Mapping an Overlooked Spiral of Trauma—Exposure to Sexual Abuse and Psycho-Spiritual Outcomes in Patients With Cancer

Abstract

BACKGROUND: Cancer and sexual abuse survivorship both involve trauma, yet little evidence synthesis has examined psycho-spiritual outcomes at the intersection of both. This may limit nurses' recognition of compounded distress in patients with cancer and sexual trauma, who often remain silent. OBJECTIVE: To appraise psycho-spiritual outcomes associated with sexual abuse exposure in patients with cancer. INTERVENTIONS/METHODS: A systematic search was conducted on 10 databases until April 21, 2026. Unadjusted and adjusted effect estimates were pooled separately. RESULTS: Of the identified sources, 11 studies involving 79,318 patients were included. Sexual abuse was associated with depression (unadjusted standardized mean difference [SMD] = 0.51, 95% confidence interval [CI] = 0.31-0.71; adjusted SMD = 0.32, 95% CI = 0.24-0.41), anxiety (unadjusted SMD = 0.42, 95% CI = 0.17-0.67), and spiritual concerns (unadjusted SMD = 0.32, 95% CI = 0.11-0.53; adjusted SMD = 0.27, 95% CI = 0.16-0.38). Findings on posttraumatic stress symptoms were inconclusive (unadjusted SMD = 0.34, 95% CI = 0.17-0.50; adjusted SMD = 0.02, 95% CI = -0.19 to 0.23). Childhood exposure demonstrated a stronger association with depression in adulthood (unadjusted SMD = 0.68, 95% CI = 0.65-0.70) than lifetime exposure (unadjusted SMD = 0.35, 95% CI = 0.07-0.63). CONCLUSIONS: This meta-analysis clarifies the extent to which past exposure to sexual abuse may aggravate psycho-spiritual symptoms in patients with cancer. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE: Oncology nurses must practice trauma-informed care to prevent re-traumatization. Awareness of sexual abuse survivorship should be incorporated into continuing professional development in oncology nursing.