1. Introduction
Cancer remains a significant global health concern, with millions of new cases and deaths reported annually. In 2022, an estimated 20 million new cases of cancer and 9.7 million deaths were reported worldwide [1]. Despite advancements in treatment and prevention strategies, the burden of cancer continues to impact individuals and communities worldwide. However, it is noteworthy that approximately 53.5 million individuals survive within a five-year period after diagnosis, emphasizing the importance of effective management and support for cancer patients [1].
Efforts to combat cancer focus not only on prevention and treatment but also on improving the overall well-being and quality of life of patients. Prevention strategies targeting known risk factors can potentially avert 30 to 50% of cancer cases, highlighting the significance of public health interventions and lifestyle modifications. Moreover, early detection and timely treatment significantly enhance the chances of successful outcomes across various cancer types [2,3]. Currently, research has started focusing on less invasive approaches for the early diagnosis and the targeting of potential specific biomarkers for various types of malignancies [4]. Nevertheless, the journey of cancer diagnosis and treatment often imposes profound physical and emotional challenges for patients. Coping with the uncertainties, fears, and changes associated with cancer can significantly impact the well-being and quality of life of individuals affected by the disease [5]. In this context, spirituality and religion have emerged as potent coping mechanisms that offer solace, strength, and hope amidst the turmoil of illness.
Spirituality encompasses an individual’s quest for transcendence and meaning, engaging with existential questions regarding purpose, connection, and significance. It represents a deeply personal aspect of human experience, often intertwined with one’s values, beliefs, and relationships. Religion, on the other hand, refers to organized systems of beliefs and practices shared by communities, offering a framework for spiritual expression and communal support [6], whereas religiousness refers to the degree to which an individual believes and practices a religion and follows its dogma, often shaping how one choses to live and interact with the others [7]. Studies show that religious coping was a stronger predictor of outcomes during negative life events than general religiosity [8]. It is pertinent to recognize the significance of spirituality in all patients, irrespective of their religious affiliations, as it serves as a fundamental aspect of holistic care.
Moreover, practices such as yoga, which integrate physical postures, breathing exercises, and meditation, are increasingly recognized for their potential to enhance spirituality and well-being among cancer patients [9]. By fostering a connection between the body, mind, and spirit, yoga offers a holistic approach to coping with the challenges of cancer diagnosis and treatment.
While much of the literature focuses on the positive impact of spirituality and religion on health outcomes, it is important to emphasize that it can also have negative effects, particularly through negative religious coping. Negative religious coping involves maladaptive religious behaviors, such as spiritual struggle, anger with God, or feelings of abandonment, which have been associated with poorer quality of life (QoL) and increased psychological distress in some individuals. This aspect of spirituality and health highlights the complexity of the relationship between religious beliefs and well-being. Although this review focuses specifically on the positive outcomes of spiritual and religious support in cancer care, it is essential to acknowledge the existence of negative religious coping, as it underscores the need for an understanding of spirituality in health contexts [10,11,12].
This systematic review aims to explore the impact of spirituality and religion on the lives of cancer patients, emphasizing their role in coping strategies, quality of life, and mental health. By synthesizing existing evidence, we seek to demonstrate the importance of integration of spiritual and religious support into cancer care protocols. Recognizing the importance of patient-centered approaches, improved healthcare provider-patient communication, and holistic support can potentially enhance the efficacy of conventional cancer treatments and foster a more compassionate and comprehensive approach to cancer care.
2. Materials and Methods
To conduct a comprehensive systematic review on the role of spirituality and religion in providing reassurance to cancer patients, a rigorous methodology was employed.
2.1. Study Design and Search Strategy
A systematic search of electronic databases was conducted across PubMed, Scopus, and Google Scholar. This systematic review was registered in PROSPERO with the registration number CRD42024530357. Our investigation was centered around a 10-year time frame, from 2014 to 2024. This time frame was carefully chosen due to the relatively novel integration of spirituality and religion in the treatment of cancer patients, which presents a fresh approach for medical and clinical professionals. We strategically used the following search phrases including (“influence of spirituality AND cancer patients”), (“influence of religion AND cancer patients”), (“spirituality AND quality of life cancer”), (“religion AND quality of life cancer”), (“influence of spirituality AND coping cancer”), and (“influence of religion AND coping cancer”).
2.2. Inclusion/Exclusion Criteria
The inclusion criteria comprised studies with full-text availability, published in English, involving adult oncology patients across diverse cancer types and stages, all of whom were actively undergoing treatment, with reported positive outcomes. Exclusion criteria included studies focusing on populations other than cancer patients, such as caregivers or pediatric patients, as well as medical staff (nurses/doctors) and cancer patients in recovery. Review/meta-analysis studies, outcomes unrelated to spirituality/religion in cancer care, or studies not involving cancer patients were also excluded.
