Indian Journal of Clinical Psychiatry RESEARCH ARTICLE

An Official Journal of Association of Clinical Psychiatry

doi: 10.54169/ijocp.v4i02.142
(Indian Psychiatric Society- Uttar Pradesh State Branch (IPS-UPSB))

Existential Concerns and Interventions in Patients

with Cancer: Insights from Yalom’s Framework
Maryam Farzan*, Hamid Ebrahimi, Maryam Pourali
Isfahan University of Medical Sciences, Isfahan Province, Isfahan, Iran.

Abstract
Cancer patients confront profound existential distress, influenced by the awareness
of mortality, loss of autonomy, isolation, and meaninglessness. This narrative review
explores the application of Irvin Yalom’s existential psychotherapy framework in
understanding these concerns. We conducted a comprehensive literature search
across major academic databases, using keywords such as “cancer,” “existential
concerns,” “Yalom,” “existential psychotherapy,” “logotherapy,” “meaning-centered
psychotherapy,” and “dignity therapy.” The review highlights the heightened death
anxiety among cancer patients linked to demographic and psychological factors
and the challenges to their sense of freedom and autonomy. It also examines the
deep isolation experienced by patients and the existential crisis of meaninglessness.
Empirical evidence supports the efficacy of interventions such as meaning-centered
ARTICLE INFO psychotherapy, logotherapy, and dignity therapy in mitigating existential distress
and enhancing psychological well-being. Future research should focus on long-term
*Correspondence: outcomes, cultural considerations, and integrating these therapies into standard
Maryam Farzan oncology care to improve the quality of life for cancer patients.
drmaryamfarzan@
gmail.com
Isfahan University
of Medical Sciences,
Isfahan Province,
Introduction

C
Isfahan, Iran. ancer is a major global health problem, with patients not only grappling
with physical challenges but also facing profound existential concerns.
Dates:
Confronted with their mortality and the difficulties accompanying the disease,
Received: 10-08-2024
Accepted: 23-08-2024
cancer patients often experience existential distress. Our hypothesis is that
Published: 25-10-2024 addressing these existential concerns is crucial for their overall well-being.
Irvin Yalom’s existential psychotherapy framework provides a comprehensive
Keywords: approach to understanding and addressing these concerns. Yalom identifies
Existential distress, four primary existential dimensions: death, freedom, isolation, and meaning-
Meaning-based lessness. Each of these dimensions is particularly relevant to cancer patients.
psychotherapy, Cancer
patients, Existential The confrontation with death is immediate and personal for them, eliciting
psychotherapy, I.D. fears and anxieties about their mortality. The dimension of freedom, which
Yalom is the responsibility of shaping one’s own life, can be overwhelming when
choices seem limited by illness. Isolation, both physical and emotional, is often
How to Cite:
intensified by the experience of cancer, leaving patients feeling alone in their
Farzan M, Ebrahimi
H, Pourali M.
suffering. Finally, the search for meaning becomes acute as patients struggle
Existential Concerns
and Interventions in
Patients with Cancer: © IJOCP, 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-Sha-
Insights from Yalom’s reAlike 4.0 International (CC BY-NC-SA 4.0) License, which allows users to download and share the article for
non-commercial purposes, so long as the article is reproduced in the whole without changes, and the original
Framework. Indian
authorship is acknowledged. If you remix, transform, or build upon the material, you must distribute your con-
Journal of Clinical tributions under the same license as the original. If your intended use is not permitted by statutory regulation
Psychiatry. 2024;4(2): 13-20. or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit https://creativecommons.org/licenses/by-nc-sa/4.0/
doi: 10.54169/ijocp.v4i02.142
 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

