The Influence of Religiousness in the Process of Development of Cancer

1 Departamento de Enfermagem. Faculdade de Juazeiro do Norte. R. São Francisco, 1224. São Miguel, Juazeiro do Norte, CE. 2 Departamento de Pós-graduação em ciências da saúde; Laboratório de Delineamento de Estudos e Escrita Científica. Faculdade de Medicina do ABC. Av. Príncipe de Gales, 821. Príncipe de Gales, Santo André, SP. 3 Laboratório de Delineamento de Estudos e Escrita Científica. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM. Vitória, Espirito Santo, Brasil. Av. N. S. da Penha, 2190, Santa Luiza, Vitória. ES, 29045-402.


Introduction
Cancer is a worldwide public health problem that really affects Brazil [1], associating the physical and emotional effects characterized by a biochemical disorder that originates from the uncontrolled growth of cells that invade tissues and organs and can spread metastasized to other parts of the body [2].
The diagnosis of cancer causes a strong impact on the lives of those affected and their families.Therefore, in the face of hopelessness and suffering caused by the discovery of the disease, seek in spirituality/religiosity positive or negative sense to experiences [3].
Spirituality is an existential intimate feeling, a search for the meaning of life and being in the world and it will not necessarily be linked to a belief in something bigger, like God [4].It is universal, is the essence of being human, and goes beyond any doutrin [5].
It is observed that religiousness and spirituality, although they relate, are not equal.Religiosity can be understood as a set of beliefs and practices belonging to a doctrine, which are shared and followed by a group of people through services or rituals that necessarily involve the notion of faith [4].
Brazilian clinical populations have shown that religious and spiritual involvement enhances the quality of life and reduces depression and anxiety in ambulatory treatments [6].It also notes that in young people with cancer, spirituality seems to emerge as a component that increases the hope for them, helping to face the challenges generated by the chronicity of the disease and the search for the meaning of life [7].Elderly patients related to religious faith to hope, balance and fortification [8].
Researchers (?) point out the benefits of religiousness/spirituality to face disease, justifying the inclusion of the theme in the interventions in health [7][8][9].
Each individual expresses spirituality in their own way, relating it to hope to survive cancer, since the frightening disease and renewed spirituality, which demonstrates the importance of recognizing this, as a coping strategy in the planning of patient care with cancer [3].
Clearly the need to gather information alluding to spirituality in association with oncology, which legitimizes the relevance of this work and provides more scientific knowledge on the subject.
In view of this, it questions which the cancer patient's view about spirituality and religion, and how this influences the coping of the disease.
Thus, this study aims to analyze the influence of spirituality and religiosity in facing cancer from the perspective of cancer patients.

Methods
This is an exploratory descriptive study with qualitative approach, carried out with 10 patients in chemotherapy treatment, hosted in a support for patients with cancer, linked to a referral hospital for cancer treatment, located in the city of Barbalha, interior of the State of Ceará, Brazil.
For selection of the individual, was used as inclusion criteria: patients in cancer treatment, staying in that unit, over 18 years, conscious and able to respond to physical and emotional interview.
A prior visit in the locus of research was made to know the space and dynamics of service, as well as the best way of recruitment of individuals.Subsequently, the patients were invited individually, privately, to participate in the survey, having been informed of the objectives and methods adopted.Those who accepted, responded a semi-structured interview, prepared by researcher, containing guiding criteria: (I) what is the meaning of carrying cancer?(II) What is the meaning of spirituality/religiosity (Faith) for you?(III) What is the relationship between spirituality/religiosity (Faith) and cancer?(IV) The religiosity and spirituality helped you before the cancer treatment?If it did, how?
The speech of each individual was recorded in a digital media device and then transcribed in their entirety.Each interview lasted approximately 45 minutes.The collections were carried out between September and October 2015, was still used the criterion of data overflow.
Was opted the content Analysis proposed by Bardin [10], thematic mode, which involves three steps: pre-analysis; exploration of the material and treatment of information.
The study complied with the ethical precepts of 466/12 resolution of the National Health Council, having an opinion by the Committee of Ethics in Research (CER) of the Faculdade de Juazeiro do Norte (FJN), under the 1,287,874 Protocol.For confidentiality of the users, they were named by the letter "E" followed by numbers, according to the order of interviews (E1, E2… E15).Participants who accept to participate in research have signed an informed consent (TFCC).