2.3. Data Extraction
Two independent reviewers assessed titles and abstracts for eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies underwent full-text screening, and relevant data were extracted. Data included authorship, publication year (2014–2024), population characteristics (including cancer type and gender), sample size, measures of spirituality and religion, and outcomes related to reassurance, coping, quality of life, and mental health. In addition to commonly studied interventions like yoga and mindfulness, the review also considered other forms of spiritual practices such as prayer, nature-based experiences, and social connections, providing a comprehensive view of diverse strategies that promote spiritual well-being.
2.4. Data Synthesis and Analysis
The extracted data were synthesized and analyzed to identify common themes, patterns, and associations between spirituality, religion, and the experiences of cancer patients. Findings were organized systematically to provide a comprehensive overview of the role of spirituality and religion in offering reassurance throughout the cancer journey, including diagnosis, treatment, and survivorship. This synthesis aimed to elucidate the impact of spirituality and religion on coping strategies, quality of life, and mental well-being, contributing to a deeper understanding of their significance in cancer care.
2.5. Risk of Bias Assessment and Ethical Considerations
Methodological quality assessment of included studies was performed using appropriate tools, such as the Cochrane risk of bias tool for RCTs and the Newcastle–Ottawa Scale (NOS) for observational studies. The Cochrane risk of bias tool evaluates various aspects of trial design, execution, and documentation to assess the potential for bias in randomized controlled trials (RCTs). The NOS assesses the quality of non-randomized studies based on selection, comparability, and exposure or outcome determination.
Ethical approval was not required for this systematic review, as it involved the analysis of published literature and did not entail direct contact with human participants. All data were obtained from publicly available sources and were anonymized during analysis to ensure confidentiality and compliance with ethical standards.
3. Results
Literature search results
Through a rigorous database search, a total of 2591 papers were initially identified. After removing 931 duplicates, 1544 studies were excluded as they did not meet the inclusion criteria upon review (Figure 1).
During the primary screening, exclusions were made based on criteria such as the absence of spirituality/religion (n = 524), incorrect population focus (n = 399), inappropriate outcome measures (n = 214), and studies not involving cancer patients (n = 136).
Following an assessment of titles and abstracts, 113 studies were selected for further evaluation in full-text format. Additionally, during the secondary screening, reports were excluded if they were available only as abstracts (n = 55) or were written in foreign languages including Chinese, German, French, Spanish, or Hungarian (n = 6). Consequently, only 53 papers were deemed suitable for inclusion in this review.
3.1. Study Characteristics
Of the 53 identified studies, 8 were prospective cohort, 17 were cross-sectional, 16 were observational descriptive, and 12 were randomized controlled trials (RCTs). The studies encompassed diverse populations and sample sizes across different years, reflecting a broad perspective on the impact of spirituality and religion on cancer patients’ well-being. Commonly reported positive outcomes included enhanced quality of life, emotional well-being, improved coping mechanisms, and reduced psychological distress. The most frequently used assessment tools for evaluating spirituality included the FACIT-Sp (Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being), the Daily Spiritual Experience Scale (DSES), and the Spiritual Well-Being Scale (SWBS). Psychological outcomes were typically measured using tools such as the Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety Stress Scales (DASS-21), providing a comprehensive evaluation of both spiritual and mental health. Barata A. et al. [1] conducted research in 2022 involving 242 women with breast cancer undergoing chemotherapy. Majda A. et al. [2] surveyed 101 Polish cancer patients in 2021, with 101 correctly completed questionnaires out of 150 individuals approached. Zare A. et al. [5] investigated 208 Iranian and Muslim cancer patients receiving chemotherapy in 2019.
Zargani A. et al. [6] studied 84 Muslim patients with breast cancer in 2017. Zok A. et al. [9] focused on 41 breast cancer patients in 2023. Joshi A. et al. [13] included 32 breast cancer patients undergoing chemotherapy in their 2021 study. Ferrell B. et al. [14] conducted research with 479 cancer patients with solid tumors in 2020. The sample sizes and characteristics varied across studies, reflecting diverse populations and cancer types, providing a broad perspective on the impact of spirituality and religion on cancer patients’ well-being.
3.2. Summary of the Selected Studies
Breast Cancer Patients
According to the PRISMA methodology, 53 studies were included in the review (Table 1). Breast cancer patients were the most frequently studied population, with 14 studies focusing on this group. Breast cancer remains a significant health concern globally, and many patients face difficulties in coping with the disease and its treatment [13]. Interventions such as spirituality, mindfulness therapy, religiosity, and yoga were assessed for their potential benefits and broader application. These studies, collectively involving 929 participants, consistently demonstrated a positive correlation between greater spiritual well-being and improved quality of life, emotional well-being, enhanced functional capacity, and better social interactions [14,15,16,17]. Spirituality was seen as a critical source of hope and meaning for patients, helping them navigate the cancer journey. One study reported that low spiritual fulfillment was linked to higher levels of demoralization, underscoring the importance of addressing spiritual needs [18]. Group therapy was found to facilitate spiritual fulfillment among breast cancer patients, leading to enhanced quality of life [19].
