Cent Eur J Nurs Midw 2026, 17(2):2466-2476 | DOI: 10.15452/cejnm.2026.17.0010

Evaluating the effectiveness of selected existential therapies for death anxiety in advanced cancer: a systematic review and meta-analysis

Nurlelasari Harahap, Renidayati, Heppi Sasmita, Tasman, N. Rachmadanur, Welly
Department of Nursing, Poltekkes Kemenkes Padang, Padang, West Sumatra, Indonesia

Aim: To evaluate the effectiveness of selected existential therapies, including Dignity Therapy (DT), Meaning-Centered Psychotherapy (MCP), Logotherapy, and Reminiscence Therapy (RT), in reducing death anxiety among adults with advanced cancer.

Design: A systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A comprehensive search of PubMed, ProQuest, and EBSCO databases was conducted for RCTs published between 2018 and July 2025. Eligible studies included adult cancer patients receiving any of the four existential therapies. Data extraction and quality assessment were performed independently by two reviewers. Pooled effect sizes were calculated using a random-effects model, and subgroup analyses were conducted by therapeutic modality.

Results: Nine RCTs involving 821 participants met the inclusion criteria. The pooled overall effect of existential therapies on death anxiety was small and not statistically significant. Subgroup analysis, however, demonstrated that dignity therapy significantly reduced death anxiety compared with control conditions. Other existential therapies showed modest but inconsistent effects.

Conclusion: While existential therapies offer limited overall benefit for reducing death anxiety in advanced cancer, dignity therapy appears to be the most effective intervention. Further research employing comparative designs, more extended follow-up periods, and culturally adapted approaches is recommended to optimize psychosocial care for terminally ill patients.

Keywords: advanced cancer, death anxiety, dignity therapy, existential therapy, logotherapy, meaning-centered psychotherapy, palliative care, reminiscence therapy

Received: July 17, 2025; Revised: March 4, 2026; Accepted: March 5, 2026; Published: June 5, 2026  Show citation

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Harahap N, Renidayati, Sasmita H, Tasman, Rachmadanur N, Welly. Evaluating the effectiveness of selected existential therapies for death anxiety in advanced cancer: a systematic review and meta-analysis. Central European Journal of Nursing and Midwifery. 2026;17(2):2466-2476. doi: 10.15452/cejnm.2026.17.0010.
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    References

