The Unseen Burden: Women With Gynecologic Cancer Carry Deep Spiritual Needs

When a woman receives a diagnosis of gynecologic cancer, the clinical conversation typically revolves around tumors, staging, surgical options, and chemotherapy regimens. Yet beneath the scans and lab values lies a dimension of suffering that rarely appears on a medical chart: the spiritual dimension. A new cross-sectional study published in Supportive Care in Cancer offers one of the most detailed quantitative portraits to date of what women with gynecologic cancer actually need spiritually, and how well those needs are being met. The findings suggest that while many patients achieve a surprisingly high level of spiritual well-being, substantial unmet needs persist, and clinicians may be missing critical opportunities to address them.

The research team, led by Buse Güler of Dokuz Eylul University Faculty of Nursing in İzmir, Turkey, together with Cahide Ayik and Selin Özgen, surveyed 213 women being treated for gynecologic cancers, a category that includes ovarian, cervical, uterine, vulvar, and vaginal malignancies. These cancers collectively represent a significant global health burden; recent burden-of-disease analyses project that the number of new gynecologic cancer cases will continue climbing through mid-century as populations age and grow. Each diagnosis confronts a woman not only with a life-threatening disease but with questions about fertility, body image, sexuality, mortality, and meaning, questions that are spiritual in the broadest sense even for patients who reject religious frameworks entirely.

Methodologically, the study employed two validated instruments that are worth understanding in some detail. The first, the Spiritual Needs Scale (SNS), asks patients to rate how often they experience various spiritual needs, with response options ranging from “never” to “very often.” The scale captures six distinct dimensions of spirituality, spanning from explicitly religious concerns to existential and interpersonal ones. The second instrument, the 12-item Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp), produces a total score between 0 and 48, with higher numbers indicating greater spiritual well-being. This measure, originally developed by Peterman and colleagues in 2002, has become a standard tool in psycho-oncology because it operationalizes a construct that might otherwise seem hopelessly vague: a sense of meaning, peace, and faith in the context of serious illness.

The statistical approach combined descriptive statistics with multiple linear regression, allowing the researchers to identify which sociodemographic and clinical variables independently predicted spiritual well-being scores. This design matters because simple correlations can be misleading; regression modeling adjusts for confounding factors, revealing which characteristics carry genuine predictive weight. The study received ethical approval from the Dokuz Eylul University Ethics Committee and was conducted in accordance with the Declaration of Helsinki, with data collected in 2024 and analyzed for publication in 2026.

The results paint a nuanced picture. Across the six dimensions of the Spiritual Needs Scale, patients most frequently reported needs tied to spiritual and existential well-being. These included engaging in religious or spiritual practices, having someone pray with or for them, giving and receiving love, addressing end-of-life issues, reviewing their lives, offering or receiving forgiveness, achieving a sense of peace and contentment, and maintaining a hopeful or positive outlook. Notice what this list reveals: the most pressing needs are not narrowly doctrinal. They concern love, forgiveness, life review, and hope, the raw materials of human meaning-making. A patient may never set foot in a house of worship yet still desperately need someone to help her take stock of her life and find peace with what she finds there.

On the FACIT-Sp, the cohort achieved a mean total score of 36.32 with a standard deviation of 4.23, out of a possible 48. In practical terms, this indicates a relatively high level of spiritual well-being among the participants, a finding that may surprise clinicians who assume that a cancer diagnosis uniformly crushes the spirit. The literature offers a plausible explanation: confronting mortality can catalyze what psychologists call post-traumatic growth, in which patients report deepened relationships, revised priorities, and a strengthened sense of meaning. Qualitative work with Turkish women with gynecological cancer has echoed this theme, with participants describing gratitude for each day they live and reframing their illness as a spiritual trial that brought them closer to the divine.

Yet the regression analyses uncovered a counterintuitive pair of predictors. Being unemployed and not receiving chemotherapy were both associated with higher spiritual well-being. The unemployment finding invites careful interpretation. Work can be a source of identity, purpose, and social connection, so its loss, whether caused by the disease or by treatment demands, may erode the existential scaffolding that supports spiritual well-being. Alternatively, employed patients may face the compounded strain of managing both a career and a cancer, leaving less psychological space for the kind of reflective processing that the FACIT-Sp rewards. The chemotherapy finding is equally thought-provoking. Patients actively receiving chemotherapy endure physical toxicity, frequent hospital visits, and the visceral reminder that they are in active battle with their disease, any of which could strain their sense of peace and meaning. Those not on chemotherapy may be in surveillance phases or earlier disease stages, circumstances that plausibly foster greater equanimity.

The study’s most consequential conclusion may be its simplest: spiritual needs should be treated as an integral component of holistic cancer care, not as an optional add-on. This position aligns with guidance from the World Health Organization, whose definition of palliative care explicitly includes spiritual and existential suffering, and with the National Cancer Institute’s physician data query materials on spirituality in cancer care, which recommend routine spiritual screening. International research has repeatedly shown that spiritual well-being correlates with quality of life and inversely with anxiety, depression, and death anxiety in gynecologic oncology populations. A meta-analysis of spiritual interventions in cancer care has further suggested that structured spiritual support can produce measurable benefits, giving clinicians an evidence-based reason to move beyond intuition.

For gynecologic oncology specifically, the stakes are heightened by the nature of the diseases. Cancers of the reproductive tract strike at organs bound up with femininity, fertility, and intimacy, and young patients in particular report profound distress around fertility loss and preservation decisions. Surgical treatment may involve ostomies or abdominal drains that alter body function and self-image, and research has documented elevated spiritual care needs among patients managing such devices. Nurses, who spend more continuous time at the bedside than any other professional group, are often the first to hear existential questions surface, yet studies of nursing experiences in Turkey and elsewhere suggest that many feel unprepared to respond, lacking training in spiritual assessment and uncertain about professional boundaries around religious topics.

The Turkish setting of this study adds a valuable cross-cultural data point. In a predominantly Muslim society, religious practices such as prayer occupy a central place in coping with illness, and prior research with Turkish oncology patients has documented strong relationships between religious attitudes and mental adjustment to cancer. But the study’s findings on love, forgiveness, life review, and hope transcend any particular faith tradition, reinforcing a growing consensus in the palliative care literature that spiritual care must be person-centered rather than doctrine-centered. Screening tools like the SNS and FACIT-Sp give clinical teams a way to open that conversation systematically, identifying which patients feel spiritually depleted and which dimensions of need, religious, existential, or relational, deserve attention. As gynecologic cancer incidence continues to rise worldwide, the study’s message is clear: healing the body while ignoring the spirit is only half a cure, and the half that gets ignored may be the one patients feel most keenly.

Subject of Research: Spiritual needs and spiritual well-being among patients with gynecologic cancer

Article Title: Spiritual needs, spiritual well-being and related factors among patients with gynecologic cancer: A cross-sectional study

Article References: Güler, B., Ayik, C., & Özgen, S. (2026). Spiritual needs, spiritual well-being and related factors among patients with gynecologic cancer: A cross-sectional study. Supportive Care in Cancer, 34(10), Article 957. https://doi.org/10.1007/s00520-026-11183-y

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11183-y

Keywords: gynecologic cancer, spiritual needs, spiritual well-being, FACIT-Sp, Spiritual Needs Scale, supportive care, palliative care, oncology nursing, cross-sectional study, psycho-oncology, quality of life, Turkey