Mindfulness therapy was evaluated in two studies, resulting in significantly reduced psychological distress and improved spiritual well-being, thus enhancing overall quality of life [20,21]. On the other hand, religiosity emerged as a significant coping mechanism, with three studies investigating its impact on quality of life among breast cancer patients of various faiths, demonstrating higher levels of well-being among those with greater religiosity [22,23,24]. Similarly, spirituality and mindfulness practices, particularly through yoga, were associated with pain reduction, increased quality of life, reduced psychological distress, and improved coping and sense of purpose in life [25,26,27].
3.3. Other Cancer Types
Three studies focusing on patients with gynecological cancer were included in our review, comprising a total of 932 participants. These studies found that both spirituality and religion, while often interconnected, positively influenced various aspects such as illness perception, quality of life, existentiality, and one’s relationship with something greater than themselves [28,29,30]. This suggests that spirituality and religious beliefs play a significant role in coping with the challenges of gynecological cancer, providing patients with a sense of meaning and support during their journey.
In the case of gastrointestinal cancer, two studies were identified. One of these studies utilized fatwas, which are Islamic legal opinions or rulings issued by qualified scholars in response to specific questions about Islamic law. The study aimed to enhance participants’ spiritual well-being and quality of life through this culturally tailored intervention. This approach was viewed as an important coping mechanism, potentially reducing the stigma associated with treatment and disease [31]. The second study explored the role of spirituality in improving life quality and overall well-being among patients with gastrointestinal cancer, showing positive outcomes. These findings highlight the potential benefits of incorporating spirituality into coping strategies for gastrointestinal cancer patients [32].
Brain cancer was the subject of two studies included in the review, involving a total of 633 participants. The results indicated that greater spiritual well-being and religious coping were associated with better health-related quality of life for patients in this category. This suggests that spirituality may serve as a valuable resource for individuals facing the challenges of brain cancer, offering comfort and support throughout their journey [33,34].
Two studies focused on patients with solid tumors, comprising a total of 679 cases. The findings suggested that higher levels of spirituality were associated with higher quality of life and support, as well as reduced severity of fatigue and overall symptom interference. This underscores the importance of addressing the spiritual needs of patients with solid tumors to enhance their well-being and coping mechanisms [35,36].
Additionally, one study investigated the impact of yoga practice on spiritual well-being and quality of life among patients with prostate cancer. The results revealed a positive correlation between yoga practice and emotional, physical, and social scores, indicating the potential benefits of integrating yoga into holistic cancer care approaches [37].
Lastly, a cohort of 864 patients with lung cancer was evaluated, demonstrating that increased spirituality was associated with decreased emotional distress. This suggests that spirituality may serve as a protective factor against emotional distress among patients with lung cancer, highlighting the importance of addressing spiritual needs in comprehensive cancer care plans [38]. The studies reviewed demonstrate that both spirituality and religion enhance the quality of life of cancer patients. Spirituality contributes to a sense of meaning and purpose, and religion frequently offers structured coping mechanisms, both playing significant roles in the well-being of the cancer patients.
3.4. General Cancer Population
For the remaining 28 studies included in the review, the patient cohort did not specify the cancer type. However, 11 studies (involving 4183 participants) investigated the influence of spirituality on participants’ well-being and quality of life. These studies reported positive outcomes, including stronger social support, enhanced quality of life, reduced neuropathic pain, decreased psychological distress, fatigue, and depression, as well as improved overall spiritual health [39,40,41,42,43,44,45,46,47,48,49]. Another 11 studies focused on the impact of religiosity and prayer, highlighting their effects on various aspects of cancer patients’ lives. With a total population of 4495, these studies demonstrated improvements in pain management, coping mechanisms, social support, quality of life, optimism, and mental health [50,51,52,53,54,55,56,57,58,59,60].
Additionally, four studies examined the effects of spirituality through yoga practice on 337 patients, showing positive outcomes such as reduced fatigue, physical and psychosocial distress, anxiety, and increased quality of life [36,46,48,50,53]. Furthermore, mindfulness therapy was evaluated in two studies involving 165 participants, resulting in reduced suffering scores and improved life quality [61,62].
3.5. Assessment Tools Identified in the Studies
Spirituality and religion were assessed using different tools (Table 2). The studies revealed diverse impacts of spirituality and religion on cancer patients’ well-being. Barata A. et al. [14] associated higher spiritual well-being (FACIT-Sp) with decreased distress and enhanced quality of life in women undergoing chemotherapy.
Majda A. et al. [2] found a positive link between spiritual experiences (DSES) and well-being among Polish cancer patients. Zare A. et al. [5] linked elevated spiritual well-being, mental health, and quality of life (DASS-21) with improved overall well-being in Iranian and Muslim cancer patients. Zok A. et al. [9] noted increased satisfaction post-yoga, targeting spiritual well-being. Joshi A. et al. [13] showcased MBAT’s efficacy in reducing distress and enhancing spiritual well-being in breast cancer patients. Ferrell B. et al. [14] and Randazzo D. et al. [17] highlighted spirituality’s importance in patients’ quality of life (FACIT-Sp12). Similarly, Dabo I. et al. [24] linked Croatian cancer patients’ well-being (EORTC QLQ-SWB32) with spiritual well-being, emphasizing spirituality’s multifaceted role in coping.
