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Existential distress and meaning-focused interventions in cancer survivorship

Vehling, Sigruna,b,c; Philipp, Rebeccaa

Current Opinion in Supportive and Palliative Care: March 2018 - Volume 12 - Issue 1 - p 46–51
doi: 10.1097/SPC.0000000000000324

Purpose of review Cancer can challenge fundamental assumptions about security, controllability and life priorities, which may lead to clinically relevant existential distress. We review recent studies on the prevalence of existential distress in cancer survivors, its distinctness from other distress concepts and interventions to address cancer-specific existential challenges. We further describe psychological mechanisms that may underlie change resulting from such interventions.

Recent findings One-third to one-half of cancer survivors experienced existential fears and concerns related to reduced control, identity and uncertainty about the future. Clinically relevant levels of demoralization (a state comprising loss of meaning and a sense of poor coping) were found in one in four to five cancer patients in mixed samples. Existential interventions have shown positive effects in facilitating personal meaning and promoting psychological adaptation.

Summary Existential distress can be understood as a distinct dimension of cancer-related distress requiring attention from healthcare professionals. Psychosocial interventions can facilitate dealing with existential challenges during and while transitioning to longer term survivorship. Such interventions can effectively support survivors to manage uncertainty, link cancer to their life story and engage in meaningful activity despite an uncertain and potentially foreshortened future.

aDepartment of Medical Psychology

bDepartment of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology

cUniversity Cancer Center Hamburg (UCCH) – Hubertus Wald Tumor Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence to Sigrun Vehling, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 – W26, 20246 Hamburg, Germany. Tel: +49 40741056805; e-mail:

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