Psychological Adaptation to Cancer Progression and End-of-Life: State Anxiety, Stress-Related Growth, Well-Being, and Spiritual Experiences

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Abstract
Objective: This study examined psychological adaptation across cancer progression by following the same oncology patients from diagnosis to a terminal-phase assessment and by comparing them with survivors of severe non-cancer life-threatening events. Outcomes were state anxiety, unconditional self-acceptance, stress-related growth, psychological well-being, purpose and meaning in life, and exploratory reports of near-death experiences (NDEs), deathbed visions (DBVs), and other end-of-life experiences (ELEs). Methods: The analytic sample comprised 206 unique participants: 103 oncology patients with paired assessments at diagnosis (Time 1) and after three years in the terminal phase (Time 2), and an independent comparison group of 103 survivors of severe life-threatening events. The oncology cohort was drawn from 649 patients initially assessed in the same clinical setting; longitudinal analyses included the 103 patients with complete paired data through the final assessment. Repeated-measures ANOVA tested within-person psychological change; independent-samples t tests compared newly diagnosed oncology patients with life-threatening-event survivors; Pearson chi-square compared the frequency of documented spiritual-experience reports between the independent terminal-phase oncology and life-threatening-event groups; and McNemar’s exact test examined within-person change in spiritual-experience reporting from diagnosis to the terminal phase. Results: In the paired oncology cohort, state anxiety decreased and unconditional self-acceptance, stress-related growth, psychological well-being, and purpose/meaning increased from diagnosis to the terminal-phase assessment (all p < 0.001). Life-threatening-event survivors showed lower state anxiety and higher scores on the positive psychological outcomes than newly diagnosed oncology patients (all p < 0.001). Reports consistent with NDEs, DBVs, and ELEs were documented more frequently in terminal-phase oncology patients (94.2%) than in life-threatening-event survivors (63.1%), χ2(1, N = 206) = 29.59, p < 0.001, Cramer’s V = 0.38. Within the paired oncology cohort, spiritual-experience reporting also increased from 14.6% at diagnosis to 94.2% in the terminal phase; 85 patients changed from no report to a report and only 3 changed in the opposite direction (McNemar exact p < 0.001). Conclusion: Psychological functioning differed markedly across phases and contexts of mortality-related threat. Reports consistent with NDEs, DBVs, and ELEs were documented more frequently in the terminal phase and increased within the paired oncology cohort, but the observational design does not establish that these experiences caused or predicted psychological improvement. The findings support further longitudinal, controlled, and qualitative research on adaptation, meaning, and spiritual experience in oncology and end-of-life care.

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