The Psychosocial Burden of the 'Lazarus Effect': A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy.
- 1Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador.
- 2Faculty of Educational Sciences and Languages, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador.
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.
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BibTeX
@article{ponce2026psychosocial,
title = {{The Psychosocial Burden of the 'Lazarus Effect': A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy.}},
author = {Johanna Alcívar Ponce and Wilson Alexander Zambrano Vélez and Marianela Silva Sánchez and Gioryi Sornoza Zavala},
journal = {Diseases (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diseases14100354},
url = {https://europepmc.org/article/MED/42929982},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Psychosocial Burden of the 'Lazarus Effect': A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy.
AU - Johanna Alcívar Ponce
AU - Wilson Alexander Zambrano Vélez
AU - Marianela Silva Sánchez
AU - Gioryi Sornoza Zavala
PY - 2026
DA - 2026/09/25
JO - Diseases (Basel, Switzerland)
DO - 10.3390/diseases14100354
UR - https://europepmc.org/article/MED/42929982
AB - 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.
SN - 2079-9721
ER -