Work

The Psychosocial Burden of the ‘Lazarus Effect’: A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy

Year: 2026

Type: review

Abstract: BACKGROUND/OBJECTIVES: Immune checkpoint inhibitors have transformed oncology by inducing unexpected and sustained remissions in some patients; however, this atypical survival may be accompanied by significant psychosocial and existential challenges. The objective was to synthesize the available scientific evidence on the psychosocial burden of the 'Lazarus Effect', characterized by survivor guilt, identity shift, and discontinuation anxiety. METHODS: A systematic review was conducted following the PRISMA2020 guidelines, based on a preregistered protocol on the OSF. Searches were performed in PubMed, Scopus, Web of Science, and APA PsycINFO using PICOS-based eligibility criteria. Seven primary empirical studies were included, and their methodological quality and risk of bias were assessed using the MMAT 2018. RESULTS: Survivor guilt stems interpersonally from peer deaths and intrapersonally from perceived autonomy loss. Identity shift involves transitioning into an "existential limbo," re-establishing self-identity while off active treatment. Discontinuation anxiety relates to recurrence fears, absence of curative biomarkers, and uncertainty regarding treatment duration. Interactively, these dimensions drive broader psychosocial burden, including social isolation, "scanxiety," and a discrepancy between physical recovery and emotional vulnerability. CONCLUSIONS: Current evidence-limited to seven heterogeneous studies concentrated in high-income settings-indicates exceptional responses to immunotherapy may involve nuanced psychosocial challenges. Given small sample sizes, melanoma overrepresentation, potential report retrieval bias, and non-standardized assessment tools, findings require cautious interpretation. They offer an exploratory foundation for future research rather than definitive clinical conclusions, supporting preliminary psycho-oncological screening during treatment transitions.

Source: Diseases

DOI: 10.3390/diseases14100354

Authors: Johanna Alcívar Ponce, Wilson Alexander Zambrano Vélez, Marianela Silva Sánchez, Gioryi Sornoza Zavala

Institution: Universidad Estatal Península de Santa Elena

Language: English

Topic: Cancer survivorship and care

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,172