Nurse-Led Support Reduces Death Anxiety in Breast Cancer Care

A structured, nurse-led comprehensive support program significantly decreases death anxiety among women undergoing long-term hormonal therapy for breast cancer, according to clinical trial results published in Supportive Care in Cancer. The trial demonstrated that integrating multidimensional supportive nursing care—spanning physical, psychological, spiritual, and sexual health domains—yielded marked improvements in patient psychological well-being compared to standard routine care.

Breast cancer accounts for 11.7% of all new cancer cases in women worldwide, the study authors noted. Approximately 75% of breast tumors are hormone receptor-positive, requiring adjuvant endocrine therapies such as selective estrogen receptor modulators or aromatase inhibitors for 5 to 10 years following initial diagnosis.

While hormonal therapy can decrease recurrence risk by up to 40%, long-term treatment is frequently accompanied by existential suffering and death anxiety. Death anxiety remains a prevalent psychological challenge among oncology patients navigating long-term cancer survivorship.

Key Takeaways for Oncology Nurses

• Prevalence of Death Anxiety: Existential distress and fear of mortality are widespread among survivors undergoing long-term endocrine therapy, directly affecting overall quality of life.
• Impact of Adherence: Hormonal therapy reduces recurrence risk by up to 40%, making psychological stability and treatment adherence critical clinical targets.
• Holistic Assessment Need: Routine oncology care often focuses primarily on physical side effects, underscoring the need for structured screening of psychological and spiritual distress.

Study Methodology and Patient Cohort

The parallel two-group clinical trial (IRCT20240120060738N1) was conducted at the Breast Cancer Clinic of Motahari Outpatient Center, affiliated with Shiraz University of Medical Sciences, between February 20, 2024, and July 20, 2024. Investigators screened 550 patients undergoing hormonal therapy, identifying 210 eligible individuals. From this eligible population, 70 women were randomly assigned to either the intervention group (n=35) or the routine care control group (n=35).

Eligible participants had a confirmed diagnosis of primary hormone receptor-positive breast cancer, had completed surgery, chemotherapy, and radiotherapy, and had received hormonal therapy for at least one year. Exclusion criteria included deterioration of the patient's condition, substance abuse, and use of psychoactive medications.

Intervention Structure and Evaluation Metrics

The intervention comprised a comprehensive support program consisting of 6 hybrid sessions delivered through in-person and virtual platforms. Led by oncology nursing professionals, the curriculum addressed physical symptom management, psychological coping strategies, spiritual support, and sexual health education, while also engaging patients' family companions.

Primary psychological outcomes were evaluated using the Templer Death Anxiety Scale (DAS) at baseline (T0), immediately post-intervention (T1), and 1 month following completion (T2). Statistical analysis was performed by a blinded consultant using non-parametric Wilcoxon and Friedman tests.

Quantitative Results and Anxiety Reductions

At baseline (T0), mean death anxiety scores were comparable between the intervention group (7.45 ± 2.87) and control group (7.09 ± 2.54; p = 0.465). Immediately following the 6-session program (T1), the intervention group demonstrated a significant reduction in death anxiety, scoring 4.03 ± 2.51 compared to 8.40 ± 2.60 in the control group (p < 0.001).

At the 1-month follow-up assessment (T2), death anxiety remained significantly lower in the intervention arm (5.82 ± 2.15) than in the control arm (8.40 ± 2.60; p < 0.001). Control group participants experienced an increase in death anxiety scores from baseline over the study evaluation period. Within-group analysis confirmed statistically significant score changes across timepoints for both intervention (p < 0.001) and control groups (p < 0.001).

Key Takeaways for Oncology Nurses

• Efficacy of Multidimensional Care: Combining physical, psychological, spiritual, and sexual health education in nurse-led sessions yields statistically significant reductions in death anxiety.
• Feasibility of Hybrid Delivery: Utilizing a hybrid format of in-person and virtual sessions allows oncology nurses to deliver structured support without imposing prohibitive patient travel burdens.
• Role of Family Companion Involvement: Engaging patient companions in support sessions reinforces emotional support structures during cancer survivorship.
• Need for Continuous Intervention: Death anxiety scores rebounded slightly at one month post-intervention (rising from 4.03 to 5.82), highlighting the clinical value of ongoing, booster support sessions.

Reference

1. Raisi S, Hojat M, Karimyar Jahromi M. Investigating impact of a comprehensive support program on death anxiety among women with breast cancer: a clinical trial. Support Care Cancer. 2026;34(877):1-8. doi:10.1007/s00520-026-1119-6