to find purpose in their lives amidst the challenges

posed by their illness.
Results
To address these existential concerns, several
therapeutic approaches have been developed
Existential Distress in Cancer
for cancer patients. Logotherapy, pioneered by Patients
Viktor Frankl, emphasizes finding meaning in life,
Death anxiety
even in the face of suffering. Meaning-centered
psychotherapy builds on this by helping patients Irvin Yalom’s existential psychotherapy identifies
identify and sustain a sense of purpose. Existential death as a central theme in human existence, assert-
psychotherapy, grounded in Yalom’s principles, ing that awareness of mortality is a fundamental
encourages patients to confront and explore their source of existential anxiety. For cancer patients,
existential concerns directly. Dignity therapy focuses the confrontation with their own mortality is often
on preserving the patient’s sense of dignity and immediate and unavoidable. Yalom suggests that
legacy, often through life review and the creation the proximity to death forces individuals to grapple
of meaningful narratives. In this review, we explore with the finiteness of life and the ultimate unknown,
these therapeutic modalities within the context of thereby exacerbating existential distress.1
cancer care. Research consistently shows that cancer patients
experience heightened levels of death anxiety. The
Methodology prevalence of death anxiety was 42% in the general
cancer population2 and surprisingly lower (32%)
This narrative review is grounded in the theoretical in advanced cancer patients. 3 There are in fact, a
framework of Irvin Yalom’s existential psychother- few systematic reviews on death anxiety in cancer
apy. To gather relevant literature, we conducted a patients, most of which emphasize the correlates
comprehensive search across well-known academic and contributing factors. A systematic review and
databases, including PubMed, PsycINFO, and meta-analysis4 recently showed that the positive
Scopus. Keywords used in the search process correlates of death anxiety in patients with cancer
included “cancer,” “existential concerns,” “Yalom,” were: female gender, symptom burden, anxiety
“existential psychotherapy,” “logotherapy,” “mean- level, depression level, fear of recurrence, attach-
ing-centered psychotherapy,” and “dignity therapy.” ment avoidance, psychological distress, resignation
Our inclusion criteria focused on studies and and confrontation coping. The negative correlates
reviews that discussed existential concerns in cancer were age, educational level, ability to perform daily
patients, particularly those that applied Yalom’s activities, a sense of meaning in life, resilience,
existential dimensions. We excluded articles that quality of life, social support and religious beliefs. In
did not directly address existential issues or were conclusion, death anxiety is deeply connected with
not related to the cancer patient population. demographic and psychological status.
After identifying and reviewing the pertinent On the other hand, one other systematic review
literature, we applied Yalom’s theoretical framework and meta-analysis by Soleimani et al. in 2020 5
to categorize and interpret the findings. We then showed that death anxiety scale results were higher
integrated these theoretical insights with empirical in Asian studies, breast cancer studies, studies with
findings from the literature, providing a compre- female-only participants, and studies with married
hensive understanding of how existential concerns participants. The findings of the study might
manifest in cancer patients and how they can be suggest more complex psychosocial factors and
addressed through various therapeutic approaches. mechanisms affecting fear of death.
This methodology allowed us to contextualize the There are also remarkable studies assessing
theoretical framework within real-world clinical death anxiety and fear of dying in patients with
settings, highlighting the practical implications for cancer. While most studies suggest religious beliefs
cancer care. as a mediating factor for death anxiety, 3 a study by

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 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

