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Muhammad Awais-E-yazdan
Dr. Aqeel Ahmad Khan
Dr. Aftab Hussain
Bisma Akhlaq
Ahmed Ikram
Ammara Iqbal


social support, self-esteem, resilience, medical coping, cancer


The objective of this study was to examine the factors associated with death anxiety among cancer patients, namely self-esteem, social support, medical coping, and resilience, considering the mediating role of religious orientation and the moderating role of meaning in life. In the current study, 386 cancer patients voluntarily participated, of which 66% were male and 34% were female. The results of the regression analysis suggest that self-esteem, social support, medical coping mechanisms, and resilience exert a negative influence on death anxiety. Furthermore, a negative meaning in life moderates the relationship between self-esteem, social support, and medical coping, and death anxiety. However, in terms of the resilience scale, meaning in life does not demonstrate a statistically significant correlation with death anxiety. An external religious orientation significantly mediates the relationship between self-esteem and death anxiety, and between social support and death anxiety. Conversely, an internal religious orientation mediates negatively between self-esteem, social support, medical coping, resilience, and death anxiety.

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1. Abbas, Mr. A., Eliyana, Prof. A., Ekowati, Dr. D., Saud, Mr. M., Raza, Mr. A., & Wardani, Ms. R. (2020). Data set on coping strategies in the digital age: The role of psychological well-being and social capital among university students in Java Timor, Surabaya, Indonesia. Data in Brief, 30, 105583.
2. Abbas, Q., Kanwal, U., Saeed, W., Khan, M. U., Shahzadi, M., & Faran, M. (2021). Relationship of Muslim Religiosity and Death Anxiety with the Mediating Effect of Optimism and Depression Among Cancer Patients in Pakistan. Journal of Religion and Health.
3. Ahmadi, F., & Ahmadi, N. (2013). Nature as the Most Important Coping Strategy Among Cancer Patients: A Swedish Survey. Journal of Religion and Health, 54(4), 1177–1190.
4. Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5(4), 432–443.
5. Aumack, L. (1962). A social adjustment behavior rating scale. Journal of Clinical Psychology, 18(4), 436–441. 227018 0412%;2-o
6. Bibi, A., & Khalid, M. A. (2019). Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan. Death Studies, 1–6. https://doi. org/10.1080/07481187.2019.1614108
7. Boring, B. L., Maffly-Kipp, J., Mathur, V. A., & Hicks, J. A. (2022). Meaning in Life and Pain: The Differential Effects of Coherence, Purpose, and Mattering on Pain Severity, Frequency, and the Development of Chronic Pain. Journal of Pain Research, Volume 15, 299–314.
8. Brant, J. M., & Silbermann, M. (2021). Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Current Oncology Reports, 23(5). https://doi. org/10.1007/s11912-021-01044-8
9. Chang, B., Cheng, J., Fang, J., & Dang, J. (2021). The Indirect Effect of Death Anxiety on Experienced Meaning in Life via Search for Meaning and Prosocial Behavior. Frontiers in Psychology, 12.
10. Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82.
11. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.
12. Czekierda, K., Banik, A., Park, C. L., & Luszczynska, A. (2017). Meaning in life and physical health: systematic review and meta-analysis. Health Psychology Review, 11(4), 387–418.
13. Darvyri, P., Galanakis, M., Avgoustidis, A. G., Pateraki, N., Vasdekis, S., & Darviri, C. (2014). The Revised Intrinsic/Extrinsic Religious Orientation Scale in a Sample of Attica’s Inhabitants. Psychology, 05(13), 1557–1567.
14. Dobríková, P., Pčolková, D., AlTurabi, L. K., & West, D. J. (2014). The Effect of Social Support and Meaning of Life on the Quality-of-Life Care for Terminally Ill Patients. American Journal of Hospice and Palliative Medicine®, 32(7), 767–771. 10.1177/ 1049909114546208
15. Fernández-Martínez, E., Martín-Pérez, I., Liébana-Presa, C., Martínez-Fernández, Mc., & López-Alonso, A. I. (2021). Fear of death and its relationship to resilience in nursing students: A longitudinal study. Nurse Education in Practice, 55, 103175. 10.1016/j.nepr.2021.103175
16. Fischer, I. C., Cripe, L. D., & Rand, K. L. (2018). Predicting symptoms of anxiety and depression in patients living with advanced cancer: the differential roles of hope and optimism. Supportive Care in Cancer, 26(10), 3471–3477.
