Questionnaire Survey and Analysis of Spiritual Health, Quality of Life, and Meaning in Life Among Chinese Patients with Breast Cancer Receiving Chemotherapy: A Cross-sectional Study

Abstract

Background: Patients with breast cancer who receive chemotherapy frequently experience physical and psychological problems that adversely affect their spiritual well-being, underscoring the importance of investigating spiritual health in this population. Objectives: This study aimed to assess spiritual health, quality of life, and meaning in life among patients with breast cancer undergoing chemotherapy in China. Methods: Participants were selected by simple random sampling from the National Cancer Center (NCC) between January and December 2023. The sampling frame comprised female patients with breast cancer who were hospitalized for chemotherapy at the NCC. Three Chinese-language instruments were used to assess spiritual health, quality of life, and meaning in life: the European Quality of Life in Cancer Treatment and Research-Spiritual Health Scale (EORTC QLQ-SWB27), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), and the Meaning of Life Scale for Cancer Patients (MiLS). Cronbach's α coefficients were 0.79 for the EORTC QLQ-SWB27, 0.77 - 0.88 for the EORTC QLQ-C30, and 0.73 for the MiLS. Confirmatory factor analysis fit indices (χ2/df < 3, root mean square error of approximation < 0.08, and comparative fit index > 0.90) indicated good construct validity. Results: A total of 242 participants qualified for the study. Following standardization, the mean scores were 62.21 ± 11.25 for spiritual health and 65.40 ± 10.32 for quality of life, both on a scale of 0 - 100, and 109.24 ± 14.71 for meaning in life. Significant positive correlations were observed among spiritual health, quality of life, and meaning in life, as measured using the EORTC QLQ-SWB27, EORTC QLQ-C30, and MiLS, respectively (all P < 0.01). Total spiritual health scores were significantly associated with occupational status (P = 0.035) and monthly household income per capita (P = 0.016). Total meaning-in-life scores were significantly correlated with occupational status (P = 0.04). Multiple linear regression analyses further identified monthly household income per capita, quality of life (EORTC QLQ-C30 standardized score), and meaning in life as significant predictors of spiritual health (all P < 0.05). Monthly household income per capita had the greatest weight. Conclusions: Patients with breast cancer in China had moderate spiritual health scores and high scores for quality of life and meaning in life. Monthly household income per capita was identified as the factor most strongly associated with spiritual health, suggesting that patients’ economic circumstances should be considered when planning care in Chinese clinical practice.