed  Google Scholar 

  23. Liu L, Fiorentino L, Rissling M, et al. Decreased health-related quality of life in women with breast cancer is associated with poor sleep. Behav Sleep Med. 2013;11(3):189–206.

    Article  PubMed  Google Scholar 

  24. Palesh O, Aldridge-Gerry A, Zeitzer JM, et al. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37(5):837–42.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Taylor TR, Huntley ED, Makambi K, et al. Understanding sleep disturbances in African-American breast cancer survivors: a pilot study. Psychooncology. 2012;21(8):896–902.

    Article  PubMed  Google Scholar 

  26. Park S, Sato Y, Takita Y, et al. Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer-a randomized controlled trial. J Pain Symptom Manage. 2020;60(2):381–9.

    Article  PubMed  Google Scholar 

  27. Voiss P, Hoxtermann MD, Dobos G, Cramer H. Cancer, sleep problems, and mind-body medicine use: results of the 2017 National Health Interview Survey. Cancer. 2019;125(24):4490–7.

    Article  PubMed  Google Scholar 

  28. Khoramirad A, Mousavi M, Dadkhahtehrani T, Pourmarzi D. Relationship between sleep quality and spiritual well-being/religious activities in Muslim women with breast cancer. J Relig Health. 2015;54(6):2276–85.

    Article  PubMed  Google Scholar 

  29. He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett. 2020;19(3):2085–96.

    PubMed  PubMed Central  Google Scholar 

  30. Nassif T, Brunelle CL, Gillespie TC, et al. Breast cancer-related lymphedema: a review of risk factors, radiation therapy contribution, and management strategies. Curr Breast Cancer Rep. 2020;12:305–16.

    Article  Google Scholar 

  31. Shaitelman SF, Cromwell KD, Rasmussen JC, et al. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin. 2015;65(1):55–81.

    Article  PubMed  Google Scholar 

  32. Sander AP, Wilson J, Izzo N, Mountford SA, Hayes KW. Factors that affect decisions about physical activity and exercise in survivors of breast cancer: a qualitative study. Phys Ther. 2012;92(4):525–36.

    Article  PubMed  Google Scholar 

  33. Togawa K, Ma H, Smith AW, et al. Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors. Sci Rep. 2021;11(1):10701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Yildiz Kabak V, Gursen C, Aytar A, Akbayrak T, Duger T. Physical activity level, exercise behavior, barriers, and preferences of patients with breast cancer-related lymphedema. Support Care Cancer. 2021;29(7):3593–602.

    Article  PubMed  Google Scholar 

  35. Sanderson M, Pal T, Beeghly-Fadiel A, et al. A pooled case-only analysis of reproductive risk factors and breast cancer subtype among Black women in the Southeastern United States. Cancer Epidemiol Biomarkers Prev. 2021;30(7):1416–23.

    Article  PubMed  PubMed Central  Google Scholar 

  36. FACIT.org. (2021). FACIT-Sp-12. https://www.facit.org/measures/FACIT-Sp-12. Last accesed 08-27-23.

  37. Munoz AR, Salsman JM, Stein KD, Cella D. Reference values of the functional assessment of chronic illness therapy-spiritual well-being: a report from the American Cancer Society’s studies of cancer survivors. Cancer. 2015;121(11):1838–44.

    Article  PubMed  Google Scholar 

  38. Staten LK, Taren DL, Howell WH, et al. Validation of the Arizona activity frequency questionnaire using doubly labeled water. Med Sci Sports Exerc. 2001;33(11):1959–67.

    Article  CAS  PubMed  Google Scholar 

  39. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: U.S. Department of Health and Human Services; 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf. Accessed 27 Aug 2023.

  40. Southern Community Cohort Study. (2021). https://www.southerncommunitystudy.org/. Accesed 08-27-23.

  41. Fontes F, Goncalves M, Maia S, Pereira S, Severo M, Lunet N. Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients. Support Care Cancer. 2017;25(10):3059–66.

    Article  PubMed  Google Scholar 

  42. National Institute of Health: National Heart, Lung, and Blood Institute. (2022). How much sleep is enough? https://www.nhlbi.nih.gov/health/sleep/how-much-sleep. Accesed 08-27-23.

  43. Norman SA, Miller LT, Erikson HB, Norman MF, McCorkle R. Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer. Phys Ther. 2001;81(6):1192–205.

