"Having a Why to live can bear almost any How" - Meaning-focused Interventions on Cancer-related Clinical Symptoms: Systematic Review and Meta-Analysis.

Context: According to Dr Viktor Frankl's existential framework, distress in patients' spiritual dimensions could manifest as symptoms in both physical/biological and the psychological dimensions. Meaning-focused interventions (MFI) refer to the subset of spiritual care/existential interventions designed to prominently address cancer patients' loss of meaning in life.

Objectives: To evaluate the effects of MFI on cancer-related physical and psychological symptoms.

Methods: Search was conducted across 10 databases from inception to October 8, 2024. Primary outcomes included a list of symptoms previously reported as prevalent among cancer patients. Secondary outcome was symptom distress.

Results: 23 RCTs and 3 quasi-experimental studies, involving 2,889 patients, were included. Significant effect were found on Fatigue (SMD, -2.48; 95% CI, -3.95 to -1.00; k = 6), Pain Intensity (SMD, -0.42; 95% CI, -0.74 to -0.09; k = 2), Insomnia (SMD, -0.74; 95% CI, -1.44 to -0.04; k = 4), Depressive Symptoms (SMD, -0.39; 95% CI, -0.61 to -0.18; k = 17), Anxiety (SMD, -0.51; 95% CI, -0.78 to -0.25; k = 15), Cognitive Function (MD, 1.65; 95% CI, 1.00 to 2.31; k = 2), Retrospective Memory (MD, -2.90; 95% CI, -5.35 to -0.46; k = 2) and Prospective Memory (MD, -2.22; 95% CI, -3.71 to -0.74; k = 2). Non-significant effects were found on Appetite Loss, Symptom Distress.

Conclusion: Our meta-analysis could inform future integration of spiritual care into routine medical care for cancer patients. Meanwhile, findings on cognitive function and memory were based on poor-quality studies and hence should be interpreted with caution. Healthcare providers might consider (i) infusing a meaning-in-life component into physical exercise intervention for cancer patients to reduce dropout, (ii) exploring Low-intensity MFI as a cost-saving option for providing spiritual care.