CN2 - An updated evidence on the effects of spiritual interventions in cancer: A systematic review with meta-analysis

Background

To date, a few meta-analyses have comprehensively addressed the impact of spiritual interventions on cancer patients’ physical, psychological, and spiritual outcomes. However, these reports synthesized findings of studies up to 2015, and they have some methodological obstacles that may raise questions about integrating spiritual care modalities into clinical practice. Therefore, this study aimed to provide comprehensive and high-quality updated evidence on the effects of spiritual interventions on cancer patients.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, the literature search was performed through the Cochrane Library, PubMed, Web of Science, and Scopus, until April 20, 2023. Randomized controlled trials (n=17) were included in the meta-analysis. The Cochrane risk-of-bias tool for randomized trials version 2 was used to assess the risk of bias. Heterogeneity was evaluated using the Q-statistic and I ² statistic, and effect sizes were calculated using Hedges’s g. Publication bias was assessed using Kendall’s Tau and Egger’s tests.

Results

Spiritual interventions yielded beneficial effects on fatigue (Hedges’s g=0.900, p=0.028), pain (Hedges’s g=0.633, p<0.001), and symptom burden (Hedges’s g=0.330, p=0.005). A significant effect was found for anxiety (Hedges’s g=0.269, p<0.001), depression (Hedges’s g=0.148, p=0.031), and psychological distress (Hedges’s g=0.180, p=0.018), except for hopelessness (Hedges’s g=0.144, p=0.091). Spiritual interventions improved faith (Hedges’s g=0.254, p=0.032), the meaning of life (Hedges’s g=0.714, p=0.031), spiritual well-being (Hedges’s g= 0.704, p=0.004), and quality of life (Hedges’s g=1.276, p=0.001). Moderator analysis indicated that cancer stages, intervention content, providers, delivery format, and follow-up duration significantly affect the physical, emotional, and spiritual outcomes and quality of life.

Conclusions

This study highlighted the beneficial effects of spiritual interventions with varying effect sizes on physical, emotional, and spiritual outcomes, as well as quality of life in cancer, and shed on how to incorporate spiritual interventions into holistic care.

Clinical trial identification

The study protocol was registered on PROSPERO (ID: CRD42024516213).

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.