Existential distress in advanced cancer: A cohort study

Abstract

Objective: Clinically significant existential distress may impair quality of life and communication about illness. We investigated the presence of existential distress in the form of demoralization, death anxiety, and dignity-related distress, and its co-occurrence with mental disorders in patients with advanced cancer.

Methods: We conducted structured clinical interviews and administered self-report questionnaires to assess existential distress and mental disorders. We recruited patients with different Union for International Cancer Control (UICC) stage IV solid tumors from in- and outpatient oncology and palliative care settings.

Results: A total of 671 patients completed assessments (55 % participation rate, 48 % female, primary tumor site: 28 % lung, 14 % prostate, 11 % breast). Clinically relevant levels of existential distress were present in 46.4 % (95 % CI, 41.7 % to 51.1 %), including demoralization, 12.5 % (95 % CI, 9.6 % to 15.9 %), death anxiety, 27.3 % (95 % CI, 23.2 % to 31.6 %), and dignity-related distress, 38.7 % (95 % CI, 34.2 % to 43.3 %). Frequent existential distress symptoms were sense of entrapment and fear of own and close others' suffering. Mental disorders occurred in 26.2 % (95 % CI, 22.2 % to 30.4 %), including major depression, 8.6 % (95 % CI, 6.2 % to 11.5 %), anxiety disorders, 8.4 % (95 % CI, 6.0 % to 11.3 %), and ICD-11-adjustment disorder, 10.5 % (95 % CI, 7.9 % to 13.7 %). Existential distress and mental disorders co-occurred in 20.0 % (95 % CI, 16.4 % to 24.0 %).

Conclusion: Existential distress is a common, clinically significant problem in patients with advanced cancer. Its recognition in multiprofessional clinical settings can contribute to improve quality of life. Most patients with a mental disorder show comorbid existential distress requiring treatment of both.

Keywords: Advanced cancer; Death anxiety; Demoralization; Dignity-related distress; Existential distress; Mental disorder; Psycho-oncology.