Philipp, Rebecca, Walbaum, Charlotte, Koch, Uwe, Oechsle, Karin, Daniels, Thies, Helmich, Friederike, Horn, Marlitt, Junghans, Johanna, Kissane, David, Lock, Guntram, Lo, Christopher, Mruk-Kahl, Anne, Muller, Volkmar, Reck, Martin, Schilling, Georgia, Schuhlze, Kornelius, von Felden, Johann, Bokemeyer, Carsten, Harter, Martin, and Vehling, Sigrun (2025) Existential distress in advanced cancer: A cohort study. General Hospital Psychiatry. (In Press)

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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.

Item ID:	84906
Item Type:	Article (Research - C1)
ISSN:	0163-8343
Related URLs:	Publisher
Copyright Information:	© 2025 Published by Elsevier Inc. CC license Attribution-NonCommercial-NoDerivatives 4.0 International
Date Deposited:	18 Mar 2025 02:23
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320221 Psychiatry (incl. psychotherapy) @ 34% 42 HEALTH SCIENCES > 4203 Health services and systems > 420316 Palliative care @ 33% 52 PSYCHOLOGY > 5203 Clinical and health psychology > 520399 Clinical and health psychology not elsewhere classified @ 33%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 34% 20 HEALTH > 2002 Evaluation of health and support services > 200202 Evaluation of health outcomes @ 33% 20 HEALTH > 2004 Public health (excl. specific population health) > 200409 Mental health @ 33%
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