Loving life’s impermanence: How existential gratitude sparks transformation in cancer survivors

Cancer survivorship is often accompanied by existential distress as individuals confront mortality and search for meaning in their experiences. This study examines existential gratitude, which is a heightened appreciation of life shaped by suffering and impermanence, as a mediator between spirituality and post-traumatic growth (PTG) among Indian cancer survivors. Grounded in Terror Management Theory (TMT), this research explores how spirituality, rather than directly fostering PTG, requires existential gratitude as a transformative mechanism. A sample of 118 Indian cancer survivors, at least six months post-active treatment, participated in the study. Spearman’s rho correlations revealed significant positive associations between existential gratitude, spirituality, and PTG. Mediation analysis demonstrated that existential gratitude fully mediated the relationship between spirituality and PTG (β = .16, p = .003), with spirituality showing no direct effect on PTG (β = .08, p = .414) when existential gratitude was introduced. These findings challenge traditional views of spirituality as an inherent driver of growth, highlighting instead that PTG arises when existential gratitude transforms mortality awareness into an appreciation of life’s fragility.