Self-esteem and existential distress among patients with advanced cancer: mediation by a sense of control and meaning in life

Aim Self-esteem has been reported to be associated with existential distress (ED) in patients with advanced cancer; however, the nature of this association remains insufficiently understood. This study aimed to examine the mechanisms underlying the association between self-esteem and ED in patients with advanced cancer. Methods This cross-sectional study was conducted between July 2022 and March 2023. A total of 390 patients with advanced cancer were recruited from two tertiary hospitals in Southeast China using convenience sampling. Self-esteem, sense of control, meaning in life, and ED were assessed. Path analysis was performed to examine the mediating roles of sense of control and meaning in life in the association between self-esteem and ED. Result Self-esteem was directly and indirectly associated with ED ( p < 0.001). Both sense of control and meaning in life significantly mediated the association between self-esteem and ED ( p < 0.001). The serial mediation pathway through sense of control and meaning in life was also significant and accounted for 21.48% of the total indirect effect ( p < 0.001). Conclusion The findings suggest that self-esteem, sense of control, and meaning in life are interrelated psychological factors associated with ED. Interventions targeting these factors may be relevant in clinical efforts to support patients with advanced cancer experiencing ED.