Effects of Spiritual Healing for Women Undergoing Long-Term Hormone Therapy for Breast Cancer: A Qualitative Investigation

Abstract

Background:

Spiritual Healing is widely available and used, but is a neglected area for research and its biologic and psychologic mechanisms are not understood. The side-effects of long-term hormonal therapy for breast cancer are onerous and have been reported to lead to “drug holidays” that could diminish the long-term treatment benefits. It was investigated whether Spiritual Healing could support patients with breast cancer undergoing this treatment.

Methods:

The qualitative observation study took place in a specialist research facility in a general hospital. Spiritual Healing was provided by 4 healers registered with the National Federation of Spiritual Healers. Twelve (12) patients with breast cancer undergoing long-term hormone treatment and who found the effects onerous, self-referred themselves and were given ten weekly sessions of approximately 40 minutes each. Data collected included participant's daily records, direct observations noted by healers, the researcher's field diary and a one-to-one semi-structured interview.

Findings:

The positive effects of Spiritual Healing included alleviation of the physical side-effects of their treatment, increased energy levels, enhanced well-being, emotional relaxation, and re-engagement with precancer activities. Although 1 participant admitted considering a drug holiday prior to joining the study, none of the participants felt tempted to stop their hormonal treatments while receiving Spiritual Healing.

Conclusions:

These qualitative findings indicate that Spiritual Healing has the potential to support patients with breast cancer in the maintenance of their long-term orthodox treatments. Further research is needed to test Spiritual Healing as a cost-effective complementary therapy, for those undergoing long-term cancer treatments.

Introduction

B reast cancer accounts for 32% of all cancers in women. Since the introduction of breast screening in 1988, the incidence of breast cancer has increased, without a reciprocal increase in mortality, suggesting that early detection and treatment has improved survival rates.¹ However, these statistics fail to address physical or psychologic morbidity associated with long-term disease management, or the personal costs of survival. Breast cancer treatments include surgery, chemotherapy, and radiotherapy, each of which causes bodily changes and discomforts that can negatively impact on women's self-image and quality of life.^2
–4

The majority of women have estrogen-sensitive tumors and after initial treatments are prescribed long-term hormone therapy (tamoxifen or aromatase inhibitors) for up to 5 years, to prevent recurrence. This form of treatment extends life but can significantly impact on quality of life.⁵ Side-effects can include hot flushes, joint pain, fatigue, mood swings, headaches, bloating and weight gain, hair loss, vaginal dryness, and diminished sexual functioning.^6,7 For some women these side-effects are brief, mild, and manageable, but others struggle, with 54% still experiencing hot flushes after 10 years.⁸

Due to the seriousness of their disease, patients with cancer are regarded as highly motivated and adherent to therapy regimens,⁹ yet 13% of patients with breast cancer report seeking a respite from the side-effects of tamoxifen by intentionally missing tablets, in the form of a “drug holiday.”¹⁰ Fallowfield identified the discontinuation rate for tamoxifen at 22% after 1 year, rising to 35% after 3.5 years. Clinical observations suggest that adherence to aromatase inhibitors may be even lower, with only 69% of women taking their hormonal therapy regularly, based on prescription control data.⁹ The effects of discontinuation are not known, but could be potentially life threatening,¹¹ so finding effective ways of helping women to manage unpleasant treatment effects is important.

Spiritual Healing is probably one of the oldest paramedical treatments,¹² with the links between spiritual well-being and concepts of wellness acknowledged.¹³ Spiritual healers do not diagnose or prescribe, but claim to channel what they term “universal energy” to restore a holistic (mind, body, spirit) balance within the healee. Anecdotally, this appears to alleviate symptoms of disease, accelerate recovery, and engender a state of well-being and/or acceptance.^14,15 Spiritual Healing is classified as a complementary and alternative medicine and therefore, not part of mainstream medicine.¹⁶ Although a small number of National Health Service (NHS) Trusts do offer Spiritual Healing, it is rarely provided through NHS agencies.

