Existential distress is common in patients living with advanced cancer. It is clinically significant, yet generally under-recognised, and can influence treatment adherence, symptom burden, and the therapeutic relationship between patients and their care teams.
Facing one’s mortality often brings existential concerns into sharp focus. Among people affected by advanced cancer, the prospect of death can challenge one’s sense of safety, identity, autonomy, dignity, and belonging, prompting a search for meaning. While living well remains possible throughout the illness trajectory, with some experiencing psychological growth and strengthened relationships, others may struggle to find meaning and purpose, giving way to demoralisation and despair. These existential concerns may further activate underlying psychological vulnerabilities, impacting how distress is experienced, expressed, and understood. In clinical interactions, existential concerns are not always recognised or articulated directly, and may instead surface as heightened symptom burden, treatment non-adherence, requests for hastened death, conflict, or behaviours perceived as challenging.
Drawing on research and clinical experience, this presentation examines key psychological concepts underpinning existential distress in advanced cancer and the concerns commonly raised by patients approaching the end of life. It offers a clinical perspective on the role of psychologists during this phase of life, supporting individuals to make sense of illness, navigate cumulative losses, and begin the process of saying goodbye - to others, themselves, and life itself. Practical considerations for patient care will also be discussed, including ways of fostering psychological safety and human connection, within the everyday realities of oncology care.
This presentation aims to enhance understanding of the inner worlds of patients from a clinical psychology and trauma-informed lens. It highlights the value of a holistic, multidisciplinary approach that recognises the unique strengths and experiences that each person brings to the final phases of life.