    1. Alavi, F., Tafti, S. H. A., Alaeddini, F., Ebrahimyan, Z., Ebrahimyan, A., & Mansourian, M. (2022). The effect of group logotherapy on spirituality and preoperative anxiety in patients seeking open heart surgery referring to Tehran Heart Center in 2020. Journal of Education and Health Promotion, 11(1), 233. https://doi.org/10.4103/jehp.jehp_917_21 Go to original source... Go to PubMed...
    2. Alizadeh, S., Taklavi, S., Alilou, M. M., & Feizipour, H. (2021). The effectiveness of existential therapy on death anxiety and meaning of life in recovered patients of Covid-19. Studies in Medical Sciences, 32(5).
    3. Amini, K., Tahrekhani, M., Abbas-Alamdari, Z., & Faghihzadeh, S. (2020). The effect of spiritual care on anxiety about death in patients with gastrointestinal cancer undergoing chemotherapy: a randomized controlled trial. European Journal of Integrative Medicine, 36, 101117. https://doi.org/10.1016/j.eujim.2020.101117 Go to original source...
    4. An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018). Demoralization and death anxiety in advanced cancer. Psycho-Oncology, 27(11), 2566-2572. https://doi.org/10.1002/pon.4843 Go to original source... Go to PubMed...
    5. Babaei, N., Zamanzadeh, V., Pourabbasi, M., Avazeh, M., & Shokoufamanesh, A. (2024). The effect of virtual reminiscence therapy on depression and anxiety in patients with gastric cancer undergoing chemotherapy. Supportive Care in Cancer, 32(1), 64. https://doi.org/10.1007/s00520-023-08268-3 Go to original source...
    6. Berlin, P., & von Blanckenburg, P. (2022). Death anxiety as general factor to fear of cancer recurrence. Psycho-Oncology, 31(9), 1527-1535. https://doi.org/10.1002/pon.5974 Go to original source...
    7. Breitbart, W., Rosenfeld, B., Pessin, H., Applebaum, A., Kulikowski, J., & Lichtenthal, W. G. (2015). Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33(7), 749-754. https://doi.org/10.1200/JCO.2014.57.2198 Go to original source... Go to PubMed...
    8. Chen, J., Yan, J., Wang, C., Wang, Y., Wu, Y., & Hu, R. (2021). Effects and satisfaction of dignity therapy among patients with hematologic neoplasms in the Chinese cultural context: a randomized controlled trial. Supportive Care in Cancer, 29(11), 6819-6829. https://doi.org/10.1007/s00520-021-06227-4 Go to original source... Go to PubMed...
    9. Chen, X., Yan, Q., Tang, Y., Zhu, J., Zhang, W., & Zhang, J. (2024). Financial toxicity, family resilience and negative emotions among young and middle-aged breast cancer patients: a multicentre cross-sectional study. The Breast, 75, 103735. https://doi.org/10.1016/j.breast.2024.103735 Go to original source... Go to PubMed...
    10. Dong, X., Sun, G., Zhan, J., Liu, F., Ma, S., Li, P., Zhang, C., Zhang, H., Xing, C., & Liu, Y. (2019). Telephone-based reminiscence therapy for colorectal cancer patients undergoing postoperative chemotherapy complicated with depression: a three-arm randomised controlled trial. Supportive Care in Cancer, 27(8), 2761-2769. https://doi.org/10.1007/s00520-018-4566-6 Go to original source...
    11. Faraji Emafti, M., Hedayatizadeh-Omran, A., Noroozi, A., Janbabai, G., Tatari, M., & Modanloo, M. (2019). The effect of group logotherapy on spirituality and death anxiety of patients with cancer: an open-label randomized clinical trial. Iranian Journal of Psychiatry and Behavioral Sciences, 13(3), e93572. https://doi.org/10.5812/ijpbs.93572 Go to original source...
    12. Fraguell-Hernando, C., Limonero, J. T., & Gil, F. (2020). Psychological intervention in patients with advanced cancer at home through individual meaning-centered psychotherapy-palliative care: a pilot study. Supportive Care in Cancer, 28(10), 4803-4811. https://doi.org/10.1007/s00520-020-05322-2 Go to original source...
    13. Frankl, V. E. (1992). Man's search for meaning: an introduction to logotherapy (4th ed.). Beacon Press.
    14. Grossman, C. H., Brooker, J., Michael, N., & Kissane, D. (2018). Death anxiety interventions in patients with advanced cancer: a systematic review. Palliative Medicine, 32(1), 172-184. https://doi.org/10.1177/0269216317722123 Go to original source... Go to PubMed...
    15. Guo, Q., Li, T., Cao, T., & Ma, C. (2022). Reminiscence therapy involved care programs as an option to improve psychological disorders and patient satisfaction in elderly lung cancer patients: a randomized, controlled study. Journal of Cancer Research and Therapeutics, 18(7), 1937-1944. https://doi.org/10.4103/jcrt.jcrt_425_22 Go to original source... Go to PubMed...
