Death Anxiety During the Last Year of Life in Patients With Advanced Cancer: Longitudinal Results From the eQuiPe Study

Abstract

BACKGROUND: Death anxiety in patients with advanced cancer may increase during the last year of life due to increasing symptom burden and growing awareness of prognosis. AIMS: To examine the trajectory of death anxiety during the last year of life in patients with advanced cancer and its associated factors. METHODS: Data from the prospective, multicentre, observational eQuiPe study were used. Patients with stage IV solid cancer were included (2017-2020) and completed three-monthly questionnaires until death. Death anxiety was measured using a single item from the Problem and Needs in Palliative Care questionnaire (yes, a little bit, or no). Additionally, 32 patients completed the Death and Dying Distress Scale (DADDS). Longitudinal analyses were performed using mixed-effects regression. RESULTS: In total, 629 patients were included (mean age: 66 years, SD = 10). During the last year of life, 12%-15% experienced death anxiety, 30%-34% a little, and 52%-58% none. The prevalence of death anxiety remained stable over time and was significantly associated with female sex (OR 2.48), age (OR 0.93), fatigue (OR 1.10), planning (OR 1.84) and acceptance coping (OR 0.20), and social support (OR 1.39). Concerns about the impact of their death on relatives was the most frequently reported issue (84%) in patients with available DADDS data. CONCLUSIONS: The prevalence of death anxiety does not change in the last year of life and is associated with several psychosocial factors. These findings underscore the value of open communication and care approaches that strengthen adaptive coping and address the relational aspects of distress.