Any attempt to introduce Spiritual Healing into health care must be based on research evidence. There are few studies of Spiritual Healing and even fewer of Spiritual Healing for cancer. Most studies are small-scale quantitative studies, using questionnaires that reflected the researchers' views of useful healing outcomes, rather than exploring all possible outcomes. A few studies have used qualitative interviews to enhance quantitative findings.^17,18 Contemporary studies have focused primarily on pain, stress and anxiety, depression, sleep, opioid use,^{18

–26} and biologic effects, such as changes in heart rate and blood pressure²⁷ and changes in salivary immunoglobulin A.²⁴ There have also been a limited number of nonhuman studies focusing on cell growth^28,29 and noise-stressed rats.³⁰

Although some studies were equivocal, the majority of the findings demonstrated that Spiritual Healing might support patients with cancer, through pain reduction, alleviating anxiety and stress, improving sleep, facilitating relaxation, and thereby improve the quality of survivorship. Yet systematic reviews of Spiritual Healing show variations in treatments and methodological inadequacies.^31

–34

Methods

Research into Spiritual Healing creates complex and important methodological challenges, as the mechanisms of Spiritual Healing are not understood, so the provision of a placebo is problematic. There are no data at present on dose–response rates, and it is not known how long the effects of healing last, making crossover trials inappropriate. So, as a first step toward exploring the potential therapeutic use of Spiritual Healing, this qualitative study sought to detail any reported effects of Spiritual Healing in patients who had breast cancer and who reported onerous side-effects from long-term hormonal therapies.

Unitary Appreciative Inquiry (UAI)³⁵ is a qualitative methodology that is unconfined by academic disciplinary boundaries (such as physiology, psychology, or sociology), so it can capture a range of potential aspects of experience in terms of body, mind, and spirit. Participants' experiences of Spiritual Healing were captured in several ways, to give a triangulation of data. Any immediate responses were recorded by the healers in their session reports. Participants kept daily records during their course of Spiritual Healing. A retrospective overview was captured in an audio-recorded, semistructured interview, at the end of each participant's course of healing.

Twelve (12) women with breast cancer (Appendix 1) self-referred themselves into the study, following invitation via local media. While the women experienced many of the known side-effects, all experienced joint aches and hot flushes, which they attributed to their hormonal therapy. In accordance with criteria for inclusion agreed upon with the local oncology and breast surgery unit, all had completed their initial treatments for breast cancer and had been taking a hormonal therapy for at least 6 months. They were excluded if they had known metastases, or had recently been diagnosed with a recurrence of their cancer. Women were also to be excluded if they had a pre-existing medical condition, prior to their cancer, or were currently receiving treatment for a major mental health problem. Those who had previously received Spiritual Healing for their breast cancer and those who were Spiritual healers themselves were not included.

Participants were offered 10 weekly Spiritual Healing sessions of approximately 40 minutes' duration. In order to maintain confidentiality, participants selected their own pseudonyms, and these are used throughout the study. The study took place in a specialist clinical research facility, in a district general hospital. Spiritual Healing was provided by 4 healers from the Harry Edwards Healing Sanctuary (HEHS) who were trained to a minimum of practitioner standard, as defined by the National Occupational Standards, drafted by UK Healers, under the guidance of Skills for Health.³⁶ Participants received no reimbursement for costs, including transport and parking. Ethical approval was gained from the Isle of Wight, Portsmouth and South East Hampshire Research Ethics Committee (06/Q1701/87).

The Spiritual Healing intervention followed a protocol (Appendix 2), developed by the researcher and the Head of Healing at HEHS. Participants were greeted by the healer and, after a brief discussion about their previous week's experiences, were invited to lie on the bed, or remain seated, to receive healing. The healer then commenced healing the full length of the participant's body, either touching, or, where that was inappropriate, holding their hands just above the body. Once the healing was completed, participants were gently roused and offered a glass of water. The researcher accompanied the participant from the room. Sessions were video-recorded in lieu of a chaperone, but the recordings were not included in the research data.

A thematic synthesis of common experiences, perceptions, and expressions associated with the physical, emotional, and spiritual lives of the participants was compiled. UAI is a participatory and collaborative research method, so the analysis was checked by the participants to ensure that it reported their priorities and focus, and accurately conveyed their experiences.

Results

This study did not seek to understand the mechanisms of Spiritual Healing. However, responses cannot be attributed to a one-to-one relationship between participant and healer, as all participants had more than 1 healer during their 10 healing sessions. None of the participants reported any new adverse events during the course of their healing treatment.

The findings are organized in terms of the body (physical), mind (mental), and spiritual effects of healing and associated quality of survivorship.

Body (physical) impact of Spiritual Healing

All participants reported relief or respite from all of their physical symptoms. At the start of the study, participants' concerns focused mainly on physical treatment effects. All 12 women complained of hot flushes and joint aches. Hot flushes occurring up to 30 or more times a day caused embarrassment and for a few, a dread of social situations. By the third healing session, all participants reported a decline or cessation in their hot flushes. (In the following comments, participants' names follow the comment, in parentheses)

Well they're virtually nonexistent.…Yeah, virtually gone, the hot flushes…It [has] happened since the healing started so, yeah, I would think it is the healing. (Violet)

I had hot flushes.…. That's another thing that has definitely improved—my daily hot flushes. I still find I get them if I get slightly agitated. (Fuschia)

I seemed a lot better during the day, just having, like feeling hot but not dripping wet if you know what I mean. (Camellia)

Night sweats and sleep patterns also improved.