Although not included in the studies mentioned before, the Spiritual Needs Questionnaire (SpNQ) is a widely used tool designed to assess the spiritual needs of patients, particularly in palliative and cancer care. It explores various dimensions of spirituality, including existential issues, hope, and the need for spiritual support, offering a comprehensive approach that goes beyond religious practices. The SpNQ is validated across multiple cultural contexts, demonstrating its adaptability and relevance in diverse healthcare settings. One of its strengths is its holistic view of spirituality, recognizing both religious and non-religious aspects, which allows it to capture the full range of spiritual concerns patients may face. This makes it especially valuable in cancer care, where patients often seek meaning and emotional support. Additionally, the tool has been widely applied in countries such as the Netherlands, Japan, and the UK, further supporting its global applicability. However, the SpNQ, like any self-report instrument, may be influenced by personal biases and cultural factors, which could impact its accuracy in certain patient groups. Despite these limitations, the SpNQ remains a useful and reliable instrument for identifying spiritual needs and informing spiritual care interventions in cancer treatment [63,64].
3.6. Risk of Bias Assessment
After conducting a comprehensive analysis of the studies included in the systematic review, it was determined that the risk of bias ranged from low to medium across all types of studies considered. The NOS was utilized for cohort and cross-sectional studies, while the Cochrane risk of bias tool was employed for RCTs. This approach ensured a rigorous evaluation of study quality and minimized the potential for bias in the findings. By utilizing established assessment tools tailored to the study designs, the review was able to establish a robust and reliable foundation for the conclusions drawn from the data. As a result, the credibility of the results obtained is strengthened, instilling confidence in the reliability of the findings presented in the systematic review.
4. Discussion
4.1. Summary of Evidence
This study conducted a comprehensive systematic review, encompassing 53 diverse studies that collectively evaluated 13,590 patients diagnosed with various types of cancer. The primary objective of these investigations was to delve into the impact of spirituality and religion on the overall well-being and quality of life of individuals undergoing cancer diagnosis and treatment. Despite the advancements in technology and treatment modalities within contemporary medical practice, the significance of spiritual and compassionate care remains paramount. This holistic approach not only addresses the physical aspects of illness but also attends to the emotional, social, and spiritual needs of patients, recognizing the profound influence of spirituality on coping with challenging diagnoses [65].
A total of 25 included studies focused on exploring the role of spiritual well-being as a coping mechanism for individuals grappling with cancer. These studies consistently demonstrated that heightened spirituality correlates with improved quality of life, enhanced coping mechanisms, and reduced psychological distress. The profound influence of spirituality on psychological well-being underscores its significance in shaping health-related behaviors and perceptions, bridging the realms of physical health and psychosocial well-being [66]. In various studies, the spiritual care needs of patients were addressed by a range of professionals, including healthcare staff, spiritual care specialists, and even volunteers. This highlights that patients’ spiritual needs can be met through support from diverse individuals with different perspectives, all having specific roles in achieving the patient’s well-being.
Among the interventions explored, yoga practice emerged as particularly promising, offering benefits not only for physical and mental well-being but also for spiritual well-being. Eight studies within the review highlighted the effectiveness of yoga in enhancing satisfaction levels, fostering self-compassion, and mitigating psychological distress, anxiety, and neuropathic pain. The holistic approach of yoga nurtures both body and mind, cultivating a state of equanimity in perception that complements conventional interventions like analgesia in managing chronic pain associated with cancer [67,68].
The interconnection of spirituality and mindfulness was a notable theme across the included studies. While spirituality embodies a state of mindfulness, mindfulness entails the deliberate cultivation of spirituality. Both concepts are deeply intertwined. Four studies within the review underscored the beneficial effects of mindfulness, showcasing its potential to reduce overall suffering scores and enhance quality of life for cancer patients [69].
Religion emerged as a consistent and significant coping mechanism for individuals navigating life-threatening illnesses such as cancer. The review included 15 studies examining the impact of religiosity and faith on the lives of cancer patients. These studies collectively revealed a positive influence of religion on various aspects of well-being, including improved quality of life, enhanced coping mechanisms, and bolstered physical and mental health outcomes [70].
Although most studies emphasize the beneficial effect religion and spirituality have on the QoL of cancer patients, several studies have raised important negative aspects regarding the measurement of spirituality and well-being in healthcare research. Koenig (2008) [71] highlighted that the definition of spirituality has broadened, often incorporating traits like optimism, forgiveness, and well-being, leading to measures that overlap with mental health. He argued that such overlap results in tautological findings and called for either a clearer, traditional definition or the elimination of spirituality as a research construct.
