Artikel 'Examining the mediating role of cancer-related problems on spirituality and self-rated health among African American cancer survivors: a report from the American Cancer Society’s Studies of Cancer Survivors-II' (2015)

Objective: African American (AA) cancer survivors report poorer self-rated health (SRH) compared to other racial/ethnic groups. Spirituality is often linked to positive health outcomes, with AAs reporting greater levels of spirituality. This study examined the potential mediating role of cancerrelated problems in the relationship between spirituality and SRH among AA cancer survivors compared to non-African American (non-AA) survivors.

Methods: We analyzed data on 9006 adult cancer survivors from the American Cancer Society’s Study of Cancer Survivors-II. Preliminary analyses compared characteristics of AAs and non-AAs and identified significant covariates of SRH. We tested a path model using multi-group structural equation modeling (SEM), and then examined race as a moderator.

Results: Of the three domains of spirituality assessed, AAs had higher levels of peace (p<.001) and faith (p<.001), but not meaning, compared to non-AAs; and of four domains of cancer-related problems assessed, AAs had greater physical distress (p<.001), emotional distress (p<.001), and employment/finance problems (p<.001), but not fear of recurrence. In SEM analyses adjusting for number of comorbidities and income, race moderated the impact of spirituality and cancer-related problems on SRH. Specifically, spirituality had significantly stronger associations with cancer-related problems among AAs than non-AAs. Spirituality was positively associated with all four domains of cancerrelated problems, but only physical distress was associated with SRH among AAs.

Conclusions: The negative effects of physical distress may attenuate the positive effects of spirituality on AA’s SRH. Future studies should consider racial/ethnic differences in the determinants and   conceptualization of SRH, which is a known predictor of survival.