The Role of a Spiritual Approach in Patients With Cancer: A Systematic Review.

Health encompasses physical, psychosocial, cultural, economic, and spiritual well-being. Spirituality is a dynamic, personal dimension that, when nurtured, can enable the individual to feel balanced (with themselves, others, and the environment). The increase in chronic diseases and, in parallel, the growing need for palliative care (PC) are undeniable. Given the scarcity of such care, it is important that primary healthcare (PHC) addresses this type of need, with a particular focus on spirituality. The aim of this study is to assess the role of a spiritual approach in terms of symptom control, disease adaptation, or quality of life in patients with cancer. A systematic search was conducted in PubMed (MEDLINE), Cochrane Library, EMBASE, and PsycINFO. MeSH terms (or keywords when not applicable) were used: "Neoplasms" AND "Spiritual Therapies" AND ("Stress, Psychological" OR "Pain" OR "Quality of Life"). A total of 722 articles were obtained, and after a phased analysis, involving the review of titles, abstracts, and full-text documents, seven studies were selected. Risk of bias was assessed using the "Cochrane RoB 2.0" tool. The Strength of Recommendation Taxonomy (SORT) tool was applied to evaluate the quality of evidence. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. All analyzed articles were randomized controlled trials, reporting favorable outcomes for interventions (such as mindfulness programs, religious practice, the combination of both, and transcendental meditation). Overall, across the studies and despite the use of different scales, statistically significant differences were found in several outcome dimensions (including quality of life, symptoms - anxiety, depression, pain, nausea and vomiting - spiritual well-being, and suffering), all in favour of the various spiritual approaches. In line with other synthesis studies, the results of this review support the benefits provided by a spiritual approach (in its various dimensions). The risk of bias in the analyzed studies was qualitatively classified as "low risk" in most domains and "some concerns" in only one domain, which affected the overall assessment. Noted limitations include the heterogeneity of the interventions compared, as well as the multiple scales used. According to the SORT tool, the studies in this review were determined to be Level 1 evidence and the conclusions were given a Strength of Recommendation A; therefore, they should be considered in clinical practice. In summary, a beneficial effect of a spiritual approach in the complementary management of patients with cancer can be recognized. The findings support the need to expand the PC network and the relevance of its interdisciplinary nature. It also reflects on the importance of including spirituality in the practice of PHC, which is often the provider of longitudinal care until the end of life.