Death Anxiety Among Patients With Advanced Cancer: A Systematic Review and Meta‐Analysis

ABSTRACT

Aims

To identify and synthesise the levels of death anxiety and potential moderating factors in patients with advanced cancer.

Design

A systematic review and meta-analysis of observational studies.

Data Sources

A comprehensive search was conducted across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Infrastructure, and WANFANG, covering publications in both English and Chinese from inception through June 18, 2025.

Review Methods

Two independent reviewers performed study selection, data extraction, and quality assessment. Meta-analyses were conducted using STATA 16 software. Predefined subgroup analyses and meta-regression were carried out to examine variations in death anxiety among advanced cancer patients based on participant characteristics, disease-related factors, and study-level variables.

Results

Twenty-one studies involving 4337 patients with advanced cancer met the inclusion criteria. These studies, published between 1978 and 2025, were conducted across five countries. Meta-analyses were performed separately for 16 studies using the original 15-item dichotomous Templer Death Anxiety Scale and 3 studies using an adapted five-point Likert version. Both analyses indicated high levels of death anxiety among patients. Differences in participant age, country, continent, and publication year contributed to the variation in findings.

Conclusion

Advanced cancer patients experience high levels of death anxiety, with age, country, continent, and publication year identified as key moderating factors. Targeting these factors through tailored interventions, promoting a supportive culture around death, and providing effective psychological training for patients can help reduce anxiety. These efforts aim to equip patients to understand and cope with the realities of death, ultimately improving their psychological well-being.

Impact

This review highlights the high levels of death anxiety in advanced cancer patients and identifies potential moderators. It underscores the need for targeted interventions to improve psychological care, particularly in end-of-life settings.

Patient or Public Contribution

No patient or public contribution.

Prospero Registration

The review was registered on PROSPERO (registration number: CRD420251033114).