Spiritual Well-Being, Religiosity, Psychological Distress and Quality of Life in Adults with Cancer: A Cross-Sectional Study in a Romanian Oncology and Palliative Care Centre

Abstract

Background: Spiritual wellbeing is increasingly recognised as a key area of complex oncology and palliative care, but evidence from Eastern Europe is still limited. Understanding how spiritual well-being and religiosity are related to psychological distress and quality of life can inform holistic support interventions in cancer patients. Objective: To describe spiritual well-being, religiosity, anxiety, depression, and quality of life in a Romanian cancer cohort, and to examine associations between spiritual well-being and psychological distress. Methods: A cross-sectional study was carried out in 124 cancer-stricken adults at a regional cancer centre in Romania. Participants completed FACIT-Sp-12 (spiritual well-being), RCI-10 (religious belief), HADS (depression), and EQT QLQ-C30 (QoL). Multivariable linear regression was used to determine independent predictors of outcomes in patients. Results: Participants had a median age of 65 years (53–71) and 70 (56%) patients had metastatic disease. Religious involvement was high and spirituality related to disease was commonly reinforced, with 66 (53%). There were twice as many cases of clinical depression symptoms (28%) as anxiety symptoms (14%). A median QoL score of 51 (IQR: 37–64 points) was revealed by descriptive analysis of the EORTC QLQ-C30. In adjusted multivariable models, spiritual well-being was significantly and independently associated with lower anxiety (β = −0.25, p = 0.030) and depression (β = −0.29, p = 0.013), with models accounting for 11.5% and 10.8% of variance, respectively. Global quality of life was best explained by the model (R2 = 26.4%), with independent contributions from impaired ECOG performance status (β = −0.27, p = 0.006) and depressive symptoms (β = −0.22, p = 0.014), whereas religious commitment showed no independent association with any primary outcome. Conclusions: In this Romanian cohort, spiritual well-being, not religious adherence, remained independently associated with lower anxiety and depression, suggesting that spiritual well-being is associated with better psychological health among cancer patients. Religious affiliation has not been shown to be independent of any outcome, a difference with direct implications for the screening of spiritual care. Global quality of life, on the other hand, was independently associated with both physical functional status (ECOG) and depressive symptom burden, rather than with spiritual or religious factors, underlining that both functional decline and psychological distress remain central to cancer-related quality of life.