Is spiritual well-being related to survival time of inpatients with advanced cancer? An East Asian cohort study

Abstract Purpose: It has been suggested that psychosocial factors are related to survival time in patients with cancer. However, there is no cross-cultural study examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries. Methods: This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea and Taiwan. SWB was measured at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors. Results: A total of 2638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5 to 19.5) in Japan, 23.0 days (95% CI 19.9 to 26.1) in Korea and 15.0 days (95% CI 13.0 to 17.0) in Taiwan. Four variables were significant in Japan, Korea and Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01 to 1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00 to 1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77 to 1.35; p = 0.89). Conclusion: SWB of patients with advanced cancer was related to survival time in Taiwan but not in Japan or Korea. The findings suggest that spiritual care may contribute to prolonged survival in patients with far advanced cancer.