Spirituality and religiosity in cancer care: A targeted review of the NCCN distress thermometer and implications for holistic screening.

purposeSpiritual and religious concerns are an integral yet often overlooked component of distress in cancer care. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) includes a "spiritual/religious concerns" item on its Problem List, but little is known about how this item is used or how it informs clinical care.

methodsThis targeted review examined how spiritual distress is identified and addressed using the DT in oncology settings. A PubMed search yielded 44 articles; six met inclusion criteria. Most studies were cross-sectional, conducted outside the United States, and varied widely in design, populations, and measurement tools.

resultsFindings suggest that spiritual/religious concerns are endorsed by a meaningful subset of patients-especially during active treatment or at critical points such as diagnosis or recurrence-and often coincide with high distress scores. However, prevalence rates varied significantly (5%-60%), and few studies evaluated whether positive screens led to referrals or meaningful spiritual support. Only two studies used validated measures of spiritual well-being alongside the DT, and some findings-such as unexpectedly strong correlations between spiritual well-being and anxiety/depression-warrant further investigation.

conclusionDespite its inclusion in a widely used screening tool, the spiritual/religious concerns item remains underutilized and poorly understood. This review identifies major gaps in understanding when and how spiritual concerns arise, what influences their reporting, and how needs are addressed in practice. In the United States, where the DT is routinely collected, these gaps present a clear opportunity for targeted research and implementation efforts to improve holistic, values-aligned cancer care through better spiritual support integration.