Cancer is the second leading cause of death worldwide;
about 1 in 6 deaths is due to cancer. Diagnosis and
medical treatment for cancer usually cause great physical
and emotional distress and add stress to cancer patients’
lives. Spirituality and religious beliefs have been found,
especially important for patients who suffer from severe
illness and/or are facing life‑threatening health problems.
Spirituality is an aspect of one’s life regarding seeking
meaning, purpose, and connection to a higher power, and it
allows the individual to effectively function toward his/her
life goal. It is believed that spirituality is one essential
factor providing a context for cancer patients to derive hope
and meaning to cope with their illness from the diagnosis
through treatment, survival, recurrence, and dying, and it
could serve as a protector buffers the deteriorating impacts
of life stress and illness. Individuals who are living
with a life‑threatening illness such as cancer may be most
vulnerable to spiritual distress and are more aware and
sensitive to their spiritual selves and spiritual needs.
Addressing spiritual needs could help patients cope with
the challenges associated with illness. As spirituality
is a critical component of holistic and person‑centered
care, spiritual interventions should be considered and
incorporated into the plan of care for each cancer patient.
During the past decade, there has been a considerable
increase in the number of studies in spiritual and religious
coping in adjustment to severe illness such as cancer.
Spirituality is one essential indicator of quality of life,
and spiritual well‑being is found to be positively associated
with spirituality and health outcomes in patients diagnosed
with cancer. Cancer patients who had high levels of
spiritual well‑being reported better quality of life, a lower
level of depression, less anxiety about death, and a lower
level of distress. Cancer patients reported that spirituality
is a source of strength that helps them cope with their
cancer experiences, define wellness during treatment and
survivorship, find meaning in their lives, find a sense of
health, and make sense of their cancer experiences during
illness. Consistent associations between spirituality,
spiritual well‑being, and health outcomes found in published
studies highlight the importance of providing spiritual care
to enhance cancer patients’ spiritual well‑being and address
their spiritual needs.

Experiencing spiritual distress is not uncommon
among cancer patients. Unfulfilled spiritual needs
could be a contributor causing distress. Spiritual distress
and suffering may influence a person’s experiences and
symptoms associated with illness and contribute to poorer
health and psychosocial outcomes. Cancer patients’
spiritual needs should be assessed and addressed when
planning and providing care to them, and the assessment
for spiritual wellness and distress is vital in addressing
cancer patients’ needs, Health‑care providers have
responsibilities to provide holistic care to patients with
cancer and to acknowledge and encourage exploration
of their spiritual issues and needs. Nurses and other
health‑care professionals should be educated and trained to
be competent in assessing and addressing cancer patients’
spiritual needs.
The impacts of culture should be taken into account to
provide holistic and culturally competent spiritual care to
provide each cancer patient with appropriate spiritual care
and to address each cancer patient’s spiritual needs.
The connections between spirituality, culture, and religion
are dynamical and reciprocal. Culture could influence a
person’s spiritual belief, spiritual well‑being, and spiritual
practices since spirituality is experienced through daily lived
experience. Reciprocally, spiritual and religious beliefs may
contribute to an individual’s interpretation and management
of physical and psychological distress as well as play an
imperative role in shaping one’s cultural understandings of
life, death, and living a meaningful life. For example,
cancer patients’ perceptions and interpretations of pain
could be influenced by a combination of various social,
cultural, and spiritual factors. Patients from some cultures
may believe that pain is a part of God’s plan or is a sign of
progress toward recovery, while other patients from different
cultural groups may review pain as the result of an imbalance
between yin and yang. A spiritual intervention may be
as effective as a medical intervention in pain management
for cancer patients. Assessing cancer patients’ spiritual,
cultural, and social beliefs is important, and it could help
health‑care providers to more accurately assess cancer
patients’ perceptions of physical and psychological distress
and adequately provide interventions and medications to
cancer patients. While individuals with the same cultural
background or within the same religious group most likely
share a set of common beliefs, it should be acknowledged
that there is variance in beliefs and spiritual needs among
different individuals and situations. The mixture of
spirituality, religion, culture, and the beliefs of individuals,
families, communities, and other social structures powerfully
influence patients’ decision‑making, care delivery, and views
about death and illness. It is crucial that health‑care
providers acknowledge and adapt culturally appropriate and
patient‑centered care to fulfill the diverse spiritual needs of