    16. Hong, Y., Yuhan, L., Youhui, G., Zhanying, W., Shili, Z., Xiaoting, H., & Wenhua, Y. (2022). Death anxiety among advanced cancer patients: a cross-sectional survey. Supportive Care in Cancer, 30(4), 3531-3539. https://doi.org/10.1007/s00520-022-06795-z Go to original source... Go to PubMed...
    17. Kleijn, G., Lissenberg-Witte, B. I., Bohlmeijer, E. T., Steunenberg, B., Knipscheer-Kuijpers, K., Willemsen, V., Becker, A., Smit, E. F., Eeltink, C. M., Bruynzeel, A. M. E., van der Vorst, M., de Bree, R., Leemans, C. R., van den Brekel, M. W. M., Cuijpers, P., & Verdonck-de Leeuw, I. M. (2018). The efficacy of Life Review Therapy combined with Memory Specificity Training (LRT-MST) targeting cancer patients in palliative care: a randomized controlled trial. PloS One, 13(5), e0197277. https://doi.org/10.1371/journal.pone.0197277 Go to original source...
    18. Lehto, R., & Negarandeh, R. (2024). Mental health adaptation to cancer: the role of death anxiety. Asia-Pacific Journal of Oncology Nursing, 11(8), 100513. https://doi.org/10.1016/j.apjon.2024.100513 Go to original source...
    19. Liang, Y., & Zhang, L. (2024). Influence of reminiscence therapy on mental health and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer. Brazilian Journal of Medical and Biological Research, 57, e13344.https://doi.org/10.1590/1414-431X2024e13344 Go to original source... Go to PubMed...
    20. Mahdavi, A., Jenaabadi, H., Mosavimoghadam, S. R., Langari, S. S. S., Lavasani, M. G., & Madani, Y. (2019). Relationship between mental, existential, and religious well-being and death anxiety in women with breast cancer. Archives of Breast Cancer, 6(1), 29-34. https://doi.org/10.32768/abc.20196129-34 Go to original source...
    21. Mamashli, L., Okhli, H., Fattahi, M., Hajibeglo, A., & Bekmaz, K. (2021). The effect of group logotherapy on the life expectancy of cancer patients in the north of Iran: a quasi-experimental study. Psychiatria, 18(1), 30-35. https://doi.org/10.5603/PSYCH.a2020.0049 Go to original source...
    22. Moher, D., McKenzie, J. E., Bossuyt, P. M., Boutron, I., & Mulrow, C. D. (2021). PRISMA 2020 flow diagram. PRISMA Statement.
    23. Philipp, R., Kalender, A., Härter, M., Bokemeyer, C., Oechsle, K., Koch, U., & Vehling, S. (2021). Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study. BMJ Open, 11(4), e046351. https://doi.org/10.1136/bmjopen-2020-046351 Go to original source... Go to PubMed...
    24. Philipp, R., Walbaum, C., Koch, U., Oechsle, K., Daniels, T., Helmich, F., Horn, M., Junghans, J., Kissane, D., Lock, G., Lo, C., Mruk-Kahl, A., Müller, V., Reck, M., Schilling, G., Schulze, K., von Felden, J., Bokemeyer, C., Härter, M., & Vehling, S. (2025). Existential distress in advanced cancer: a cohort study. General Hospital Psychiatry, 94, 184-191. https://doi.org/10.1016/j.genhosppsych.2025.02.023 Go to original source...
    25. Rosenfeld, B., Cham, H., Pessin, H., & Breitbart, W. (2018). Why is Meaning-Centered Group Psychotherapy (MCGP) effective? Enhanced sense of meaning as the mechanism of change for advanced cancer patients. Psycho-Oncology, 27(2), 654-660. https://doi.org/10.1002/pon.4578 Go to original source...
    26. Seiler, A., Amann, M., Hertler, C., Christ, S. M., Schettle, M., Kaeppeli, B. M., Jung-Amstutz, J., Nigg, C., Pestalozzi, B. C., Imesch, P., Dummer, R., Blum, D., & Jenewein, J. (2024). Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliative Care, 23(1), 73. https://doi.org/10.1186/s12904-024-01408-4 Go to original source... Go to PubMed...
    27. Seiler, A., & Jenewein, J. (2019). Resilience in cancer patients. Frontiers in Psychiatry, 10, 208. https://doi.org/10.3389/fpsyt.2019.00208 Go to original source...
    28. Walbaum, C., Philipp, R., Bokemeyer, C., Härter, M., Junghans, J., Koch, U., Oechsle, K., Schilling, G., & Vehling, S. (2024). Death anxiety in patients with advanced cancer and their family caregivers. Journal of Pain and Symptom Management, 68(6), 622-631. https://doi.org/10.1016/j.jpainsymman.2024.08.027 Go to original source... Go to PubMed...
    29. Xie, M., Wang, C., Li, Z., Xu, W., Wang, Y., Wu, Y., & Hu, R. (2024). Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: a randomized controlled trial. International Journal of Nursing Studies, 151, 104668. https://doi.org/10.1016/j.ijnurstu.2023.104668 Go to original source... Go to PubMed...
    30. Zhang, Y., Pang, Y., He, Y., You, M., & Tang, L. (2024). Feasibility of online managing cancer and living meaningfully (CALM) in Chinese patients with metastatic breast cancer: a pilot randomized control trial. Scientific Reports, 14(1), 4892. https://doi.org/10.1038/s41598-024-52574-7 Go to original source...

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