Existential or spiritual suffering is one of the most debilitating conditions found in cancer patients and yet is a neglected area of care because of the lack of conceptual understanding and definition, few documented interventions, and the absence of appropriate training for healthcare providers. Failure to recognize suffering may result in treatment of the patient with cancer in such a way as to increase suffering. A literature search focusing on the conceptualization, assessment and management of suffering across all cancers was undertaken.
The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases. To ensure a sufficiently broad range of conceptualizations of suffering in cancer were identified, the search strategy was drafted using an iterative process, using results of preliminary searches to develop a list of concepts identified as synonymous with suffering, or potentially measurable ‘symptoms’ of suffering in the literature. Following the development of a definition of suffering, validated instruments for measurement of this phenomena were identified and specific interventions proven to effective alleviate suffering were sought.
Although there is no universally recognized definition of suffering, it is generally accepted to be experienced by the whole person. There is disagreement as to the benefit of identifying the different domains where suffering is focused: social, physical, psychological or spiritual/existential. While this process may assist in identifying triggers and symptoms of suffering, it may impede an holistic approach to care. Suffering results from personalization of illness and the meaning attributed to symptoms by the individual patient must be understood before symptoms can be fully addressed.
Suffering in cancer patients is a significant problem which needs to be diagnosed before treatment can proceed. The literature was reviewed in order to improve patient care by educating healthcare providers regarding how to understand the concept of suffering, how to identify it in patients, and what interventions may be of benefit.