Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study

Jennifer M. Hulett, Brick Johnstone, Jane M. Armer, Chelsea Deroche, Rami Millspaugh, Joshua Millspaugh

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: Chronic stress is associated with neuroimmune inflammation and adverse outcomes in breast cancer survivors. Some breast cancer survivors rely on religious and spiritual (R/S) variables to manage stress after breast cancer treatment. A spiritually based psychoneuroimmunological (PNI) model of health suggests that R/S variables influence neuroimmune activity; however, these associations are not well-established. A pilot study was conducted to assess the feasibility of studying associations between R/S variables and neuroimmune biomarkers in breast cancer survivors. Method: Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) were sampled among women previously treated for breast cancer. The primary aim was to assess feasibility and acceptability of the sampling protocol. A secondary aim explored associations between sAA, IL-6, R/S variables, and health outcomes. Result: Forty-one women completed the study. Biomarker sampling yielded 246 acceptable specimens used for analysis. SAA was detectable in 96% of specimens and IL-6 was detectable in 44% of specimens. The R/S variables with the strongest associations to sAA were spiritual self-rank (rs =.39; p <.05) and forgiveness (rs =.40; p <.05). The R/S variable with the strongest association to salivary IL-6 was positive congregational support (rs =.42; p <.05). Conclusion: Feasibility and acceptability of the sampling protocol were confirmed. Reference ranges for sAA and IL-6 for female breast cancer survivors are presented. Results suggest that spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based PNI model of health. Findings lay the foundations for future R/S-based interventions to promote health and well-being in breast cancer survivors.

Original languageEnglish
Pages (from-to)6421-6429
Number of pages9
JournalSupportive Care in Cancer
Issue number11
StatePublished - Nov 2021


  • Breast cancer
  • Interleukin-6
  • Neuroimmune
  • Religious
  • Salivary alpha-amylase
  • Spiritual


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