Similarly, Visser et al. (2017) [72] found that existential well-being (EWB), commonly included in spirituality measures, overlaps with psychological well-being. Using the Spiritual Attitude and Involvement List (SAIL), they showed that traits like coping belong to well-being, while meaning in life aligns more with spirituality. They advocate for distinct measures to better assess the relationship between these constructs.
Future research would benefit from the development of more nuanced and culturally sensitive tools that can better assess the role of spirituality in health outcomes.
Another important aspect that needs to be addressed is the role of spirituality and religion in palliative care. Palliative care plays a critical role in supporting cancer patients, particularly those facing advanced or terminal stages of their illness. As defined by the World Health Organization (WHO), palliative care focuses on improving the quality of life by addressing the physical, psychological, emotional, and spiritual needs of patients. In the context of cancer, patients often experience profound existential distress, fear of death, and emotional suffering, which can severely affect their well-being [73]. Spiritual care, an essential part of palliative care, provides patients with a means of finding meaning, hope, and peace amidst their illness. Interventions such as religious support, spiritual counseling, and mindfulness practices are specifically designed to help patients navigate these emotional and existential challenges. Despite its significance, spiritual care remains underexplored in research on cancer patients within palliative care settings [74]. Studies in the field of cancer care focus primarily on the medical and physical aspects of treatment, neglecting the emotional and spiritual needs of patients [74,75,76]. This gap in research highlights the need for a more holistic approach to palliative care, one that fully integrates spiritual care as a core component. Spiritual care is not a peripheral aspect of care but is central to improving the quality of life for cancer patients, particularly in the final stages of their illness [76]. It is crucial to further investigate how spiritual care can be effectively integrated into palliative care to enhance the well-being of cancer patients, alleviate psychological distress, and improve their overall quality of life, particularly in their final stages of life. More research is needed to ensure that palliative care fully meets the spiritual and emotional needs of cancer patients, providing holistic and compassionate care that goes beyond physical symptom management.
In summary, the findings from this systematic review underscore the profound influence of spirituality and religion on the well-being and quality of life of individuals grappling with cancer. From heightened spiritual well-being to the therapeutic benefits of yoga and mindfulness practices, as well as the resilience offered by religiosity, these insights provide valuable avenues for holistic care and support for cancer patients.
4.2. Limitations of This Review
The primary limitation of this review is the restricted access to sources, as many full-text unavailable studies were excluded, potentially limiting the scope and conclusions. Additionally, focusing solely on patients after diagnosis or during treatment may have limited diversity in perspectives. While this approach enhanced result accuracy by considering coping mechanisms’ psychological implications, it excluded perspectives from recovered patients. Future research could benefit from expanding inclusion criteria to encompass recovered patients and accessing a broader range of sources. Expanding this approach could yield a more comprehensive understanding, providing valuable insights to inform oncology clinical practices and decisions.
4.3. Practical Implications and Future Directions
The primary objective of this review was to emphasize the significance of integrating spirituality/religion into the care of individuals diagnosed with cancer, in accordance with their personal preferences and beliefs. Integrating spirituality or religion into cancer care can provide patients with solace, optimism, and a sense of purpose during challenging, emotionally taxing times. Research indicates that attending to the spiritual needs of patients can enhance their quality of life, overall well-being, and treatment outcomes. By incorporating these dimensions into patient care plans, healthcare providers can adopt a more comprehensive approach that acknowledges the interconnectedness of the mind, body, and spirit. It is imperative to honor each individual’s beliefs and choices to provide comprehensive support throughout their cancer journey.
5. Conclusions
This review highlights spirituality and religion’s vital role in cancer patients’ lives. Engaging in these practices provides profound reassurance, enhancing well-being and quality of life while alleviating symptoms like pain, depression, and anxiety. Integrating spirituality and religion into care plans offers a holistic approach, addressing patients’ multifaceted needs. These practices not only enhance the overall well-being and quality of life of patients but also serve as powerful coping mechanisms, alleviating symptoms such as neuropathic pain, depression, and anxiety. By acknowledging and integrating spirituality and religion into patient care plans, healthcare providers can adopt a more holistic approach that addresses the multifaceted needs of cancer patients. Healthcare providers must recognize its significance in cancer care, fostering resilience and hope throughout the treatment journey. This review emphasizes the need to incorporate spirituality into the broader framework of cancer care, ensuring that patients receive comprehensive support during their challenging battle against cancer.
Conceptualization, D.S.N. and S.M.N.; methodology, D.S.N. and D.I.P.; software and A.C.M.; validation, D.I.P., S.M.N. and D.S.N.; formal analysis, A.I.; investigation, A.C.M. and R.G.D.; resources, A.C.M. and R.G.D.; data curation, A.I. and R.G.D.; writing—original draft preparation, D.S.N.; writing—review and editing, A.I.; visualization, A.C.M.; supervision, D.S.N., D.I.P. and S.M.N.; project administration, D.S.N.; funding acquisition, A.I. All authors have read and agreed to the published version of the manuscript.