Profile of participants
The total of 10 individuals participated in treatment for cancer aged 37 and 75 years, where there was found female prevalence (80%), married marital status (50%), with complete High School (40%).All claimed to have ties with any religious or spiritual practice, Christianity (90%) was the most cited, especially Catholicism (50.0%).The type of cancer more presented was that of breast (80%), most live with the diagnosis more than 02 years (60%).
After application of content analysis process proposed by Bardin, the results have been prepared and organized in three categories: Perceptions/ conceptions of patients' in the discovery of cancer; vision and experience of spirituality/religiosity of oncology patients and influence of spirituality/ religiosity in cancer treatment.

Perceptions/conceptions of patients' cancer discovery.
After the diagnosis of cancer, some respondents reported feelings of surprise; others reacted naturally, comparing cancer to any other simple pathology.However, the majority of respondents reported shock conditions, wrapped with feelings of fear, sadness, despair and grief, as demonstrated in the lines below: Having cancer made me scared, desperate, I was very worried, upset, almost went into depression when the doctor told me...

Be dead in life, I felt fear and suffocating despair, It's terrible, you're completely shaken, ungrounded.
E-6.
...I know that its evolution is death for many and that bothers a lot when we are notified that we are with this bad.

E-9.
It is sad when we get these news, cancer brings fear of dying and it seems that everything loses flavor, the world falls apart and you collapse, it seems that life ends there.
In modern society, the symbolism built on cancer is a disease that invades the body, incurable and mysterious, which generates suffering and losses.Even in the face of progress for early diagnosis and therapy have extended the survival of patients, the symbolism persists.With this in mind, depression is observed, which is directly linked to these cases [11].
In a study conducted in Africa11, religiosity was proved to be of reasonable importance to help the patients, considering that in depression, the spiritual needs to be greater, and in terms of mental health, the use of this practice may favor or not the rehabilitation process.Differently, it was observed that some patients had other reports before the cancer diagnosis, emphasizing show no sentiment or negative reaction: ...I wasn't really scared, had no reaction, I received the news of the cancer with calm.
For me nothing has changed, having cancer is having a disease that has to recieve a special attention because of the possibility of advancement and evolution.
In some popular social groups, the moral/religious connotation of cancer is associated with disease and fatal punitive [12].This statement is presented in the following reports: I think when we plant some not good things, in the future we will reap the bitter fruits.I know I was very unfair and now I'm paying for my mistakes and my choices... E-10.

E-8.
Religion occupies an important space in people's lives, and religiosity can help them find the meaning and coherence of the world.For many religious, the divine/superior being is seen as the absolute owner of wisdom, his plans and purposes going beyond human knowledge, taking the cancer patient to a condition of spiritual peace, making it so the treatment [13].
It can be seen that this higher being can use various ways to bring or make sense of people's lives, even in the form of pain, such as cancer.The idea of disease as something necessary and pre-determined y the divine is exposed by some participants I think there are things that come into our lives to change our hard heart, if I'm with cancer is by my godfather Ciço allowed...
My life with God makes me understand that if I am with this disease is because there is a purpose...
...at first I questioned God every day why it was me?I've always been such a good person and fair to everyone and went to mass every Sunday.But it was during my prayers I could understand that I had cancer because I should go through this, because God never gives a burden that we carry, and from that moment on I could understand that there was a purpose.
The moral/religious connotation of cancer is a feature came from Western Christianity, that conveys the notion of a person subjected to the forces of destiny of life, in a relationship of punishment and redemption.When the man takes the submission to God and the acceptance of the chaotic situations in life, it is possible that the sacred subject the profane.In this context, the divine entity dominates the lives of the men, the unpredictable (illness), it is laid down, the accident is explained and the fatality gives space to the security offered by Divine Providence [12].
In a study conducted in England, is noticeable ease cancer acceptance of respondents when spirituality is associated, resulting directly in the confrontation and in reducing anxiety.Thus, the use of religious/spiritual resources in the initial stages of the cancer is of total importance, considering that this religious struggle might break the disease development [12].
Still noted in the literature, that the perception of professionals is positive spiritual and religious activities front applied in hospital environments, because they help in the process of acceptance, treatment and rehabilitation of patients [14].

Vision and experience of spirituality/ religiosity of cancer patients
All participants mentioned the spirituality in your lines, plus demonstration of religious features.The representation of spirituality as a search for meaning of life appears clearly, it is still described as a relationship with the faith and practice of love and compassion: Faith is the certainty of the existence of a being that is always on our side, who loves us and cares about us even in the face of more circumstances.And the name of this being is God.
Know that our Lord is there, He is everything, to have faith is to believe in his love and compassion, is very good talking constantly with him and always receive a response.

