A meta-analysis of death anxiety in people living with or beyond cancer: the important role of culture

Abstract

Purpose: This review explored associations between death anxiety and a range of psychosocial outcomes, such as fear of cancer recurrence (FCR), depression, anxiety, and quality of life, in people living with or beyond cancer. We also investigated culture (individualistic versus collectivist) as a moderator of the relationship between death anxiety and psychosocial outcomes.

Methods: We included studies that measured death anxiety and one or more psychosocial outcomes in people with a history of cancer. Forty-one studies were included and meta-analysed to identify the strength of relationships between death anxiety and psychosocial outcomes. Cultural orientation was investigated as a moderator of these relationships. The quality of included studies was appraised.

Results: Death anxiety was strongly associated with all psychosocial outcomes, including increased FCR, depression, anxiety, and poorer quality of life, self-esteem, and sense of meaning. Younger people and those currently in active treatment had higher levels of death anxiety. The relationship between death anxiety and depression was stronger in collectivist than individualistic cultures. Collectivist versus individualistic cultures differed in their death anxiety depending on the outcome measure used.

Conclusions: Death anxiety is an important construct for people living with or beyond cancer, and this review confirms that different cultures may be concerned about different aspects of death, which warrants further empirical research.

Implications for cancer survivors: These findings highlight the importance of providing targeted and culturally sensitive psychological interventions for death anxiety in those living beyond cancer.

Keywords: Cancer; Culture; Fear of cancer recurrence; Oncology; Psycho-oncology; Psychosocial; Thanatophobia.