The authors declare no conflicts of interest.
Footnotes
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Enlarge this image.Figure 1. A PRISMA flowchart was created to summarize the selection process of the eligible studies. Potential content was extracted from selected studies.
Overview of the studies assessing spirituality/religion in cancer patients.
| Author | Year | Population | Population Size | Strategy Assessment | Outcome | Cultural Backgrounds |
|---|---|---|---|---|---|---|
| Barata A. et al. [ | 2022 | Women with breast cancer undergoing chemotherapy | 242 | Spiritual well-being (using FACIT-Sp) | Greater spiritual well-being is associated with less concurrent distress and better quality of life, as well as with greater emotional, functional, and social well-being over time | Hispanic culture |
| Majda A. et al. [ | 2021 | Polish cancer patients, both men and women | Enrolled = 150, Completed = 101 | Daily Spiritual Experience Scale (DSES) | The level of spirituality/religiosity was positively and significantly correlated with quality of life (p < 0.001), physical functioning (p < 0.048), fulfilling one’s role (p < 0.004), emotional functioning (p < 0.001) and social functioning (p < 0.001) | Central-Eastern Europe, |
| Zare A. et al. [ | 2019 | Iranian and Muslim cancer patients receiving chemotherapy | 208 | Spiritual well-being, mental health, and quality of life using DASS-21 questionnaire | Participants with higher level of spiritual well-being indicated higher level of mental health (p = 0.001) and quality of life (p = 0.01) | Muslim culture |
| Zargani A. et al. [ | 2017 | Muslim patients with breast cancer | 84 | Serajzadeh’s Muslim Religiosity questionnaire | Quality of life was significantly higher in patients with high religiosity status compared to moderate religiosity status (p < 0.0001); and a direct correlation between QoL and religiosity (total and all subscales) (p < 0.0001) | Muslim culture |
| Zok A. et al. [ | 2023 | Breast cancer patients | 41 | Spiritual well-being using 60-min vinyasa yoga practice followed by 15-min shavasana relaxation | After three months of exercise, the participants’ satisfaction levels improved significantly | Central-Eastern Europe, |
| Joshi A. et al. [ | 2021 | Breast cancer patients undergoing chemotherapy | 32 | Mindfulness-Based Art Therapy (MBAT) for improving spiritual well-being | MBAT intervention for breast cancer patients undergoing chemotherapy significantly decreased the psychological distress, improved the spiritual well-being in terms of meaning, peace, faith. | Indian culture |
| Ferrell B. et al. [ | 2020 | Cancer patients (with solid tumors) | 479 | FACIT-Sp12 assessment tool | Spirituality is a key aspect of the quality of life and a source of support during serious illness and treatment | Australian culture |
| Kimani C. et al. [ | 2023 | Cancer patients | 169 | Determinants of progressive utilization of palliative care services by cancer patients | Muslim religion was a significant factor in palliative care utilization | Kenyan culture |
| Kaushik D. et al. [ | 2021 | Prostate cancer patients | 29 | Spiritual well-being and quality of life using yoga practice | Yoga has a positive effect on emotional, physical, and social scores | American culture (USA) |
| Randazzo D. et al. [ | 2021 | Brain tumor patients | 606 | FACIT-Sp12 assessment tool | Greater spiritual well-being was associated with better health-related quality of life (p < 0.0001) | American culture (USA) |
| Vilhena E. et al. [ | 2014 | Patients with chronic disease, including cancer | 774 | Self-reporting questionnaires to assess general well-being, physical and mental health | For the cancer disease group, positive effect and spirituality showed a statistically significant association with general well-being, mental health, and subjective well-being (p < 0.01) | Portuguese culture |
| Ahmadi F. et al. [ | 2019 | Cancer patients in Malaysia | 29 | Religious coping methods assessed | Malay culture and Islamic belief strongly influences coping methods of cancer patients | Turkish culture |
| Iqbal F. et al. [ | 2016 | Patients with colorectal cancer and stoma | 10 | Religious coping using stoma-specific non-binding legal opinions (fatawas) | These fatawas are a way to improve quality of life in patients with stomas | Muslim culture |
| Cheng F. [ | 2017 | Case study | 1 | Religious impact on pain reduction | Buddhism underpins pain tolerance and therefore reduces pain intensity | Buddhist culture |
| Rong H. et al. [ | 2022 | Cancer patients | 208 | Assessing the relationship between social support and benefit finding as mediated by perceptions of spirituality | Spirituality mediated the effect of social support on benefit finding (p < 0.01) | Chinese culture |
| Hekmati P. et al. [ | 2015 | Cancer patients undergoing chemotherapy | 96 | Relationship between praying and life expectancy | There was a significant relationship between praying and life expectancy (p = 0.01) | Iranian culture |