Is believing in something big, something much bigger that you can't explain.
E-1.
The speeches described above are also related to an individual search for a supreme being.The spirituality by giving purpose to the lives of the people becomes an important component that contributes to positive health outcomes and quality of life [15].
In terms of religiosity is evident participation in an institution or religious community, these lines show that the respondents are linked to a religious core, which shows the importance of this to the respondents, as the following reports: I was raised Catholic tradition and always looked for developing my spirituality with readings, meditations, prayers, rosaries and masses, they are great and helped me to grow up and face any situation or circumstance.

E-5.
Many prayers were made by me and by my family, the brothers of the church be gathered also cried for me and I know that the chemotherapy treatment and the action of the powers of God has brought healing to me.
Was in the Evangelical Church of a friend that God spoke to me through the pastor and I understood that he heals, but it is important to do the treatment.
The data of the respondents about religion reveal that 90% of the subjects belong to Christianity (Catholic and liberal and Evangelical Christians), they claim to be spiritual ones and believe in God, but not everyone experienced assiduously religious practice.

E-1.
Approach or rapprochement of patient to a divine being or with your religious belief, practiced by the increase of faith, feeling the presence of God and him were reported after the diagnosis of cancer: But it was after the cancer that much has changed, I discovered how important it is to be in God's House along with our family, because along with the faith we get many brothers...

E-1.
After discovering the disease, I can say that my faith only increased, it seems like He "God", is always on my side, where do I go He goes in front, protecting me and guiding me.

E-3.
At that moment, I realized more and more the presence of God and feeling him beside me, I can see that I was not alone.

E-4.
But after the shock received, I stopped to think and reflect a lot, that's where I turned more and more to God, gave myself and went ahead.
The strengthening of the faith at the time when it is faced with a condition related to end of life, cited by participants, is related to the sense of helplessness and frailty of existence, which awakens the patient need to seek divine protection.
For a large proportion of patients with diseases such as cancer, the pain experienced may be the opportunity for the resignification of life, many patients who have experienced malignant neoplasm and felt the threat to their lives, they might do great twists to prioritize what was most significant, even when there remained but a short time to live.Given this kind of experience, it was observed that the higher the degree of peace and understanding of what is happening, the better the pain tolerance, coping capacity and maintain quality of life [2].
Faced with similar experiences, it was observed that the participants met at the moment, a chance to reflect and find values in the details of your daily life, which previously were not prioritized.Reports of a rethink, a auto analyze were also common: Human life can reach its fullness not only in create and enjoy, but it is true to say that many people reach the fullness in the face of stressful situations and suffering.The disease often presents a loss of meaning, but rather, a meaning of a gain [16].
Before the reports of respondents also perceive the adoption of practices common to some religions, "the prayers and prayers", the search for a religious leader, an act of manifestation of faith and search for support and comfort, in addition to providing devotion and gratitude to the divine being.

Even in the days when I was shot down because of the treatment, He helped me bringing peace and strength through the prayers and prayers.
E-4.
...I believe that all of this was related to my prayers, was Jesus listening to me when I cried out for mercy and strength to keep fighting.Would ease the pain and He because of his goodness answered my requests.

E-6.
I have the great opportunity to work on some things in my interior that will help me to evolve and build a much better...
despair gave way to joy of appreciating every moment with my son and husband, in addition to all that passed unnoticed in my everyday life E-1.

...this disease keeps me the like of living, on the contrary, makes me cherish every moment and person!
The little things, everything has value....the disease and faith made me think about many things that I thought were not so important, and actually were.I woke up to life, it made me see and valuing simple things and like my ransom of spiritual life, and after this rescue of faith I could see light and a lot of hope because the fear and despair gave way to joy of appreciating every mo-I've made some big mistakes in my life and now I stopped to think about the things I've done and this disease came to warn me.
...I pray and I'm in the masses to speak with Saints and ask for strength and healing to stay a few more days here.
Believe in God and support the practice of prayer are strategies and sources of comfort7.A study on the effectiveness of prayer in reducing anxiety in cancer patients demonstrates that the spirituality through prayer becomes beneficial to trigger relief of tensions and increase hope [17].

