Death anxiety in patients with cancer: A systematic review and meta-analysis

Purpose: The present study was designed to estimate the rate of death anxiety and the factors influencing its occurrence in cancer patients using a systematic review and meta-analysis approach. Method: Five academic databases, including Scopus, PubMed, Science Direct, Embase, and ProQuest, were searched systematically from inception until the end of January 2020. Observational studies that reported mean score of death anxiety in cancer patients, regardless of language restriction, were eligible to be included. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. A meta-analysis was performed using a random effect model with the DerSimonian and Laird weighted method. Publication bias was assessed using the funnel plot and Begg's and Egger's tests. Results: The estimated pooled mean for death anxiety among cancer patients was 6.84 (CI95% = [5.98, 7.69]). Publication bias and small study effects were not detected. Subgroup analysis and a meta-regression showed that the estimated pooled mean was higher in Asian studies (M = 7.57) compared to European (M = 6.47) and North American studies (M = 5.57); in breast cancer patients (M = 9.68) compared to studies examining different types of cancers; in female only participants (M = 7.37) compared to studies with both genders (M = 6.60); and in married participants compared to non-married participants. Conclusions: The findings suggest that death anxiety in patients with cancer is moderate and is influenced by socio-demographic factors such as region, type of cancer, sex, and marital status.