I was waking up, I mean to start off with on tamoxifen we would change the bed. I'd have to get up and change the bed it would be that wet.…I have the occasional sweats and occasional bad nights [after Spiritual Healing], but I was sleeping…which was wonderful. (Snowdrop)

Sleeping well every night. No more sleeping tablets and that “can't wake up” feeling. I look forward to every day. (Sweetpea)

Joint aches appeared to have the most impact on participants' ability to engage fully in life. All experienced relief while receiving Spiritual Healing and were able to re-engage with pre-cancer activities. In some cases, participants became completely free of joint pain.

I was really crippled with joint pain, walking, anything, sitting, lying down was painful. Reading a book I had to, I couldn't hold the book. I could hardly write or use the computer.…So over the weeks…Altogether the ten sessions wasn't it, something like that, the joint pain has virtually all gone. (Foxglove)

I had not knitted for about 4 years, because I had joint ache.…Suddenly I thought I wonder if I can and Yes! I knitted a cardigan for a 3-year-old that would fit a 6-year-old but that is beside the point! (Fuschia)

Mind–body impact of Spiritual Healing

All participants experienced benefit from feelings of physical relaxation (letting go of body tension) and mental relaxation (letting go of emotional stress). After the first Spiritual Healing session, several participants spoke of an emotional release as though “a weight had been lifted” from them. Later reported effects included an increase in self-confidence and a positive outlook.

I think I am a lot calmer,…I don't get quite so stressed;…I feel it [has] [Spiritual Healing] just calmed the whole thing down.…It smoothes round the edges, if you like. You don't feel, you know, raw, so raw anymore. (Rose)

My life was a vast amount of stress and I didn't feel stressed to any great level. (Jasmin)

I think it [has] [Spiritual Healing] restored or helped to restore my self-confidence. I feel more positive, I think, possibly than I did before I started it. (Camellia)

Many participants had used their general practitioner (GP) for emotional support during their cancer journey, but after Spiritual Healing participants reported seeing their GP much less.

I would sit and talk to him [GP] and he was like a support system, he was very good, he's an excellent GP, and he was very, very good. But once I went to the Spiritual Healing I felt I didn't need it and so I never, I've not visited him at all. (Jasmin)

This reported stress-reducing effect of Spiritual Healing was particularly emphasized during the one-to-one interviews and highlights benefits that extend beyond the physical effects of cancer and its treatments.

Spiritual impact of Spiritual Healing

While the spiritual impact of healing was not as immediately apparent as with the body and mind, participants felt that the effects became obvious toward the end of the 10 healing sessions. Spiritual effects are hard to express, so to illustrate this domain the participants' own words have been used, taken from their one-to-one interviews.

I think the inner peace came with Spiritual Healing; I've certainly changed a lot in myself since I've had the Spiritual Healing: calmer; it's this peace I can't describe…this inner peace. (Foxglove)

I felt a bit…uplifted. (Fuschia)

I think I could conquer the world when I come out [from Spiritual Healing session] (laughter) and I just, I suppose that's why elated would be the word to use really. (Sweetpea)

Oh I‘d say it [Spiritual Healing] was blissful, absolutely blissful. (Daffodil)

Treatment adherence

No participants reported considering taking a “drug holiday” during the study, although one had considered it prior to joining the study. All the participants stated they had benefited from Spiritual Healing and would recommend it to others. Indeed, with the decrease in side-effects, patients reported they were more content to take their hormonal therapy for the next few years, as Jasmin explains:

I just know that I've got to take it for a while to come, but I'm not sitting here counting days because my symptoms really have improved that much, and possibly part of it has been due to Spiritual Healing because certainly, the symptoms that I complained of when I started have become much less over the period of time that I have been having that treatment, so I can only draw one conclusion, that it [Spiritual Healing] certainly has helped.

Quality of survivorship

As their physical and mental symptoms subsided and participants started to re-engage with precancer activities, they talked of a sense of “returning to normal” and a belief in a future. Several participants noted that they had been gardening, decorating, re-engaging with old hobbies, and planning holidays, as Snowdrop and Sweetpea explain:

I couldn't plan a holiday even, since cancer, I would look at the computer, find something for tomorrow and think, yeah I feel okay, I'm going to go. I couldn't think, ooh, I really want to do so and so next year or, I just couldn't do that…well, I have just booked a [trip]; I'm taking the grandchildren to Florida next Easter. (Snowdrop)

[Daughter] found it [holiday] on the Internet, it's very nice…they're all booked up for May,…so I said well you better get in quick, get June. (Sweetpea)

Discussion

Orthodox medicine has been very effective in treating breast cancer and improving patient survival,¹ although breast cancer treatments have many side-effects that impact to varying degrees on their patients' quality of life. Many participants reported that they found it difficult to discuss their side-effects with their doctors. It seems that although participants and their doctors initially have the shared goals for the removal of tumors (surgery), destroying any remaining cancerous cells (chemotherapy/radiotherapy), and preventing cancer's return (hormonal therapy), many specialist doctors did not appear to share participants' concerns about coping day-to-day with the side-effects of treatments. Indeed, participants felt they were left to cope alone as their side-effects were trivialized. Foxglove asked how long her side-effects would last and was told “Five to seven years—I suggest you get used to it.”

All participants reported that Spiritual Healing helped them with the physical and emotional legacy of cancer, and the impact of ongoing hormonal therapy. In addition, social benefits were noted as participants re-engaged with precancer activities. This has important implications for the survivorship agenda within cancer, as the positive effects of Spiritual Healing, reported by the participants, helped them cope with the negative effects of long-term, lifesaving medical treatments. Although the underlying paradigms of orthodox medicine and Spiritual Healing are essentially very different, the declared focus of both is the well-being of the patient. Spiritual Healing as a complementary therapy does not seek to usurp medical authority in the management of physical health, but to work alongside it, helping women to cope with treatment side-effects and to enhance patient survivorship.

Conclusions

This small qualitative study is the first to investigate the impact of Spiritual Healing on the survivorship experiences of patients with breast cancer undergoing long-term hormonal therapy. The study involved 12 self-selected patients with breast cancer and cannot claim to represent the experiences of all patients with breast cancer. Nevertheless, the methodology facilitated participants' sharing a holistic view of their lives, which included not only physical, but also intimate and emotionally sensitive information. Triangulation of data from a variety of immediate and retrospective sources supports the trustworthiness of the data, and the emergent findings were checked by participants to ensure their validity. Overall, the findings provide sufficient justification for further quantitative research involving a sufficiently powered, pragmatic study focused on the potential benefits of Spiritual Healing as a complementary therapy.

Footnotes

Disclosure Statement

No competing financial interests exist.

Appendix

Appendix 1.

Participants' Treatment Profile

Name	Age (years)	Surgery	Chemotherapy	Radiotherapy	Hormonaltherapy
Camellia	63	M	✓	✓	✓
Daffodil	56	M	✓	✓	✓
Foxglove	52	L	✓	✓	✓
Fuchsia	61	M			✓
Jasmin	66	M	✓		✓
Orchid	62	L		✓	✓
Paintbrush	53	M	✓		✓
Poppy	63	L	✓	✓	✓
Rose	55	L		✓	✓
Snowdrop	53	M^a	✓		✓
Sweetpea	64	M		✓	✓
Violet	55	M	✓		✓
12 women		8M–4L	8	8	12

Snowdrop initially had a lumpectomy, but later had to have a mastectomy.

M, mastectomy; L, lumpectomy.

References

Office for National Statistics. Breast Cancer. Little change in incidence. www.statistics.gov.uk. 2010 April 24.

Boehmke

, Dickerson

. Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nurs, 2005; 28:382–389.

Burgess

, Cornelius

, Love

et al. Depression and anxiety in women with early breast cancer: Five year observational study. BMJ, 2005; 330:702.

Wilmoth

. The aftermath of breast cancer: An altered sexual self. Cancer Nurs, 2001; 24:278–286.

Pandy

, Thomas

, SreeRekka

et al. Quality of life determinates in women with breast cancer undergoing treatments with curative intent. World J Surg Oncol, 2005; 3:63.

Ganz

. Impact of tamoxifen adjuvant therapy on symptoms, functioning, and quality of life. J Natl Cancer Inst Monogr, 2001; 30:130–134.

Shapiro

, Recht

. Side effects of adjuvant treatment of breast cancer. NEJM, 2001; 344:1997–2008.

Drisko

. Acupuncture in the treatment of hormone therapy-induced hot flushes in breast cancer and prostate cancer patients. J Chin Med, 2004; 75:5–9.

Ziller

, Kalder

, S-Albert

et al. Adherence to adjuvant endocrine therapy in post-menopausal women with breast cancer. Ann Oncol, 2009; 20:431–436.