As spiritual care for cancer patients needs to be
interdisciplinary and culturally appropriate, using valid and
reliable instruments and tools that are culturally appropriate
for assessing spiritual needs and evaluating outcomes of
spiritual care becomes extremely important. A culturally
appropriate and responsive spiritual assessment is the
initial step to address the spiritual needs of patients.
Uses of culturally appropriate tools could aid in integrating
culturally specific spiritual beliefs and practices into the plan
of spiritual care and allow health‑care providers to respond
better to cancer patients’ spiritual needs. Although many
assessment tools are available and applicable to perform
a religious and spiritual assessment, it is unclear whether
these tools originally developed for Western populations are
equally reliable and valid for the use in Asian populations.
Appropriate tools and instruments for assessing patients’
spiritual needs, spiritual distress, and spiritual well‑being
in Asian populations which are influenced by their unique
and diverse spiritual, religious, and cultural beliefs may be
absent or scarce. The lack of valid and reliable tools that are
culturally appropriate and sensitive could be a barrier that
limits nurses and health professionals’ capabilities to deliver
appropriate spiritual care to address Asian cancer patients’
spiritual needs and to evaluate the outcomes of spiritual
care. Further efforts to develop appropriate assessment tools
for the Asian populations require researchers’ attentions.
Although responding to diverse spiritual needs may be
challenging, this process can be rewarding for health‑care
providers, patients, and patients’ family members since it
provides chances for reciprocal spiritual and religious growth
during the exchange of new understandings and meanings.
Even if the integral role of providing spiritual care
as part of a holistic approach to cancer patients and the
necessity for spiritual assessment is generally recognized,
cancer patients reported their spiritual needs were not
recognized, addressed, or supported. Multiple complex
barriers have been reported in literature such as spiritual
and religious differences between patients and providers,
a lack of understanding of spirituality, a lack of education
and preparedness, and a lack of time and experience to
adequately address patients’ spiritual needs and deliver
spiritual care. The barriers to providing spiritual care
must be overcome so that appropriate and comprehensive
care can be delivered to address cancer patients’ needs.
Given the fact that the significance of providing spiritual
care to cancer patients has become increasingly more evident,
nurses and other health‑care professionals have responsibilities
to assess cancer patients’ spiritual needs as well as to plan and
deliver culturally appropriate spiritual care to them. More
studies investigating spiritual well‑being, spiritual needs, and
culturally appropriate spiritual care for cancer patients with
Asian cultural backgrounds are urgently needed to overcome
barriers preventing the delivery of proper and competent
spiritual care to all cancer patients. It is necessary to ensure
nurses become familiarized with the aspects of spirituality,
understand cultural influences on cancer patients’ spirituality
and spiritual well‑being, and overcome the barriers to
providing spiritual care to properly deliver appropriate and
comprehensive care to each cancer patient.
A growing number of studies have investigated the
linkages between spirituality and health outcomes in cancer
patients and emphasized the importance of spiritual care
and spiritual well‑being in cancer patients worldwide;
however, the majority of these studies were carried out in
Western countries. Research that explored and provided
evidence regarding spirituality and spiritual care among
cancer patients in Asian countries is scarce. The lack of
information causes a knowledge gap that limits health‑care
providers’ capabilities to deliver appropriate spiritual care
to oncology patients with Asian cultural backgrounds.
Studies to investigate barriers and facilitators to the delivery
of culturally appropriate and sensitive spiritual care among
cancer patients with diverse cultural and social backgrounds
in Asian countries require further attentions and efforts.
The aim of this special issue is to provide a platform
for health professionals, researchers, educators, politicians,
nongovernment agencies, and interested others to share
knowledge and experiences on developing and providing
spiritual care for cancer patients in Asian countries. It is our
intent to create a dialog to gain a deeper understanding about
developing and providing spiritual care in Asia and for the
future collaboration and support of each other to improve
spiritual care in this region. The papers in this issue contribute
to enhancing our knowledge and capabilities in assessing and
addressing spiritual needs as well as developing and delivering
culturally appropriate and patient‑centered spiritual care to
all cancer patients. It is a great privilege to write the editorial
for this special issue, and I appreciate all the authors who
contributed their excellent work to this special issue.

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