Influence of spirituality/religiosity in cancer treatment
Popular culture presents the cancer in two ways: in one, the diagnosis is seen as a death sentence that leads to fear, bringing a devastating effect on the psychological and emotional well-being, on the other, the diagnosis and the therapy are understood as a transformation, marking a new chance to live.For both, the patient who lives with cancer need ongoing support in four key areas: prevention, surveillance, intervention for the possible consequences and their treatment [18].
On the positive, the search of religion should not be seen as a form of escape from reality, but as a future perspective for the suffering by cancer.This view helps to understand why religions offer symbolic effectiveness results, in relation to acceptance, firmness and adaptation to their new reality [19].
Study in India in which assessed the State of mind of 50 patients with advanced cancer, defines that the spiritual well-being is an important component of quality of life for these patients, since the physical symptoms are connected to refer to psychological distress.Therefore, encourages that spirituality should be addressed properly in palliative environments [20].
Oftenly, the hope is found in the paths of religiosity, which are always fetched in situations of despair.The following reports us faith and divinity are put as a source of motivation and em-powerment, to follow the treatment and believe in healing: Faith in God brings me the hope and the sure I'll cure this disease and this has been confirmed each day via surveys the carried out.The treatment is being a success and my faith helps me to have willpower and courage to face this battle.
To the point of being able to have joy in the face of such a difficult treatment, where the questions live to spend day and night in your mind, without faith, I'd go crazy, get into despair and depression, know that it was God who gave me strength and I got up to go on living.E-10.
I feel motivated and have a lot of hope to cure me, faith promotes all the peace and tranquility of this new stage of my life.I know that the battle is long, but as long as I can, I'm going to keep on believing in God and in his miracles.
In times of uncertainty, feelings of helplessness and suffering, which are common to patients in cancer treatments, religion can emerge as a strategy for cancer patients, and many of them, they become more religious after the confirmation of the disease [21].Religious beliefs give strength to bear what are living with the disease, in confronting the effects of treatment, and the confidence that patients place in God and spiritual comfort to this host provides them [19].
For individuals the benefits of religiosity in the treatment of the disease are expressed intensely, faith and religious practices were sources of support and protection, have contributed to the acceptance and coping with the condition.Feelings of comfort, peace, tranquility, safety, hope for a cure and even relief from pain and discomfort, were associated with the presence of God: God help me at all, I feel a lot of comfort, peace and joy.Now I'm peaceful, everything is different from the beginning, no more agony and not despair.

E-3.
God has contributed at all!He moves mountains, gives me hope and help before each section, even when I went to the retreat of the chest, that was the hardest moment, He gave me the strength to accept and face all the pain I had, I just carried everything because he's always by my side, I know that part of the healing and improvement only came because of the major contribution given by God.

E-4.
In the early sections of chemo I felt a lot of pain and discomfort, it was very sad, weak and haggard, was horrible!But with the passage of time, everything was peaceful, the pains were no longer so unbearable and sometimes I even forgot them.I believe that all of this was related to my prayers, was Jesus listening to me when I cried out for mercy and strength to keep fighting.Would It ease the pain and He because of his goodness answered my requests.

E-6.
It is stated that belief may have a beneficial effect over cancer treatment, however, if the patient take ownership of the religion in order to ignore the care provided by the health sciences, the experience of religion can make effective medical treatment, increasing the psychic pain when trying to cure exclusively by religious explanations [22,23].
This can be explained by mental health, considering that religiosity may promote or hinder the patient's condition, so the health professional to be aware of the spiritual matters to know how to apply in the field of care [22,23].
On the other hand, it was observed in the accounts, that religions associated with medical treatment are important allies for the welfare of the patient: Was on a friend's Evangelical Church, which God spoke to me through the pastor and I understood that He heals, but it is important to do the treatment.During every encounter I was rebuilding my self-esteem again, lost the fear of death and even if that happens I would be happy, because life doesn't end here, everything is fleeting and I have to do is live and thank you for every day, love and be loved by everyone around me.
It is necessary to emphasize that religion offers resources to better understand the suffering and alleviate the distress experienced by the patient [24], once a strategy for patients facing cancer, given the impact that disease and clinical treatment in the lives of patients [25].
It is of great importance to know the spirituality of patients when planning treatment.Know how the patient copes with the disease and their beliefs allow professionals to understand treatment significantly health practices in this context [7,26,27].
The religious and spiritual coping can present itself as element that contributes in the acceptance and adherence to treatment in the fight against disease; relieve anxiety and other negative symptoms such as pain and discomfort.Notes that the faith and religious practice took the end of despair to the fortress, many found in adversity, a resignification of life, and the hope needed to follow the treatment.

Conclusions
The present study demonstrates that the use of spirituality in cancer treatment has been effective, given that the analyzed group, this had great influence on the stages of evolution of the tumor, helping in the recovery, control and treatment.However, it is important to note that spirituality should be used in accordance with science, respecting its procedures and acting in order to improve the condition of the patient, assisting in treatment and rehabilitation process.Also the health professional, should keep your posture etich in service.
Even if highlights the limitations of the study, the number of patients, considering so that the results presented here, do not establish rules or patterns, starting from the point that each patient has its uniqueness.