Emanuel et al. (2022) suggested that demograph- to our knowledge, none has stated that a cancer
ics, religious affiliation, intrinsic religiousness and diagnosis might confront patients with their inher-
frequency of prayers were not associated with ent freedom. In fact, literature suggests that patients
death anxiety and distress scale (DADDS) results.6 diagnosed with cancer experience a sense of loss
While religious “struggle” was positively correlated of control and autonomy, limiting their freedom of
with death anxiety, similar to dignity-related stress, choice.
the negative correlate found by the study was the A study by Xiao in 2021 showed that one of the
existential quality of life. ways cancer patients experience and define dignity
Interventions targeting death anxiety have is through autonomy and control.9 Another study by
shown promising results. For instance, Breitbart Staat et al. also suggested that patients strongly cor-
et al. (2012) demonstrated that meaning-centered related their dignity with having a sense of control
psychotherapy, which addresses existential con- and being able to make decisions for themselves.
cerns directly, effectively reduces death anxiety in In fact, having the freedom to make choices made
advanced cancer patients. This intervention helps the patients feel they had preserved their dignity.10
patients find meaning and purpose despite their On the other hand, a systematic review by
illness, thereby alleviating the existential terror asso- Simard et al. (2013) examined the fear of cancer
ciated with impending death.7 recurrence in adult survivors and found that this
In conclusion, death anxiety emerges promi- fear can severely limit patients’ perceived freedom
nently in cancer patients as a result of their confron- to make life choices.11 The constant anxiety about
tation with mortality. The literature indicates that recurrence can lead to avoidance behaviors and a
this anxiety might be closely linked to psychological restricted lifestyle, exacerbating existential distress.
distress, quality of life, and social factors. Moreover, The study highlighted the need for interventions
the role of mediating factors such as religiousness such as psychoeducation and cognitive-behavioral
and other cultural mechanisms is still argued. Thus, therapy to help patients manage these fears and
the complexity of the concept highlights the need regain a sense of autonomy.
for further evaluation, as death anxiety can decrease In conclusion, the literature highlights that the
patients’ quality of life and mood status. Therefore, concept of freedom might be a significant source
meaning-centered therapies are being widely used. of existential distress for cancer patients, often
Studies and research currently show these interven- closely related to the patient’s sense of dignity. The
tions can play a vital role in improving the psycho- perceived loss of autonomy and the responsibility
logical well-being of cancer patients.1,7 of making life-altering decisions can exacerbate
psychological distress.
Freedom
Isolation
Irvin Yalom’s existential psychotherapy identifies
freedom as a central theme in understanding Irvin Yalom’s existential psychotherapy identifies
human existence. Yalom posits that individuals are isolation as a core dimension of human existence,
condemned to freedom, meaning they are respon- positing that existential isolation stems from the
sible for making choices in their lives, which can be unbridgeable gap between individuals despite our
both liberating and anxiety-inducing.1 For cancer best efforts to connect.1 This concept becomes par-
patients, the concept of freedom is often challenged ticularly important for cancer patients, who often
by their illness, as they face numerous constraints experience profound feelings of isolation due to the
and decisions that impact their lives and sense of physical, emotional, and social challenges posed by
autonomy. their illness.
Research indicates that cancer patients fre- Research highlights that cancer patients fre-
quently experience issues with their sense of quently encounter existential distress related to iso-
freedom.8 Yet, literature concentrating solely on the lation. A systematic review conducted by Pilleron et
concept of freedom in cancer patients is scarce, and al. reviewed several empirical articles assessing lone-

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 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

liness in cancer patients via the De Jong Gierveld Meaninglessness

loneliness scale or the UCLA loneliness scale. The
Irvin Yalom’s existential psychotherapy identi-
results showed that up to 50% of adults living
fies meaninglessness as a fundamental existen-
with cancer felt lonely, and the sense of loneliness
tial concern.1 According to Yalom, the search for
increased by 6 to 12 after treatment initiation. These
meaning is central to the human experience, and the
findings suggest that cancer burdens patients with
absence of meaning can lead to profound existential
isolation. The sense of loneliness was correlated
distress. For cancer patients, the diagnosis and sub-
with anxiety and depression, and one study showed
sequent treatment journey often disrupt their sense
that sessions with healthcare professionals helped
of meaning and purpose, prompting a struggle to
people cope with the loneliness they felt.12
find or restore meaning in the face of illness.
Similarly, a systematic review was conducted,
The confrontation with cancer can shatter a
concentrating on social isolation only in young
patient’s previous worldview, leading to feelings of
adults. The results suggested that the prevalence
meaninglessness. This existential crisis is particularly
of loneliness did not differ meaningfully from that
pronounced in those facing advanced stages of the
of older cancer patient populations. In fact, the role
disease. Research by Breitbart et al. (2004) explored
of age within the study on the reported sense of
the role of meaning in the lives of terminally ill cancer
isolation was unclear. Being in healthcare settings
patients. The study found that those who perceived
and having young children are risk factors for social
their lives as meaningful exhibited lower levels of
isolation, while married/partnered, female gender
depression and despair. The authors introduced
and being employed or studying at school are the
meaning-centered psychotherapy (MCP) as an inter-
protective factors, according to the study. The study
vention aimed at helping patients rediscover a sense
suggested that young adult cancer survivors had
of purpose and meaning in their lives despite their
a tendency to connect with peers (other young
illness. MCP focuses on enhancing patients’ sense
adult cancer survivors) and often had a hard time
of meaning through various therapeutic techniques.
executing this aim. The study proposed that cancer
Another notable study by Almeida et al.15 exam-
survivors who connected with peers through social
ined the concept of post-traumatic growth (PTG)
media reported lower levels of social isolation and
along with meaninglessness among cancer sur-
a sense of loneliness.13 However, literature recently
vivors in a systematic review and meta-analysis.
suggests that high use of social media implies a
sense of loneliness; hence, setting certain boundar- PTG refers to the positive psychological change
ies - which still remain unclear - might be necessary experienced as a result of the struggle with highly
when encouraging patients to use social media as challenging life circumstances, like being diagnosed
a way to confront loneliness.14 with cancer. The huge life event might shift one’s
In conclusion, the literature underscores that attitude towards life in several aspects, one of which
isolation is a source of existential distress for cancer is spiritual and existential change, making it a close
patients. The literature emphasizes the high prev- concept to meaning in life.16 The review suggests
alence of perceived loneliness and has proposed a several studies stated meaning in life (MiL) to be
few risk factors and potential protective ones. The directly or indirectly correlated with PTG. Some
role of social media in decreasing loneliness was studies found the concept of MiL to be an import-
stated, but has to be approached cautiously due ant component of PTG, proposing the role of MiL
to yet unclear mechanisms and results. The multi- as 20% and 34% in different studies.17,18 Two studies
faceted nature of isolation—encompassing social, controversially did not find any correlations between
emotional, and existential dimensions—requires MiL and PTG.19,20 One of the studies examined the
a comprehensive approach to care. Interventions effect of meaning-making on PTG, and interestingly
that provide social support, address identity disrup- suggested the effect to be positive in cross-sectional
tions, and foster a sense of community are crucial terms and negative when followed up through a
in helping cancer patients navigate the isolating longitudinal course of time. 21 The paper states that
aspects of their illness. research proposes a positive effect of spirituality