    Article  CAS  PubMed  Google Scholar 

  44. Kwan M, Ambrosone C, Lee M, et al. The pathways study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control. 2008;19(10):1065–76.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Paxton RJ, Phillips KL, Jones LA, et al. Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer. 2012;118(16):4024–31.

    Article  PubMed  Google Scholar 

  46. Ashing-Giwa KT, Padilla G, Tejero J, et al. Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology. 2004;13(6):408–28.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sterba KR, Burris JL, Heiney SP, Ruppel MB, Ford ME, Zapka J. “We both just trusted and leaned on the Lord”: a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers. Qual Life Res. 2014;23(7):1909–20.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Knobf MT, Erdos D. “Being connected” The experience of African American women with breast cancer: a community-based participatory research project: Part I. J Psychosoc Oncol. 2018;36(4):406–17.

    Article  PubMed  Google Scholar 

  49. Torres E, Dixon C, Richman AR. Understanding the breast cancer experience of survivors: a qualitative study of African American women in Rural Eastern North Carolina. J Cancer Educ. 2016;31(1):198–206.

    Article  PubMed  Google Scholar 

  50. Davis CM, Nyamathi AM, Abuatiq A, Fike GC, Wilson AM. Understanding supportive care factors among African American breast cancer survivors. J Transcult Nurs. 2018;29(1):21–9.

    Article  PubMed  Google Scholar 

  51. Gregg G. I’m a Jesus girl: coping stories of Black American women diagnosed with breast cancer. J Relig Health. 2011;50(4):1040–53.

    Article  PubMed  Google Scholar 

  52. Yan AF, Stevens P, Holt C, et al. Culture, identity, strength and spirituality: a qualitative study to understand experiences of African American women breast cancer survivors and recommendations for intervention development. Eur J Cancer Care (Engl). 2019;28(3):e13013.

    Article  PubMed  Google Scholar 

  53. Lancaster KJ, Carter-Edwards L, Grilo S, Shen C, Schoenthaler AM. Obesity interventions in African American faith-based organizations: a systematic review. Obes Rev. 2014;15(Suppl 4):159–76.

    Article  PubMed  Google Scholar 

  54. Gordon T, Lee LJ, Tchangalova N, Brooks AT. Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review. Support Care Cancer. 2022;30(2):1093–114.

    Article  PubMed  Google Scholar 

  55. Ashing-Giwa K, Tapp C, Brown S, et al. Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates. J Cancer Surviv. 2013;7(3):283–91.

    Article  PubMed  Google Scholar 

  56. Burke NJ, Napoles TM, Banks PJ, Orenstein FS, Luce JA, Joseph G. Survivorship care plan information needs: perspectives of safety-net breast cancer patients. PloS One. 2016;11(12):e0168383.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kline RM, Arora NK, Bradley CJ, et al. Long-term survivorship care after cancer treatment - summary of a 2017 National Cancer Policy Forum Workshop. J Natl Cancer Inst. 2018;110(12):1300–10.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank the participants of the AABL Survivorship Study. We thank Mary Kay Fadden for her guidance and help with the data collection and questionnaire methods. We thank Shantel Moore for collecting all telephone interview data and day-to-day recruitment and coordination of the AABL study.

Funding

The original parent case-only study was funded by National Cancer Institute grants U54CA163069, U54CA163072, and R03CA192214. The AABL study was supported by grant K07CA184257 from the National Cancer Institute.

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Authors and Affiliations

  1. College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA

    Ally Goerge, Katherine Busen & Sarah Nechuta

  2. Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA

    Maureen Sanderson & Cristen Flewellen

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  1. Ally Goerge
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Contributions

Sarah Nechuta and Maureen Sanderson conceived and designed the AABL Survivorship Study. Sarah Nechuta and Ally Goerge conceived the research question and analysis design for this secondary data analysis with AABL Survivorship data. The analysis was performed by Ally Goerge and replicated by Sarah Nechuta. The first draft of the manuscript was written by Ally Goerge. All authors provided comments on the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sarah Nechuta.

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Ethics Approval and Consent to Participate

Institutional Review Board (IRB) approval for the AABL study was obtained from Vanderbilt University Medical Center and Meharry Medical College. All study participants provided written informed consent.

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The authors declare no competing interests.

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Goerge, A., Sanderson, M., Flewellen, C. et al. The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01791-3

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