Psychological, existential, and clinical factors independently associated with death anxiety in patients with advanced cancer: a cross-sectional study in an Italian palliative care population

Purpose To identify the psychological, existential, and clinical variables independently associated with death anxiety in Italian patients with advanced cancer receiving palliative care.Methods In this cross-sectional study, 140 patients with advanced cancer receiving palliative care in an oncology ward (n = 88) or hospice (n = 52) in Turin, Italy completed validated measures of death anxiety, dignity-related distress, demoralization, spiritual well-being, depression, anxiety, and physical symptom burden. Functional status was clinician-rated. Group differences and multivariable linear regression analyses were performed to identify factors independently associated with death anxiety.Results Death anxiety was associated with greater depression, anxiety, demoralization, dignity-related distress, and physical symptom burden and lower spiritual well-being. Hospice patients reported greater distress specifically related to the dying process than oncology inpatients. In the primary multivariable model (n = 138; adjusted R2 = .503), dignity-related distress showed the strongest independent association with death anxiety (PDI: β = .47, p < .001), followed by anxiety symptoms (GAD-7: β = .27, p < .01).Conclusion Dignity-related distress was the factor most strongly associated with death anxiety, highlighting the potential importance of comprehensive palliative care that integrates psychological and existential assessment. Given the cross-sectional design, the direction of these associations remains uncertain.