| Dabo I. et al. [ | 2021 | Croatian cancer patients | 143 | Assessing spiritual well-being using EORTC QLQ-SWB32 | Women and older patients scored higher on RG scale (Relationship to God) and spiritual well-being | Croatian culture |
| Bai J. et al. [ | 2018 | Black patients with cancer pain | 102 | Relationship between spirituality, quality of life and pain | Higher spirituality was associated with lower pain severity (p = 0.01) and significantly predicted quality of life domains of social (p < 0.0001), emotional (p = 0.002), and functional well-being (p = 0.001) | American culture (USA) |
| Chen J. et al. [ | 2021 | Patients with gynecological cancer in China | 705 | Spiritual well-being in relation to quality of life | Being religious was associated with higher scores on the existential (EX) and relationship with someone greater (RSG) scale | Chinese culture |
| Heidari J. et al. [ | 2015 | Digestive system metastatic cancer | 250 | Spiritual well-being in relation to quality of life | Significant relationship between spirituality and life quality scape (p < 0.001) | Iranian culture |
| Carson J. et al. [ | 2021 | Women with metastatic breast cancer | 48 | Mindful yoga program to reduce pain | Meditation practice showed the strongest association with lower daily pain | American culture (USA) |
| Piderman K. et al. [ | 2015 | Patients with brain cancer | 27 | Chaplain-led spiritual life interview to assess spiritual well-being, spiritual coping and quality of life in cancer patients | Increases in spiritual well-being, religious coping, and quality of life were detected | American culture (USA) |
| Nasution L. et al. [ | 2019 | Patients with gynecological cancer | 108 | Measuring spiritual well-being in cancer patients | Positive change in the average scores of coping (p = 0.001) and spiritual well-being after receiving spiritual intervention (p = 0.006) | Indonesian culture |
| Gudenkauf L. et al. [ | 2019 | Lung cancer patients | 864 | Relationship among spirituality, emotional distress of cancer patients | Spirituality was associated with lower prevalence of emotional distress | American culture (USA) |
| Amzerin M. et al. [ | 2020 | Moroccan cancer patients | 164 | Assessing quality of life in cancer patients | Patients with abnormal G8 scores (geriatric assessment with 8 questions) did less standing prayer and had lower scores of physical, emotional and social functions | Moroccan culture |
| Jetan M. et al. [ | 2023 | Cancer patients | 354 | FACIT-Sp12 | A strong positive correlation between spirituality and quality of life was observed | Palestinian culture |
| Miller M. et al. [ | 2021 | Solid tumor cancer patients | 200 | Spirituality and cancer-related symptoms | Higher spirituality was associated with lower severity of fatigue (p = 0.003) and lower overall symptom interference (p < 0.004) | American culture (USA) |
| Wnuk M. [ | 2022 | Breast or lung cancer patients | 50 | Daily Spiritual Experience Scale (DSES) | Spiritual experiences were indirectly related to life satisfaction through the pathway of hope and meaning in life | Central-Eastern European |
| McLaughlin E. et al. [ | 2024 | Young adults with cancer | 28 | 8-week yoga intervention | Participants described improvements in their ability to practice self-care, self-compassion and mindfulness both during and beyond yoga classes | Canadian culture |
| Delgado-Guay M. et al. [ | 2021 | Latin American cancer patients | 325 | Faith, Importance and Influence, Community, and Address (FICA) | Spirituality/religiosity was associated with positive brief coping strategies and higher quality of life (p < 0.0001) | Latin American culture |
| Calderon C. et al. [ | 2020 | Cancer patients | 912 | FACIT-Sp | Meaning/peace and faith are correlated positively with optimism and social support | Hispanic culture (Spain) |
| Hoseini L. et al. [ | 2016 | Breast cancer patients | 176 | Spiritual well-being scale (SWBS) | Spiritual well-being and social support had direct effects on quality of life and illness perception | Iranian culture |
| Ahmadi N. et al. [ | 2017 | Cancer patients | 2355 | Survey study on the role of religion in coping | The people in the oldest age-group, women and people raised in places with 20,000 or fewer residents showed a higher average use of religious coping mechanisms thank younger people, men and those raised in larger towns | Swedish culture |
| Kugbey N. et al. [ | 2020 | Breast cancer patients from Ghana | 11 | Spirituality coping | Reliance on spirituality, religious faith and social support are the main coping strategies | Ghana culture |
| Prince P. et al. [ | 2015 | Hispanic allogeneic hematopoietic stem cell transplant patients | 171 | Spirituality well-being (FACIT-SpWB) | Hispanic patients enjoyed greater spiritual well-being compared to non-Hispanic counterparts | Hispanic culture |
| Phenwan T. et al. [ | 2019 | Breast cancer patients | 16 | Spiritual well-being (SWB) | Religion, especially Buddhism, is part of a larger holism of their spiritual well-being | Buddhist culture |
