Brief psychosocial interventions for existential distress in advanced cancer: a scoping review of randomized controlled trials

Individuals with advanced cancer (IAC) frequently experience existential distress, including loss of meaning, fear of progression, and loss of spiritual well-being. Brief psychosocial interventions may be more readily integrated into oncology and palliative care than longer protocols. This scoping review mapped randomized controlled trials (RCTs) of brief psychosocial interventions targeting existential distress in advanced cancer. A scoping review was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines. Eligible studies were peer-reviewed English-language RCTs published between January 2000 and March 2025, enrolling ≥ 50 participants with advanced cancer and testing psychosocial interventions delivered in ≤ 12 sessions. Twenty-four RCTs met inclusion criteria, encompassing diverse frameworks: meaning-centered psychotherapy (MCP) and life review/reminiscence ( n = 4 each); cognitive-behavioral stress management (CBSM) and mindfulness ( n = 3 each); and additional interventions such as legacy-based therapy, Managing Cancer and Living Meaningfully (CALM), logotherapy, narrative interview, magnanimous therapy, Growing Resilience And CouragE (GRACE), and hope theory. Interventions were predominantly delivered individually (71%) by multidisciplinary providers. Twenty trials assessed at least one existential or spiritual construct, through 22 distinct instruments or subscales (20 validated); three addressed existential domains only indirectly, through cancer-specific distress or fear-of-recurrence measures; and one measured no existential outcome despite testing an existentially oriented intervention. Psychological distress (88%) and quality of life (QoL) (63%) were also frequently assessed. Brief psychosocial interventions targeting existential distress in advanced cancer have been evaluated across diverse frameworks, provider groups and delivery formats, with most trials reporting at least one significant existential outcome, in every case favoring the intervention arm – a uniformity that warrants interpretive caution. Greater consistency in conceptualization, measurement, and reporting is needed to strengthen the evidence base and support implementation in routine care.