17. Gonen, G., Kaymak, S. U., Cankurtaran, E. S., Karslioglu, E. H., Ozalp, E., & Soygur, H. (2012). The Factors Contributing to Death Anxiety in Cancer Patients. Journal of Psychosocial Oncology, 30(3), 347–358.
18. Gravier, A. L., Shamieh, O., Paiva, C. E., Perez-Cruz, P. E., Muckaden, M. A., Park, M., Bruera, E., & Hui, D. (2019). Meaning in life in patients with advanced cancer: a multinational study. Supportive Care in Cancer, 28(8), 3927–3934.
19. Guo, J.-W., Reblin, M., Tay, D. L., Ellington, L., Beck, A. C., & Cloyes, K. G. (2021). Patterns of stress and support in social support networks of in-home hospice cancer family caregivers. Journal of Social and Personal Relationships, 026540752110247. 1177/02654075211024743
20. Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24.
21. Hiyoshi, K., Becker, C., Oishi, N., & Fukuyama, H. (2017). A review of effects of death anxiety on the human brain. Journal of the Neurological Sciences, 381, 257. 10.1016/j.jns.2017.08.732
22. Hoelterhoff, M., & Chung, M. C. (2016). Death Anxiety Resilience; a Mixed Methods Investigation. Psychiatric Quarterly, 88(3), 635–651.
23. Krok, D., Zarzycka, B., & Telka, E. (2021). The Religious Meaning System and Resilience in Spouse Caregivers of Cancer Patients: A Moderated Mediation Model of Hope and Affect. Journal of Religion and Health, 60(4), 2960–2976.
24. Kyota, A., & Kanda, K. (2019). How to come to terms with facing death: a qualitative study examining the experiences of patients with terminal Cancer. BMC Palliative Care, 18(1).
25. Lagman, R. A., Yoo, G. J., Levine, E. G., Donnell, K. A., & Lim, H. R. (2012). “Leaving it to God” Religion and Spirituality among Filipina Immigrant Breast Cancer Survivors. Journal of Religion and Health, 53(2), 449–460.
26. Liu, X., Liu, Z., Cheng, Q., Xu, N., Liu, H., & Ying, W. (2020). Effects of meaning in life and individual characteristics on dignity in patients with advanced cancer in China: a cross-sectional study. Supportive Care in Cancer.
27. Martela, F., & Steger, M. F. (2022). The role of significance relative to the other dimensions of meaning in life – an examination utilizing the three dimensional meaning in life scale (3DM). The Journal of Positive Psychology, 1–21.
28. Masror Roudsary, D., Lehto, R. H., Sharif Nia, H., & Kohestani, D. (2022). The Relationship Between Religious Orientation and Death Anxiety in Iranian Muslim Patients with Cancer: The Mediating Role of Hope. Journal of Religion and Health.
29. Maxfield, M., Pyszczynski, T., Greenberg, J., & Bultmann, M. N. (2016). Age Differences in the Effects of Mortality Salience on the Correspondence Bias. The International Journal of Aging and Human Development, 84(4), 329–342.
30. Menzies, R. E., & Menzies, R. G. (2020). Death anxiety in the time of COVID-19: theoretical explanations and clinical implications. Cognitive Behaviour Therapist, 13(19).
31. Missler, M., Stroebe, M., Geurtsen, L., Mastenbroek, M., Chmoun, S., & Van Der Houwen, K. (2012). Exploring Death Anxiety among Elderly People: A Literature Review and Empirical Investigation. OMEGA - Journal of Death and Dying, 64(4), 357–379.
