Objective/Purpose: In those with cancer, increased Death Anxiety (DA) has been linked to increased symptoms of mental illness (Gonen, 2012) and to impact treatment decisions (Rodenbach, 2021). To strengthen theoretical and treatment models of DA in this group, an updated meta-analysis of DA correlates and treatments was conducted, including a literature appraisal.
Sample and Setting: Study inclusion criteria included: Quantitative studies in English, adults with a current diagnosis of cancer, a measure of DA (e.g., Templer’s Death Anxiety Scale), a correlate of this measure (anxiety, depression, religiosity and quality of life [QOL]) or any psychological treatment targeting DA.
Procedures: Searches were conducted in four databases in February 2022; PsycInfo, Medline, Embase and CINAHL. Grey literature from ProQuest Dissertations & Theses Global and Trove in August 2022. No date restrictions were applied.
Results: A total of 4,564 articles and n = 116 full texts were screened, resulting in n = 74 included studies. Meta-correlation analyses demonstrated significant positive associations between DA and depression (r = 0.47) and anxiety (r = 0.56), and significant negative associations with QOL (r = -0.50) and spiritual wellbeing (r = -0.29). The association with religiosity was not significant. Meta-analyses of DA treatments were unable to be conducted due to intervention and scale heterogeneity. The quality appraisal established limitations with study quality (e.g., adverse event reporting) and internal validity (e.g., confounding adjustments, adequate blinding and randomisation).
Conclusion and clinical implications: DA is significantly associated with symptoms of anxiety and depression, spiritual wellbeing and QOL in oncology populations. Longitudinal research with larger sample sizes and valid measures of religiosity are needed to establish causation between these variables. Future intervention research should utilise more homogenous intervention types and measures, with adequate blinding, randomization and confounder adjustment. Including anxiety, depression, spiritual wellbeing and QOL in models and treatments of DA is recommended.