{"id":"https://openalex.org/W7214326428","doi":"https://doi.org/10.3390/diseases14100354","title":"The Psychosocial Burden of the \u2018Lazarus Effect\u2019: A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy","display_name":"The Psychosocial Burden of the \u2018Lazarus Effect\u2019: A Systematic Review of Survivor Guilt, Identity Shift, and Discontinuation Anxiety in Exceptional Responders to Cancer Immunotherapy","publication_year":2026,"publication_date":"2026-09-25","ids":{"openalex":"https://openalex.org/W7214326428","doi":"https://doi.org/10.3390/diseases14100354","pmid":"https://pubmed.ncbi.nlm.nih.gov/42929982","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13703520"},"language":"en","primary_location":{"id":"doi:10.3390/diseases14100354","doi":"https://doi.org/10.3390/diseases14100354","is_oa":true,"landing_page_url":"https://doi.org/10.3390/diseases14100354","pdf_url":null,"source":{"id":"https://openalex.org/S2736521255","display_name":"Diseases","issn_l":"2079-9721","issn":["2079-9721"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diseases","raw_type":"journal-article"},"volume":null,"type":"review","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/diseases14100354","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5048137750","display_name":"Johanna Lilibeth Alcivar Ponce","orcid":"https://orcid.org/0000-0003-2037-6577","observed_orcids":["https://orcid.org/0000-0003-2037-6577"]},"institutions":[{"id":"https://openalex.org/I3133194271","display_name":"Universidad Estatal Pen\u00ednsula de Santa Elena","ror":"https://ror.org/01k410495","country_code":"EC","type":"education","lineage":["https://openalex.org/I3133194271"]}],"countries":["EC"],"is_corresponding":false,"raw_author_name":"Johanna Alc\u00edvar Ponce","raw_affiliation_strings":["Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador","institution_ids":["https://openalex.org/I3133194271"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5001332519","display_name":"Wilson Alexander Zambrano V\u00e9lez","orcid":"https://orcid.org/0000-0003-1061-878X","observed_orcids":["https://orcid.org/0000-0003-1061-878X"]},"institutions":[{"id":"https://openalex.org/I3133194271","display_name":"Universidad Estatal Pen\u00ednsula de Santa Elena","ror":"https://ror.org/01k410495","country_code":"EC","type":"education","lineage":["https://openalex.org/I3133194271"]}],"countries":["EC"],"is_corresponding":true,"raw_author_name":"Wilson Alexander Zambrano V\u00e9lez","raw_affiliation_strings":["Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador"],"raw_orcid":"https://orcid.org/0000-0003-1061-878X","affiliations":[{"raw_affiliation_string":"Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador","institution_ids":["https://openalex.org/I3133194271"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5018599582","display_name":"Marianela Silva S\u00e1nchez","orcid":"https://orcid.org/0000-0002-0775-6826","observed_orcids":["https://orcid.org/0000-0002-0775-6826"]},"institutions":[{"id":"https://openalex.org/I3133194271","display_name":"Universidad Estatal Pen\u00ednsula de Santa Elena","ror":"https://ror.org/01k410495","country_code":"EC","type":"education","lineage":["https://openalex.org/I3133194271"]}],"countries":["EC"],"is_corresponding":false,"raw_author_name":"Marianela Silva S\u00e1nchez","raw_affiliation_strings":["Faculty of Educational Sciences and Languages, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador"],"raw_orcid":"https://orcid.org/0000-0002-0775-6826","affiliations":[{"raw_affiliation_string":"Faculty of Educational Sciences and Languages, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador","institution_ids":["https://openalex.org/I3133194271"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5034884955","display_name":"Gioryi Augusto Sornoza Zavala","orcid":"https://orcid.org/0000-0002-5573-3119","observed_orcids":["https://orcid.org/0000-0002-5573-3119"]},"institutions":[{"id":"https://openalex.org/I3133194271","display_name":"Universidad Estatal Pen\u00ednsula de Santa