Existential distress in advanced cancer: A cohort study

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.

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.

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 %).

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.