Death Anxiety in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

Abstract

Context: Death anxiety (DA) is a common experience in many patients with breast cancer (BC) that affects their quality of life. Objectives: The aim of this study was to estimate the mean of DA in patients with BC using a systematic review and meta-analysis approach. Data Sources: An extensive search was conducted in English electronic databases, including PubMed, Web of Science (WOS), Scopus, and Embase, up to the end of December 2024. The search aimed to gather all studies reporting the mean of DA in patients with BC, ensuring a comprehensive collection of relevant literature without time limitations. Study Selection: The inclusion criteria focused on studies that reported the mean of DA in patients with BC and were published in English. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS), ensuring that only high-quality studies were considered for the meta-analysis. Data Extraction: Data were meticulously extracted from the selected studies, emphasizing the mean of DA and other pertinent metrics. A meta-analysis was then performed using the random-effects DerSimonian-Laird model, and publication bias was evaluated using a funnel plot and Begg's and Egger's tests. Results: A total of 789 studies were found in the extensive search of electronic databases. Nine articles were selected based on the inclusion and exclusion criteria. Four studies were conducted in Iran, two in China, and one in Pakistan, Turkey, and Palestine. All of the included studies were cross-sectional and published between 2017 and 2024. In total, this meta-analysis included 6 articles. The pooled mean of DA in BC patients was 9.96 [confidence interval (CI): 7.99 - 11.93, I2 = 99.69, P < 0.001]. Conclusions: This study showed that the mean of DA is high among BC patients. Therefore, it is recommended to use supportive and psychological measures in comprehensive oncology care to control this challenge.