| Mohebbifar R. et al. [ | 2015 | Patients with cancer | 210 | Spiritual health and quality of life assessment | Positive and significant relationship between spiritual health and quality of life in patients with cancer | Iranian culture |
| Moyses R. et al. [ | 2023 | Amazonian women with cervical cancer under treatment | 119 | The role of spirituality in the relationship between psychological morbidity and quality of life | Spirituality moderated the relationship between illness perception and quality of life and between psychological morbidity and quality of life | Latin American culture |
| Mallaiah S. et al. [ | 2022 | Cancer patients | 95 | Yoga as a mind-body practice for improving physical and mental health | A single yoga therapy intervention contributed to a significant improvement in global, physical, and psychosocial distress | American culture (USA) |
| Park S. et al. [ | 2017 | Breast cancer patients | 12 | Mindfulness based cognitive therapy (MBCT) | MBCT had a favorable effect on the psychological status and quality of life | Japanese culture |
| Tan S. et al. [ | 2022 | Cancer patients | 73 | Mindfulness based supportive therapy (MBST) | Statistically significant reduction in suffering score in the MBST group | Malaysian culture |
| Oliveira S. et al. [ | 2021 | Cancer patients | 49 | Spiritual well-being scale (SWBS) | Patients with a higher level of spirituality has less intense neuropathic pain (p < 0.05) | Brazilian culture |
| Zetzl T. et al. [ | 2020 | Patients with different types of cancer | 173 | 8-week yoga therapy | Yoga therapy resulted in a stronger reduction of general fatigue (p = 0.03), depression (p < 0.001), and stronger increase in quality of life (p = 0.002) | German culture |
| Chang TG. et al. [ | 2022 | Breast cancer patients | 121 | Demoralization in relation to spiritual interest and quality of life | High demoralization was associated with low spiritual fulfillment and reduced quality of life | Taiwan culture |
| Tsai TJ. et al. [ | 2016 | Cancer patients | 200 | Effect of religion on health | Religious participation stimulated positive emotions in cancer patients and contributed to the spiritual and mental comfort | Taiwan culture |
| Tan TT. et al. [ | 2021 | Cancer patients | 92 | Mindful gratitude journaling on the quality of life | 1 week of mindful journaling reduces the overall suffering score (p = 0.0001) | Malaysian culture |
| Velasco-Durantez V. et al. [ | 2024 | Cancer patients | 1807 | Assessment of psychological distress, coping and spirituality of cancer patients | Coping and spirituality reduce psychological distress in cancer patients | Hispanic culture (Spain) |
| Liu W. et al. [ | 2022 | Breast cancer patients | 136 | Mindfulness yoga and health-related quality of lfie | Mindfulness yoga is effective in improving mental health and quality of life | Chinese culture |
| Zhi WI. et al. [ | 2021 | Cancer patients | 41 | Yoga on health-related quality of life | Yoga therapy was associated with reduced anxiety and reduced chemotherapy-induced peripheral neuropathic pain | American culture (USA) |
| Shi X. et al. [ | 2023 | Cancer patients | 200 | Spiritual needs of cancer patients | Spiritual needs were significantly correlated with cancer-related fatigue, depression, and social support (p < 0.007) | Chinese culture |
| Sun XH. et al. [ | 2021 | Cancer patients | 100 | Spiritual care and quality of life | Provision of spiritual care to patients with advanced cancer significantly improves their overall spiritual health (p = 0.002) | Chinese culture |
| Guo YQ. et al. [ | 2022 | Breast cancer patients | 20 | Coping mechanisms assessment | Hope and developing spiritual growth can improve women’s quality of life | Chinese culture |
| Zamaniyan S. et al. [ | 2016 | Breast cancer patients | 24 | Spiritual group therapy and spiritual well-being | Spiritual group therapy (religious and existential health) improved the quality of life and spiritual well-being | Iranian culture |
Assessment tools identified in the studies.
| FACIT-Sp | Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being |
|---|---|
| HADS | Hospital Anxiety and Depression Scale |
| DSES | Daily Spiritual Experience Scale |
| FACT-G | Functional Assessment of Cancer Therapy—General |
| DASS | Depression Anxiety Stress Scales |
| EORTC QLQ-SWB32 | European Organization for Research and Treatment of Cancer—Spiritual Well-Being Questionnaire |
| PIL | Purpose In Life |
| SWBS | Spiritual Well-Being Scale |
| FICA | F: Faith or Beliefs, I: Importance or influence, C: Community, A: Address |
| SRBP | Spirituality, religiousness, and personal beliefs |
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; Dorel Ionel Popovici 4
; Razvan Gheorghe Diaconescu 5 ; Serban Mircea Negru 4 1 Department of Oncology, Victor Babes University of Medicine and Pharmacy, Bd. Victor Babes No. 16, 300226 Timisoara, Romania;
2 Department X of General Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania;
4 Department of Oncology, Victor Babes University of Medicine and Pharmacy, Bd. Victor Babes No. 16, 300226 Timisoara, Romania;
5 Department of Oncology, OncoHelp Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania;