Most Devout Most Likely to Fight Death to the End

March 17 (HealthDay News) -- People with advanced cancer who turn to their religion to help them cope are more likely to use aggressive measures to prolong their lives at the end, new research shows.

Published in the March 18 issue of the Journal of the American Medical Association, the study found that those who turn to their faith for comfort during their illness are significantly more likely to use intensive lifesaving measures, such as mechanical ventilation.

"In a large study of terminally ill cancer patients, we found that patients that rely more heavily on religion to cope are about three times as likely to get aggressive medical care in the last week of life," said study author Dr. Andrea C. Phelps, a senior medical resident at Beth Israel Deaconess Medical Center in Boston.

Phelps said the study wasn't able to address the question of why people who rely heavily on their religion might be more apt to use any lifesaving measure available, but there are several possible theories. One is that, "they may be more optimistic because they have faith in God, and their religious faith may provide them hope near death," Phelps said. Another possibility is that those who lean on their religion "may want all measures to extend the length of their life because they believe in the sanctity of life."

Almost nine in 10 cancer patients involved in a recent multi-center study said that religion and spirituality were important to them in handling their diagnosis, according to background information in the study.

For the current study, Phelps and her colleagues recruited 345 people with advanced cancer and asked them to complete a short questionnaire to assess how much they relied on their faith and religion to help them handle their disease. The researchers followed up with all of those interviewed until their deaths. The average follow-up time was 122 days.

Intensive life-prolonging care was defined as the use of mechanical ventilation or cardiopulmonary resuscitation during the last week of life.

Those who reported a high level of religious coping were much more likely to use intensive life-prolonging measures than those with low levels of reliance on religion for coping -- 13.6 percent vs. 4.2 percent. Just over 11 percent of those with high levels of religious coping were placed on mechanical ventilation compared to 3.6 percent of those with low levels. The rate of resuscitation for those with high levels of religious coping was 7.4 percent compared to 1.8 percent of those with low levels of religious coping.

"Many people, within the framework of their belief system, want to make sure we're giving God every opportunity to see if something can change in the course of care," said the Rev. Percy McCray Jr., director of pastoral care and social services at Cancer Treatment Centers of America's Midwestern Regional Medical Center in Zion, Ill.

"People who are religious or faith-based don't want to prematurely give in to the idea of cancer. They want to know that they did everything they could do; they want the sense of having fought," he said.

Phelps said this study shows physicians how important religion can be to their patients. "Doctors need to recognize that religion is central in how many people make their decisions, and we need to be really sensitive to this and open to talking about it," she said.

At the same time, she said, patients need to let their doctors know that faith is important to them and that it's playing a role in how they adjust to a terminal illness.


SOURCES: Andrea C. Phelps, M.D., senior medical resident, Beth Israel Deaconess Medical Center, Boston; the Rev. Percy McCray Jr., director, pastoral care and social services, Cancer Treatment Centers of America's Midwestern Regional Medical Center, Zion, Ill.; March 18, 2009, Journal of the American Medical Association

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