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 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

and religiousness on meaning in life in patients with ization of breast and gynecology cancer patients.
cancer. 22,23 The intervention group reported better status con-
cerning DS-MV subcategories of loss of meaning,
Meaning-based Interventions in dysphoria, helplessness, disheartenment, sense of
Cancer Care failure and total DS-MV score. 30
As stated by the many studies mentioned, meaning Furthermore, studies have also addressed the
can play an important role in cancer patients’ lives. effectiveness of existential psychotherapy, the
Several psychotherapy methods have addressed method that Yalom first presented, in cancer care.
meaning as a central theme, building their princi- A study by Mohammadi et al., followed cancer
ples and techniques upon human’s need for making patients receiving existential psychotherapy and
and finding meaning in life. A systematic review found improvements in dimensions of psychological
by Park et al., investigated various meaning-mak- capital (self-efficacy, hope, resilience, optimism) and
ing interventions for cancer patients. 24 The review affective control (anger, depressed mood, anxiety,
synthesized findings from multiple studies and positive affect). 31 These findings highlight the poten-
concluded that interventions focusing on enhanc- tial benefits of existential psychotherapy in support-
ing meaning significantly reduced psychological ing cancer patients’ psychological adjustment.
distress and improved quality of life. Techniques Numerous RCTs have demonstrated the effi-
such as life review therapy, dignity therapy, and cacy of dignity therapy in improving psychological
narrative therapy were identified as effective in well-being and existential distress among terminally
helping patients reconstruct a sense of meaning ill cancer patients. Chochinov et al., conducted a
and coherence in their lives. multi-site RCT comparing dignity therapy with stan-
Of the many meaning-based intervention dard palliative care and found significant reductions
methods, few have been tested in cancer patients in distress and improved dignity-related outcomes
rigorously. Several RCTs have demonstrated the in the intervention group. 32 Subsequent studies
efficacy of MCP in reducing existential distress have replicated these findings, supporting the wide-
and improving the quality of life among cancer spread adoption of dignity therapy in cancer care.
patients. Breitbart et al., published a manual for In conclusion, empirical evidence suggests
delivering this specific type of existential psycho- that meaning-based interventions are effective
therapy to advanced cancer and palliative care in addressing existential distress and improving
patients. Having assessed the effectiveness of MCP psychological well-being among cancer patients.
on cancer patients’ various aspects of well-being in RCTs and epidemiological studies provide robust
several RCTs7,24-26 Breitbart suggested that MCP led support for the efficacy of meaning-centered psy-
to improvements in spiritual well-being and mental chotherapy, dignity therapy, and, to a lesser extent,
health. Similarly, a meta-analysis by Dietrich et al. logotherapy. Epidemiological findings about the
confirmed the positive effects of MCP on psycho- effectiveness of existential psychotherapy are also
logical outcomes, including depression and anxiety, promising, though scarce. While more research
along with spiritual well-being and quality of life. 27 is needed to establish the effectiveness of these
There are also a few studies addressing the interventions across diverse cancer populations and
effectiveness of logotherapy in cancer patients. settings, the existing evidence underscores their
Viktor Frankl first introduced logotherapy follow- potential to enhance patients’ quality of life and
ing his seminal work “Man’s search for Meaning”. 28 promote psychological resilience throughout the
Mohabbat-Bahar et al. conducted an RCT in 2014 illness trajectory.
to assess the effectiveness of the method on the
anxiety of women with breast cancer. The results
were promising, decreasing the patient’s anxiety
Discussion
with the intervention. 29 Another study by Sun et al. The results of this review highlight the significance
explored the effect of group logotherapy sessions and associated factors of existential distress experi-
and found it effective on depression and demoral- enced by cancer patients, particularly in relation to

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 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

Yalom’s four dimensions: death, freedom, isolation, a sense of meaning and coherence in their lives.
and meaninglessness. The findings highlight the These interventions not only reduce psychological
pervasive nature of death anxiety, the challenges to distress but also enhance patients’ overall quality
autonomy and freedom, the profound sense of isola- of life.
tion, and the crisis of meaning that cancer patients The evidence presented in this review highlights
often face. These dimensions are interwoven with the effectiveness of meaning-based interventions
patients’ psychological and social experiences, and in addressing existential distress among cancer
addressing them is critical for improving their overall patients. Meaning-centered psychotherapy, dignity
well-being. therapy, and logotherapy have demonstrated
Death anxiety is a prominent concern among positive outcomes in reducing existential anxiety,
cancer patients, manifesting in heightened levels improving psychological well-being, and enhancing
of fear and distress. Various factors, including quality of life. These interventions are grounded in
symptom burden, psychological distress, and a the recognition that existential concerns are central
sense of meaninglessness, influence this anxiety. to the human experience and must be addressed to
The findings suggest that interventions targeting provide holistic care to cancer patients.
existential concerns, such as meaning-centered psy- In conclusion, this study shows that existential
chotherapy, can effectively reduce death anxiety by concerns might be significant in cancer patients,
helping patients find meaning and purpose despite and complicated by many risk factors and poten-
their illness. tially protective ones. The pervasive nature of death
The concept of freedom is challenged by the con- anxiety, challenges to autonomy, profound isola-
straints imposed by cancer, leading to a perceived tion, and crises of meaning highlight the need for
loss of autonomy and control. Studies indicate that comprehensive interventions that address these
maintaining a sense of dignity through autonomy dimensions. Meaning-centered therapies, particu-
and decision-making is crucial for patients’ psy- larly meaning-centered psychotherapy and dignity
chological well-being. Interventions that promote therapy, have shown promising results in improving
autonomy and support patients in making informed the psychological well-being of cancer patients.
choices can help mitigate the existential distress Future research should continue to explore the
associated with a loss of freedom. effectiveness of these interventions across diverse
Isolation is another significant source of exis- cancer populations and settings, further establish-
tential distress for cancer patients, with many ing their role in enhancing patients’ quality of life and
experiencing profound loneliness and social discon- promoting psychological resilience throughout the
nection. The literature highlights the importance of illness trajectory. By integrating these therapeutic
social support and connections in alleviating feelings approaches into cancer care, healthcare providers
of isolation. Interventions that foster social connec- can better support patients in navigating the exis-
tions, whether through peer support groups, health- tential challenges posed by their illness.
care professional interactions, or carefully managed
social media use, can play a vital role in reducing
isolation and improving patients’ quality of life.
Limitations
Meaninglessness is a critical existential concern, Limitations of this study include potential biases
particularly for those facing advanced stages inherent in the selected literature, variations in study
of cancer. The disruption of a patient’s sense of methodologies and populations, and challenges
meaning and purpose can lead to profound psy- in synthesizing findings across diverse research
chological distress. Meaning-centered interventions, approaches. Additionally, the generalizability of
such as meaning-centered psychotherapy and findings may be limited by the specific characteris-
dignity therapy, have been shown to effectively tics of the included studies and populations.
address this concern by helping patients reconstruct

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 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

Future Directions 10.

review. Psychooncology. 2021;30(8):1220-31.
Staats K, Grov EK, Husebø BS, Tranvåg O. Dignity and
Future directions in this field should focus on loss of dignity: Experiences of older women living with
incurable cancer at home. Health Care Women Int.
expanding the empirical evidence base for mean-
2020;41(9):1036-58.
ing-centered interventions across diverse cancer 11. Simard S, Thewes B, Humphris G, Dixon M, Hayden C,
populations and settings. Longitudinal studies are Mireskandari S, et al. Fear of cancer recurrence in adult
needed to assess the sustained impact of these cancer survivors: a systematic review of quantitative
therapies on patients’ psychological well-being studies. J Cancer Surviv. 2013;7(3):300-22.
12. Pilleron S, Sun V, Ayala AP, Haase KR, Arthur EK, Kenis
and quality of life over time. Additionally, research
C, et al. Loneliness in older adults living with cancer: A
should explore the integration of these interven- scoping review of the quantitative and qualitative evi-
tions into standard oncology care, examining the dence on behalf of the International Society of Geriatric
feasibility and effectiveness of implementing them Oncology Nursing and Allied Health Interest Group. J
in various healthcare settings. There is also a need Geriatr Oncol. 2023;14(5):101519.
13. Fox RS, Armstrong GE, Gaumond JS, Vigoureux TFD,
to investigate the role of cultural, social, and individ-
Miller CH, Sanford SD, et al. Social isolation and social
ual differences in patients’ responses to existential connectedness among young adult cancer survivors: A
therapies, tailoring interventions to better meet the systematic review. Cancer. 2023;129(19):2946-65.
unique needs of different patient groups. Finally, 14. Primack BA, Shensa A, Sidani JE, Whaite EO, Lin LY,
developing and evaluating innovative approaches, Rosen D, et al. Social Media Use and Perceived Social
Isolation Among Young Adults in the U.S. Am J Prev
such as digital platforms and telehealth services,
Med. 2017;53(1):1-8.
can increase accessibility to existential support for 15. Almeida M, Ramos C, Maciel L, Basto-Pereira M, Leal I.
cancer patients, ensuring that more individuals can Meaning in life, meaning-making and post-traumatic
benefit from these crucial interventions. growth in cancer patients: Systematic review and
meta-analysis. Frontiers in psychology. 2022;13:995981.

References 16. al. Te. Post-traumatic Growth Theory, Research, and

Applications 2018.
1. Yalom ID. Existential psychotherapy 1980. 17. Mostarac I, Brajković L. Life After Facing Cancer:
2. Gonen G, Kaymak SU, Cankurtaran ES, Karslioglu EH, Post-traumatic Growth, Meaning in Life and Life Satis-
Ozalp E, Soygur H. The Factors Contributing to Death faction. J Clin Psychol Med Settings. 2022;29(1):92-102.
Anxiety in Cancer Patients. Journal of Psychosocial 18. Aflakseir A, Soltani S, Mollazadeh J. Post-traumatic
Oncology. 2012;30(3):347-58. Growth, Meaningfulness, and Social Support in Women
3. Neel C, Lo C, Rydall A, Hales S, Rodin G. Determinants with Breast Cancer. International Journal of Cancer
of death anxiety in patients with advanced cancer. BMJ Management. 2018;In Press.
Support Palliat Care. 2015;5(4):373-80. 19. Loef fler S, Poehlmann K, Hornemann B. Finding
4. Li Y, Dong W, Tang H, Guo X, Wu S, Lu G, et al. Correlates meaning in suffering?—Meaning making and psy-
of death anxiety for patients with cancer: A systematic chological adjustment over the course of a breast
review and meta-analysis. J Clin Nurs. 2024;33(5):1933-47. cancer disease. European Journal of Cancer Care.
5. Soleimani MA, Bahrami N, Allen KA, Alimoradi Z. Death 2018;27(3):e12841.
anxiety in patients with cancer: A systematic review and 20. Shand LK, Brooker JE, Burney S, Fletcher J, Ricciardelli
meta-analysis. Eur J Oncol Nurs. 2020;48:101803. LA. Psychosocial factors associated with post-trau-
6. Emanuel LL, Solomon S, Chochinov HM, Delgado Guay matic stress and growth in Australian women with
MO, Handzo G, Hauser J, et al. Death Anxiety and Cor- ovarian cancer. Journal of psychosocial oncology.
relates in Cancer Patients Receiving Palliative Care. J 2018;36(4):470-83.
Palliat Med. 2023;26(2):235-43. 21. Park CL, Edmondson D, Fenster JR, Blank TO. Meaning
7. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, making and psychological adjustment following
Nelson C, et al. Meaning-centered group psychotherapy cancer: the mediating roles of growth, life meaning,
for patients with advanced cancer: a pilot randomized and restored just-world beliefs. Journal of consulting
controlled trial. Psychooncology. 2010;19(1):21-8. and clinical psychology. 2008;76(5):863.
8. Vehling S, Kissane DW. Existential distress in cancer: 22. George LS, Park CL. Are meaning and purpose distinct?
Alleviating suffering from fundamental loss and change. An examination of correlates and predictors. The Journal
Psychooncology. 2018;27(11):2525-30. of Positive Psychology. 2013;8(5):365-75.
9. Xiao J, Ng MSN, Yan T, Chow KM, Chan CWH. How 23. Thuné-Boyle C, Stygall J, Keshtgar M, Davidson T,
patients with cancer experience dignity: An integrative Newman S. The influence of religious/spiritual resources

My Research Journals 19 Volume 4 | Issue 2 | 2024

 Existential Concerns and Interventions in Patients with Cancer: Insights from Yalom’s Framework

on finding positive benefits from a breast cancer 28. Frankl VE. Man’s Search for Meaning: An Introduction to
diagnosis. Counselling and Spirituality/Counseling et Logotherapy. New York: Washington Square Press; 1963.
spiritualité. 2011. 29. Mohabbat-Bahar S, Golzari M, Moradi-Joo M, Akbari ME.
24. Breitbart W. Spirituality and meaning in supportive care: Efficacy of group logotherapy on decreasing anxiety
spirituality-and meaning-centered group psychother- in women with breast cancer. Iran J Cancer Prev.
apy interventions in advanced cancer. Supportive care 2014;7(3):165-70.
in cancer. 2002;10:272-80. 30. Sun FK, Hung CM, Yao Y, Fu CF, Tsai PJ, Chiang CY. The
25. Breitbart W, Pessin H, Rosenfeld B, Applebaum AJ, Effects of Logotherapy on Distress, Depression, and
Lichtenthal WG, Li Y, et al. Individual meaning‐cen- Demoralization in Breast Cancer and Gynecological
tered psychotherapy for the treatment of psycholog- Cancer Patients: A Preliminary Study. Cancer Nurs.
ical and existential distress: A randomized controlled 2021;44(1):53-61.
trial in patients with advanced cancer. Cancer. 31. mohammadi r, Zebardast A, rezaei s. The Effectiveness
2018;124(15):3231-9. of Existential Psychotherapy on Psychological Capital
26. Breitbart WS, Breitbart W, Poppito SR. Meaning-cen- and Affective Control in Cancer Patients Undergo-
tered group psychotherapy for patients with advanced ing Chemotherapy. Journal of Nursing Education.
cancer: A treatment manual: Oxford University Press, 2022;10(5):82-95.
USA; 2014. 32. Chochinov HM, Kristjanson LJ, Breitbart W, McClement
27. Dietrich N, Estradé A, Cruzado Rodríguez JA. Efficacy S, Hack TF, Hassard T, et al. Effect of dignity therapy
of Meaning-Centered Psychotherapy in adult patients on distress and end-of-life experience in terminally
with advanced cancer: A systematic review and ill patients: a randomised controlled trial. The lancet
meta-analysis. 2021. oncology. 2011;12(8):753-62.

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