Spirituality and Medicine, with a Focus on Oncology: A Narrative Review of the Literature
Espiritualidade e Medicina com Foco em Oncologia: Uma Revisão Narrativa
Auro del Giglio
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.
Keywords
Resumo
Contexto. A espiritualidade é hoje um domínio reconhecido do cuidado oncológico de qualidade, mas sua integração à prática oncológica permanece limitada e seus mecanismos, mal especificados. Objetivos. Sintetizar as evidências sobre espiritualidade em oncologia quanto a prevalência, mensuração, associações com desfechos, mecanismos, intervenções, provisão e suas barreiras, intensidade do cuidado no fim da vida, educação e políticas. Métodos. Revisão narrativa relatada segundo os princípios da SANRA. Foram realizadas buscas no PubMed/MEDLINE e no Consensus desde o início das bases até agosto de 2026, em inglês, em onze facetas temáticas, priorizando ensaios randomizados, revisões sistemáticas, grandes coortes e documentos de consenso. Todas as referências foram verificadas nos registros do PubMed. Resultados. Preocupações espirituais afetam a maioria dos pacientes com câncer avançado e frequentemente não são abordadas. As associações metanalíticas entre religião/espiritualidade e saúde física, mental e social são modestas, sustentadas quase inteiramente pela dimensão afetiva (z = 0,31–0,38), e não pelo comportamento religioso (z = 0,03–0,08). O bem-estar espiritual associa-se inversamente ao desespero no fim da vida e ao desejo de apressar a morte. Psicoterapias centradas no significado e na dignidade reduzem o sofrimento, mas não melhoram de forma consistente o bem-estar espiritual. O cuidado espiritual oferecido pela equipe de saúde associa-se a maior uso de hospice e a cuidados menos agressivos próximos à morte; o apoio de comunidades religiosas, ao oposto. O treinamento inadequado, e não a falta de tempo, é a principal barreira modificável. Os mecanismos vão de vias comportamentais e sociais bem evidenciadas a vias neuroendócrino-imunes não comprovadas; contravias, incluindo fatalismo e conflito religioso (religious struggle), estão documentadas. Conclusão. O cuidado espiritual justifica integração sistemática à oncologia, mas nenhuma evidência estabelece que religião ou espiritualidade altere a biologia tumoral, a resposta ao tratamento ou a sobrevida. As prioridades são desenhos longitudinais, reforma da mensuração, ensaios com poder estatístico adequado e desfechos espirituais pré-especificados, e replicação fora da América do Norte.
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Submetido em:
19/08/2026
Revisado em:
14/09/2026
Aceito em:
12/10/2026
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