Factors associated with sense of coherence in patients with malignant tumors: a systematic review and meta-analysis

Sense of coherence (SOC) is a significant positive psychological resource that influences psychological outcomes and quality of life in patients with malignant tumors. This systematic review and meta-analysis aims to identify and synthesize factors associated with SOC in this population.

A systematic search was carried out across 10 databases, from their inception to 12 October 2025, to identify studies exploring factors related to SOC in patients with malignant tumors. The Agency for Healthcare Research and Quality (AHRQ) Methodological Checklist and the Newcastle-Ottawa Scale (NOS) were used to evaluate the methodological quality of the included studies. Effect sizes were expressed as Pearson correlation coefficients (r). Heterogeneity was assessed using the I ² statistic and the Q test. Subgroup analyses and leave-one-out sensitivity analyses were conducted to explore sources of heterogeneity and assess result robustness.

Thirty-six studies were finally included, involving 11,007 participants. The systematic review revealed many factors associated with SOC, including time since disease remission, absence of self-reported functional limitations and disability, use of complementary therapies, sexual function, number of combined chronic conditions, severity of somatic symptoms, cancer-related fatigue, coping strategies, self-esteem, the level of resourcefulness, self-advocacy, self-care ability, post-traumatic growth, aging adaptation, meaning in life, family function, partner's SOC, Type C personality, death anxiety, stigma, perceived stress, perceived hospital and surgery-related stress, psychological distress, unmet needs, self-perceived burden, social alienation, disease perception, and partner's depression level. The meta-analysis showed several factors significantly associated with SOC, including depression [r = -0.65, 95% CI (-0.75, -0.51)], anxiety [r = -0.48, 95% CI (-0.61, -0.32)], acceptance of disability [r = 0.43, 95% CI (0.30, 0.54)], wellbeing [r = 0.44, 95% CI (0.24, 0.61)], perceived social support [r = 0.50, 95% CI (0.35, 0.62)], and quality of life [r = 0.41, 95% CI (0.29, 0.52)].

In this systematic review and meta-analysis, 35 factors were identified as related to SOC in patients with malignant tumors. Clinical practice should be guided by positive psychology and consider various relevant factors to comprehensively explore the developmental mechanisms of SOC in patients with malignant tumors, thereby building more targeted interventions to improve SOC.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251020931, identifier: CRD420251020931.