Elena","ror":"https://ror.org/01k410495","country_code":"EC","type":"education","lineage":["https://openalex.org/I3133194271"]}],"countries":["EC"],"is_corresponding":false,"raw_author_name":"Gioryi Sornoza Zavala","raw_affiliation_strings":["Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador"],"raw_orcid":"https://orcid.org/0000-0002-5573-3119","affiliations":[{"raw_affiliation_string":"Faculty of Social and Health Sciences, Peninsula of Santa Elena State University, La Libertad 240204, Ecuador","institution_ids":["https://openalex.org/I3133194271"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5001332519"],"corresponding_institution_ids":["https://openalex.org/I3133194271"],"apc_list":{"value":1800,"currency":"CHF","value_usd":2172},"apc_paid":{"value":1800,"currency":"CHF","value_usd":2172},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.49619499,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"10","first_page":"354","last_page":"354"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10178","display_name":"Cancer survivorship and care","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10178","display_name":"Cancer survivorship and care","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10158","display_name":"Cancer Immunotherapy and Biomarkers","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11141","display_name":"Childhood Cancer Survivors' Quality of Life","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/lazarus-effect","display_name":"Lazarus effect","score":0.9200000166893005},{"id":"https://openalex.org/keywords/immune-checkpoint-inhibitors","display_name":"immune checkpoint inhibitors","score":0.824999988079071},{"id":"https://openalex.org/keywords/cancer-immunotherapy","display_name":"cancer immunotherapy","score":0.9390000104904175},{"id":"https://openalex.org/keywords/survivor-guilt","display_name":"survivor guilt","score":0.8450000286102295},{"id":"https://openalex.org/keywords/identity-transition","display_name":"identity transition","score":0.9959999918937683},{"id":"https://openalex.org/keywords/psychosocial-burden","display_name":"psychosocial burden","score":0.9049999713897705},{"id":"https://openalex.org/keywords/exceptional-responders","display_name":"exceptional responders","score":0.4909999966621399},{"id":"https://openalex.org/keywords/scanxiety","display_name":"scanxiety","score":0.7450000047683716},{"id":"https://openalex.org/keywords/social-isolation","display_name":"social isolation","score":0.9409999847412109},{"id":"https://openalex.org/keywords/treatment-discontinuation","display_name":"treatment discontinuation","score":0.640999972820282},{"id":"https://openalex.org/keywords/melanoma","display_name":"melanoma","score":0.5540000200271606}],"concepts":[{"id":"https://openalex.org/C150966472","wikidata":"https://www.wikidata.org/wiki/Q3410145","display_name":"Psychosocial","level":2,"score":0.9007999897003174},{"id":"https://openalex.org/C2778715236","wikidata":"https://www.wikidata.org/wiki/Q55622662","display_name":"Discontinuation","level":2,"score":0.8296999931335449},{"id":"https://openalex.org/C558461103","wikidata":"https://www.wikidata.org/wiki/Q154430","display_name":"Anxiety","level":2,"score":0.6166999936103821},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.5162000060081482},{"id":"https://openalex.org/C2779549880","wikidata":"https://www.wikidata.org/wiki/Q5542226","display_name":"PsycINFO","level":3,"score":0.5047000050544739},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.47049999237060547},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.4657000005245209},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.4171999990940094},{"id":"https://openalex.org/C542102704","wikidata":"https://www.wikidata.org/wiki/Q183257","display_name":"Psychotherapist","level":1,"score":0.4097000062465668},{"id":"https://openalex.org/C43138044","wikidata":"https://www.wikidata.org/wiki/Q1937818","display_name":"Psycho-oncology","level":3,"score":0.37709999084472656},{"id":"https://openalex.org/C65414064","wikidata":"https://www.wikidata.org/wiki/Q484105","display_name":"Autonomy","level":2,"score":0.36809998750686646},{"id":"https://openalex.org/C2780674031","wikidata":"https://www.wikidata.org/wiki/Q2012719","display_name":"Cancer