10.

Fallowfield

. Acceptance of adjuvant therapy and quality of life issues. Breast, 2005; 14:612–616.

11.

Smith

I E

, Chua

. Medical treatment of early breast cancer: 1. Adjuvant treatment. BMJ, 2006; 332:34–37.

12.

Walach

, Bosch

, Haraldsson

et al.

Efficacy of distant healing: A proposal for a four-armed randomized study (EUHEALS)

Forsch Komplementarmed Klass Naturheilkd, 2002; 9:168–176.

13.

Association of American Medical Colleges. Report III: Contemporary Issues in Medicine: Communication in Medicine, Medical School Objectives Project. www.aamc.org/meded/msop/report3.htm#task 1999 2001 July 21.

14.

Benor

. Research into spiritual healing. Int J Altern Complement Med, 1994; 9:8.

15.

National Federation of Spiritual Healers. What is healing? 2009. www.nfsh.org.uk/index.php?option=com_content&view=article&id=46. 2009 April 6.

16.

House of Lords 1999–2000, Sixth Report. 2000 Select Committee on Science and Technology. London: The Stationary Office, Nov 2000.

17.

MacDermott

, Epstein

. Reiki is effective in addressing major consequences of child sexual abuse. Evaluation of Tamara's House. 2001. www.tamarashouse.sk.ca. 2008 May 3.

18.

Vaghela

, Robinson

, Gore

et al. Evaluating healing for cancer in a community setting from the perspective of clients and healers: A pilot study. Complement Ther Clin Pract, 2007; 13:240–249.

19.

Vitale

, O'Connor

. The effect of Reiki on pain and anxiety in women with abdominal hysterectomies: A quasi-experimental pilot study. Holist Nurs Pract, 2006; 20:263–272.

20.

Gillespie

, Gillespie

, Stevens

. Painful diabetic neuropathy: Impact of an alternative approach. Diabetes Care, 2007; 30:999–1001.

21.

Tsang

, Carlson

, Olson

. Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue. Integr Cancer Ther, 2007; 6:25–35.

22.

Pohl

, Seemann

, Zojer

et al. ‘Laying on of hands’ improves well-being in patients with advanced cancer. Support Care Cancer, 2007; 15:143–151.

23.

Brooks

, Schwartz

, Reece

et al. The effect of Johrei healing on substance abuse recovery: A pilot study. J Altern Complement Med, 2006; 12:625–631.

24.

Laidlaw

, Naito

, Dwivedi

et al. The influence of 10 min of Johrei healing method on laboratory stress. Complement Ther Med, 2005; 14:127–132.

25.

Shore

. Long-term effects of energetic healing on symptoms of psychological depression and self-perceived stress. Altern Ther Health Med, 2004; 10:42–48.

26.

Mitchell

, Leis

, Laing

et al. Experiencing Reiki treatments: Patients' and practitioners' perspectives. Focus Altern Complement Ther, 2004; 9,suppl 1:32–33.

27.

MacKay

, Hansen

, McFarlane

. Autonomic nervous system changes during Reiki treatment: A preliminary study. J Altern Complement Med, 2004; 10:1077–1081.

28.

Rubik

, Brooks

, Schwartz

. In-vitro effect of Reiki treatment on bacterial cultures: Role of experimental context and practitioner well-being. J Altern Complement Med, 2006; 12:7–13.

29.

Radin

, Taft

, Yount

. Effects of healing intention on cultured cells and truly random events. J Altern Complement Med, 2004; 10:103–112.

30.

Baldwin

, Wagers

, Schwartz

. Reiki improves heart rate homeostasis in laboratory rats. J Altern Complement Med, 2007; 14:417–422.

31.

Abbot

. Healing as a therapy for human diseases: A systematic review. J Altern Complement Med, 2000; 6:159–169.

32.

Crawford

, Sparber

, Jonas

. A systematic review of the quality of research on hands-on and distant healing: Clinical and laboratory studies. Altern Ther, 2003; 9:A96–A109.

33.

Herron-Marx

, Price-Knol

, Burden

et al. A systematic review of the use of Reiki in health care. Altern Complement Ther, 2008; 14:37–42.

34.

Lee

, Pittler

, Ernst

. Effects of Reiki in clinical practice: A systematic review of randomized clinical trials. J Clin Pract, 2008; 62:947–954.

35.

Cowling

. Unitary appreciative inquiry. Adv Nurs Sci, 2001; 23:32–48.

36.

Skills for Health. Competences/National Occupational Standards. www.skillsforhealth.org.uk. 2012 April 18.