The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer

Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.

DESIGN

This systematic review and meta-analysis followed the PRISMA 2020 guidelines.

METHODS

Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.

RESULTS

In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.

CONCLUSIONS

Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.

RELEVANCE TO CLINICAL PRACTICE

Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a meta-analysis based on data from previous studies.

Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review

Demoralization has been extensively studied in oncology and palliative care settings, and is characterized by a loss of meaning and purpose in life, a sense of powerlessness over life events, and a sense of helplessness. The objective of this systematic review is to synthesize the prevalence, associated factors, and adverse outcomes of demoralization in cancer patients by reviewing the literature of the last decade. Seven databases (PubMed, PsycINFO, Embase, Web of Science, Medline, CINAHL and Cochrane Library databases) were systematically searched from January 2012 to June 2022. Roughly speaking, the prevalence of demoralization in cancer patients ranges from 13.50% to 49.4%. A total of 45 factors are associated with demoralization, of which psychological factors have been studied more frequently in the last decade. There are nine outcomes related to demoralization, with the strongest evidence for the correlation between demoralization and suicidal ideation. The study emphasizes the complexity of factors associated with demoralization in cancer patients. There appears to be a intersection between the constructs of demoralization and depression, anxiety, and suicidal ideation, which may explain the correlation between them.

Clinical utility of demoralization: A systematic review of the literature

Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China

OBJECTIVE

This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.

METHODS

Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.

RESULTS

Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R ² ​= ​0.335, F ​= ​20.072, P ​< ​0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F ​= ​5.892, P ​= ​0.003). Multivariate analysis revealed no significant association between family function and death anxiety.

CONCLUSIONS

Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Testing terror management theory in advanced cancer

Death anxiety is common in advanced cancer due to heightened mortality salience. We tested terror management theory (TMT) in this population (N = 305) by evaluating the buffering effect of the distal defenses (attachment security, meaning, self-esteem) on the impact of physical impairment (a proxy for mortality salience) on death anxiety. Patients with greater numbers of strong distal defenses reported lower death anxiety than those with no strong defenses or one strong defense. These findings support the relevance of TMT in individuals facing the actual threat of death and the need for further TMT research in such populations.