Mapping an Overlooked Spiral of Trauma-Exposure to Sexual Abuse and Psycho-Spiritual Outcomes in Patients With Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND

Cancer and sexual abuse survivorship both involve trauma, yet little evidence synthesis has examined psycho-spiritual outcomes at the intersection of both. This may limit nurses' recognition of compounded distress in patients with cancer and sexual trauma, who often remain silent.

OBJECTIVE

To appraise psycho-spiritual outcomes associated with sexual abuse exposure in patients with cancer.

INTERVENTIONS/

METHODS

A systematic search was conducted on 10 databases until April 21, 2026. Unadjusted and adjusted effect estimates were pooled separately.

RESULTS

Of the identified sources, 11 studies involving 79,318 patients were included. Sexual abuse was associated with depression (unadjusted standardized mean difference [SMD] = 0.51, 95% confidence interval [CI] = 0.31-0.71; adjusted SMD = 0.32, 95% CI = 0.24-0.41), anxiety (unadjusted SMD = 0.42, 95% CI = 0.17-0.67), and spiritual concerns (unadjusted SMD = 0.32, 95% CI = 0.11-0.53; adjusted SMD = 0.27, 95% CI = 0.16-0.38). Findings on posttraumatic stress symptoms were inconclusive (unadjusted SMD = 0.34, 95% CI = 0.17-0.50; adjusted SMD = 0.02, 95% CI = -0.19 to 0.23). Childhood exposure demonstrated a stronger association with depression in adulthood (unadjusted SMD = 0.68, 95% CI = 0.65-0.70) than lifetime exposure (unadjusted SMD = 0.35, 95% CI = 0.07-0.63).

CONCLUSIONS

This meta-analysis clarifies the extent to which past exposure to sexual abuse may aggravate psycho-spiritual symptoms in patients with cancer.

IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE: Oncology nurses must practice trauma-informed care to prevent re-traumatization. Awareness of sexual abuse survivorship should be incorporated into continuing professional development in oncology nursing.