Spirituality and Medicine, with a Focus on Oncology: A Narrative Review of the Literature
Abstract
Context. Spirituality is now a recognized domain of quality cancer care, yet its integration into oncology practice remains limited and its mechanisms poorly specified. Objectives. To synthesise evidence on spirituality in oncology across prevalence, measurement, outcome associations, mechanisms, interventions, provision and its barriers, end-of-life care intensity, education and policy. Methods. Narrative review reported per SANRA principles. PubMed/MEDLINE and Consensus were searched from inception to August 2026, in English, across eleven thematic facets, prioritising randomised trials, systematic reviews, large cohorts and consensus documents. All references were verified against PubMed records. Results. Spiritual concerns affect most patients with advanced cancer and often go unaddressed. Meta-analytic associations between religion/spirituality and physical, mental and social health are modest, carried almost entirely by the affective dimension (z = 0.31-0.38) rather than religious behaviour (z = 0.03-0.08). Spiritual well-being is inversely associated with end-of-life despair and desire for hastened death. Meaning- and dignity-focused psychotherapies reduce distress but not consistently spiritual well-being. Team-delivered spiritual care is associated with greater hospice use and less aggressive care near death; religious community support with the opposite. Inadequate training, not lack of time, is the principal modifiable barrier. Mechanisms range from well-evidenced behavioural and social pathways to unproven neuroendocrine-immune ones; counter-pathways including fatalism and religious struggle are documented. Conclusion. Spiritual care warrants systematic integration into oncology, but no evidence establishes that religion or spirituality alters tumour biology, treatment response or survival. Priorities are longitudinal designs, measurement reform, adequately powered trials with prespecified spiritual endpoints, and replication beyond North America.