32. Mushtaque, I., Awais-E-Yazdan, M., Zahra, R., & Anas, M. (2022). Quality of Life and Illness Acceptance among End-Stage Renal Disease (ESRD) Patients on Hemodialysis: The Moderating Effect of Death Anxiety during COVID-19 pandemic. OMEGA - Journal of Death and Dying, 003022282210752.
33. Nawaz, M. A., Saeed, L., & Mushtaque, I. (2021). Mediating Role of Spousal Support on Internalized Stigma and Marital Satisfaction among depressive Patients. Review of Education, Administration & LAW, 4(4), 561–572.
34. Neel, C., Lo, C., Rydall, A., Hales, S., & Rodin, G. (2013). Determinants of death anxiety in patients with advanced cancer. BMJ Supportive & Palliative Care, 5(4), 373–380.
35. Park, C. L., Pustejovsky, J. E., Trevino, K., Sherman, A. C., Esposito, C., Berendsen, M., & Salsman, J. M. (2019). Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta‐analysis. Cancer, 125(14), 2383–2393.
36. Rosenberg, M. (1965). Society and the adolescent self-image. Social Forces, 44(2), 255.
37. Saleem, T., & Saleem, S. (2019). Religiosity and Death Anxiety: A Study of Muslim Dars Attendees. Journal of Religion and Health, 59(1), 309–317.
38. Sarfraz, M., Waqas, H., Ahmed, S., Rurush-Asencio, R., & Mushtaque, I. (2022). Cancer-Related Stigmatization, Quality of Life, and Fear of Death Among Newly Diagnosed Cancer Patients. OMEGA - Journal of Death and Dying, 003022282211406.
39. Sharif, S. P., Lehto, R. H., Nia, H. S., Goudarzian, A. H., Haghdoost, A. A., Yaghoobzadeh, A., Tahmasbi, B., & Nazari, R. (2018). Religious coping and death depression in Iranian patients with cancer: relationships to disease stage. Supportive Care in Cancer, 26(8), 2571–2579.
40. Soleimani, M. A., Bahrami, N., Allen, K.-A., & Alimoradi, Z. (2020). Death anxiety in patients with cancer: A systematic review and meta-analysis. European Journal of Oncology Nursing, 48, 101803.
41. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249.
42. Templer, D. I. (1970). The Construction and Validation of a Death Anxiety Scale. The Journal of General Psychology, 82(2), 165–177.
43. Tjew-A-Sin, M., & Koole, S. L. (2018). Terror Management in a Multicultural Society: Effects of Mortality Salience on Attitudes to Multiculturalism Are Moderated by National Identification and Self-Esteem Among Native Dutch People. Frontiers in Psychology, 9.
44. Tjew-A-Sin, M., Schneider, I. K., & Koole, S. L. (2015). Data from Paper “Embodied Terror Management: Interpersonal Touch Alleviates Existential Concerns among Individuals with Low Self-esteem.” Journal of Open Psychology Data, 3.
45. Uslu-Sahan, F., Terzioglu, F., & Koc, G. (2019). Hopelessness, Death Anxiety, and Social Support of Hospitalized Patients With Gynecologic Cancer and Their Caregivers. Cancer Nursing, 42(5), 373–380.
46. Vail, K. E., Soenke, M., & Waggoner, B. (2019). Terror Management Theory and Religious Belief. Handbook of Terror Management Theory, 259–285.
47. Vehling, S., Tian, Y., Malfitano, C., Shnall, J., Watt, S., Mehnert, A., Rydall, A., Zimmermann, C., Hales, S., Lo, C., & Rodin, G. (2019). Attachment security and existential distress among patients with advanced cancer. Journal of Psychosomatic Research, 116, 93–99.
48. World Health Organization. (2020). Pakistan.
49. Zamanian, H., Eftekhar-Ardebili, H., Eftekhar-Ardebili, M., Shojaeizadeh, D., Nedjat, S., Taheri-Kharameh, Z., & Daryaafzoon, M. (2015). Religious Coping and Quality of Life in Women with Breast Cancer. Asian Pacific Journal of Cancer Prevention, 16(17), 7721–7725.
50. Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L., & Miao, D. (2019). Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC Geriatrics, 19(1).

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