immunotherapy","level":4,"score":0.3391000032424927},{"id":"https://openalex.org/C2778355321","wikidata":"https://www.wikidata.org/wiki/Q17079427","display_name":"Identity (music)","level":2,"score":0.3287000060081482},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.32429999113082886},{"id":"https://openalex.org/C2777545354","wikidata":"https://www.wikidata.org/wiki/Q3557657","display_name":"Social anxiety","level":3,"score":0.32330000400543213},{"id":"https://openalex.org/C2779951463","wikidata":"https://www.wikidata.org/wiki/Q7268788","display_name":"Quality of life (healthcare)","level":2,"score":0.3228999972343445},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.30979999899864197},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.30410000681877136},{"id":"https://openalex.org/C134362201","wikidata":"https://www.wikidata.org/wiki/Q317309","display_name":"Mental health","level":2,"score":0.27730000019073486},{"id":"https://openalex.org/C2777701055","wikidata":"https://www.wikidata.org/wiki/Q1427096","display_name":"Immunotherapy","level":3,"score":0.2750999927520752}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.3390/diseases14100354","doi":"https://doi.org/10.3390/diseases14100354","is_oa":true,"landing_page_url":"https://doi.org/10.3390/diseases14100354","pdf_url":null,"source":{"id":"https://openalex.org/S2736521255","display_name":"Diseases","issn_l":"2079-9721","issn":["2079-9721"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diseases","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13703520","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13703520/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13703520/pdf/diseases-14-00354.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diseases","raw_type":"Text"},{"id":"pmid:42929982","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42929982","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diseases (Basel, Switzerland)","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:85a83eb8acfc4b8c926baf5c54a9de14","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/85a83eb8acfc4b8c926baf5c54a9de14","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Diseases, Vol 14, Iss 10, p 354 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3390/diseases14100354","doi":"https://doi.org/10.3390/diseases14100354","is_oa":true,"landing_page_url":"https://doi.org/10.3390/diseases14100354","pdf_url":null,"source":{"id":"https://openalex.org/S2736521255","display_name":"Diseases","issn_l":"2079-9721","issn":["2079-9721"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-20","russia-white-list-2"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diseases","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9940000176429749,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/systematic-review","display_name":"Systematic Review"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214326428.pdf","grobid_xml":"https://content.openalex.org/works/W7214326428.grobid-xml"},"referenced_works_count":38,"referenced_works":["https://openalex.org/W2022345552","https://openalex.org/W2164777277","https://openalex.org/W2170686873","https://openalex.org/W2171810782","https://openalex.org/W2903783629","https://openalex.org/W2918111528","https://openalex.org/W2918808704","https://openalex.org/W2959576780","https://openalex.org/W2998950458","https://openalex.org/W3012372578","https://openalex.org/W3031402389","https://openalex.org/W3037716626","https://openalex.org/W3086563989","https://openalex.org/W3118615836","https://openalex.org/W3142108115","https://openalex.org/W3153523583","https://openalex.org/W3154805493","https://openalex.org/W3165293110","https://openalex.org/W3191480438","https://openalex.org/W3193495508","https://openalex.org/W4211216724","https://openalex.org/W4281249959","https://openalex.org/W4311024271","https://openalex.org/W4386169225","https://openalex.org/W4399156095","https://openalex.org/W4400874894","https://openalex.org/W4401587741","https://openalex.org/W4401793452","https://openalex.org/W4406908000","https://openalex.org/W4407045909","https://openalex.org/W4408536134","https://openalex.org/W4410729065","https://openalex.org/W4412593603","https://openalex.org/W4414406645","https://openalex.org/W7116870597","https://openalex.org/W7129610446","https://openalex.org/W7153593118","https://openalex.org/W7161844242"],"related_works":["https://openalex.org/W4390582396","https://openalex.org/W4417182119","https://openalex.org/W2602690645","https://openalex.org/W2326530404","https://openalex.org/W4409806424","https://openalex.org/W4416266865","https://openalex.org/W4281249959","https://openalex.org/W2918111528","https://openalex.org/W4394617216","https://openalex.org/W3087742619"],"abstract_inverted_index":{"BACKGROUND/OBJECTIVES:":[0],"Immune":[1],"checkpoint":[2],"inhibitors":[3],"have":[4],"transformed":[5],"oncology":[6],"by":[7,23,47],"inducing":[8],"unexpected":[9],"and":[10,26,52,82,95,99,117,147,163,169,202],"sustained":[11],"remissions":[12],"in":[13,76,180],"some":[14],"patients;":[15],"however,":[16],"this":[17],"atypical":[18],"survival":[19],"may":[20,187],"be":[21],"accompanied":[22],"significant":[24],"psychosocial":[25,40,157,190],"existential":[27],"challenges.":[28,191],"The":[29],"objective":[30],"was":[31,59],"to":[32,140,175,185],"synthesize":[33],"the":[34,39,43,62,71,106],"available":[35],"scientific":[36],"evidence":[37],"on":[38,66,70],"burden":[41],"of":[42,80,101,144],"'Lazarus":[44],"Effect',":[45],"characterized":[46],"survivor":[48],"guilt,":[49],"identity":[50],"shift,":[51],"discontinuation":[53],"anxiety.":[54],"METHODS:":[55],"A":[56],"systematic":[57],"review":[58],"conducted":[60],"following":[61],"PRISMA2020":[63],"guidelines,":[64],"based":[65],"a":[67,164],"preregistered":[68],"protocol":[69],"OSF.":[72],"Searches":[73],"were":[74,93,103],"performed":[75],"PubMed,":[77],"Scopus,":[78],"Web":[79],"Science,":[81],"APA":[83],"PsycINFO":[84],"using":[85,105],"PICOS-based":[86],"eligibility":[87],"criteria.":[88],"Seven":[89],"primary":[90],"empirical":[91],"studies":[92,178],"included,":[94],"their":[96],"methodological":[97],"quality":[98],"risk":[100],"bias":[102],"assessed":[104],"MMAT":[107],"2018.":[108],"RESULTS:":[109],"Survivor":[110],"guilt":[111],"stems":[112],"interpersonally":[113],"from":[114,119],"peer":[115],"deaths":[116],"intrapersonally":[118],"perceived":[120],"autonomy":[121],"loss.":[122],"Identity":[123],"shift":[124],"involves":[125],"transitioning":[126],"into":[127],"an":[128,212],"\"existential":[129],"limbo,\"":[130],"re-establishing":[131],"self-identity":[132],"while":[133],"off":[134],"active":[135],"treatment.":[136],"Discontinuation":[137],"anxiety":[138],"relates":[139],"recurrence":[141],"fears,":[142],"absence":[143],"curative":[145],"biomarkers,":[146],"uncertainty":[148],"regarding":[149],"treatment":[150,228],"duration.":[151],"Interactively,":[152],"these":[153],"dimensions":[154],"drive":[155],"broader":[156],"burden,":[158],"including":[159],"social":[160],"isolation,":[161],"\"scanxiety,\"":[162],"discrepancy":[165],"between":[166],"physical":[167],"recovery":[168],"emotional":[170],"vulnerability.":[171],"CONCLUSIONS:":[172],"Current":[173],"evidence-limited":[174],"seven":[176],"heterogeneous":[177],"concentrated":[179],"high-income":[181],"settings-indicates":[182],"exceptional":[183],"responses":[184],"immunotherapy":[186],"involve":[188],"nuanced":[189],"Given":[192],"small":[193],"sample":[194],"sizes,":[195],"melanoma":[196],"overrepresentation,":[197],"potential":[198],"report":[199],"retrieval":[200],"bias,":[201],"non-standardized":[203],"assessment":[204],"tools,":[205],"findings":[206],"require":[207],"cautious":[208],"interpretation.":[209],"They":[210],"offer":[211],"exploratory":[213],"foundation":[214],"for":[215],"future":[216],"research":[217],"rather":[218],"than":[219],"definitive":[220],"clinical":[221],"conclusions,":[222],"supporting":[223],"preliminary":[224],"psycho-oncological":[225],"screening":[226],"during":[227],"transitions.":[229]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-09-26T00:00:00"}