Academic Journal
Hope and despair in cancer and other illnesses: a clinical framework for adaptive hope across the illness trajectory.
| Title: | Hope and despair in cancer and other illnesses: a clinical framework for adaptive hope across the illness trajectory. |
|---|---|
| Authors: | Cherny NI; Norman Levan Center for Humanistic Medicine, Helmsley Cancer Center, Shaare Zedek Medical Center, Jerusalem, Israel; Hebrew University, Jerusalem, Israel. Electronic address: Nathan@cherny.org., Chochinov HM; CancerCare Manitoba Research Institute, University of Manitoba, Manitoba, Canada., Emanuel L; Feinberg School of Medicine, Northwestern University, Chicago, USA., Lethborg C; Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Department of Oncology, St. Vincent's Hospital, Melbourne, Australia., Coyle N; Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA., Corn BW; Hebrew University, Jerusalem, Israel. |
| Source: | ESMO open [ESMO Open] 2026 Sep; Vol. 11 (9), pp. 108340. Date of Electronic Publication: 2026 Jul 24. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: England NLM ID: 101690685 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2059-7029 (Electronic) Linking ISSN: 20597029 NLM ISO Abbreviation: ESMO Open Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2021 : [London] : Elsevier Original Publication: London : BMJ, [2016]- |
| MeSH Terms: | Neoplasms*/psychology , Neoplasms*/therapy , Hope*, Humans ; Adaptation, Psychological ; Decision Making ; Communication |
| Abstract: | Hope and despair are central and often coexisting dimensions of the experience of cancer and other serious illnesses. Hope profoundly shapes how patients understand prognosis, engage with treatment, and make decisions across the illness trajectory. When poorly managed, hope may contribute to prognostic misunderstanding, burdensome overtreatment, erosion of trust, and clinician distress. This narrative review synthesizes empirical and conceptual literature on hope and despair in oncology and serious illness, examining their determinants, clinical manifestations, and implications for communication and decision making. Hope is presented as a dynamic, multidimensional construct that evolves over time. Although initially oriented toward cure or remission, hope often recalibrates toward achievable goals such as symptom control, maintenance of function, relational connection, meaning, dignity, reconciliation, and spiritual peace. Hope and despair are shaped by physical symptoms, psychological state, social context, cultural frameworks, spirituality, and existential concerns. Hope for exceptional outcomes or miracles is common and may coexist with realistic planning and adaptive coping. However, when hope becomes rigid or reality-incongruent, it may impair informed decision making and delay emotional and practical preparation for decline and death. Effective clinical care requires the capacity to sustain adaptive, reality-congruent hope through honest, compassionate, and relationally grounded communication. The review examines psychospiritual, relational, and interdisciplinary approaches that support adaptive hope, including empathic communication, symptom management, meaning-centered interventions, dignity-conserving care, spiritual support, and structured hope-enhancing strategies. The role of clinicians' own reflective and emotional capacities in sustaining hope-supportive care is also explored. Fostering adaptive hope is presented as a core clinical competency in oncology and serious illness care. Integrating communication training, interdisciplinary collaboration, and existentially informed care may improve patient-centered decision making, reduce distress, and enhance the quality of care across the illness trajectory. (Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.) |
| References: | JAMA. 2016 Nov 22;316(20):2104-2114. (PMID: 27893131) Am J Hosp Palliat Care. 1995 Sep-Oct;12(5):31-9. (PMID: 7546978) Int J Law Psychiatry. 2020 Sep - Oct;72:101627. (PMID: 32950802) J Clin Oncol. 2020 Mar 20;38(9):885-904. (PMID: 32023159) J Clin Oncol. 2023 Jun 1;41(16):2884-2887. (PMID: 37075272) JAMA. 2001 Dec 19;286(23):3007-14. (PMID: 11743845) Curr Opin Psychol. 2023 Feb;49:101506. (PMID: 36493525) Gerontologist. 2005 Oct;45(5):634-41. (PMID: 16199398) Psychooncology. 2004 Nov;13(11):755-68. (PMID: 15386637) Ann Intern Med. 2001 Oct 2;135(7):551-5. (PMID: 11578166) Lancet Oncol. 2011 Aug;12(8):753-62. (PMID: 21741309) J Adv Nurs. 1990 Nov;15(11):1250-9. (PMID: 2269747) Int J Older People Nurs. 2024 Jan;19(1):e12579. (PMID: 37926905) Can Fam Physician. 2016 Aug;62(8):648-56. (PMID: 27521394) Postgrad Med J. 2016 Jun;92(1088):341-5. (PMID: 26933233) Palliat Med. 2021 Apr;35(4):710-728. (PMID: 33784903) JAMA. 2001 Dec 19;286(23):2993-3001. (PMID: 11743841) Palliat Support Care. 2021 Dec;19(6):646-655. (PMID: 33641697) Patient Educ Couns. 2023 Oct;115:107879. (PMID: 37413808) J Palliat Care. 1994 Summer;10(2):57-70. (PMID: 8089819) Psychiatry. 1981 May;44(2):161-8. (PMID: 7220709) Palliat Support Care. 2015 Dec;13(6):1643-50. (PMID: 25912395) Cancer J. 2006 Sep-Oct;12(5):417-24. (PMID: 17034677) Nurs Clin North Am. 1985 Jun;20(2):379-91. (PMID: 3846980) Psychooncology. 2024 Jul;33(7):e9300. (PMID: 39010250) Health Aff (Millwood). 2019 Feb;38(2):320-323. (PMID: 30715975) BMC Psychiatry. 2025 Feb 19;25(1):156. (PMID: 39972435) J Adv Nurs. 1992 Oct;17(10):1251-9. (PMID: 1430629) Psychooncology. 2008 Jul;17(7):641-59. (PMID: 18022831) Indian J Palliat Care. 2019 Jul-Sep;25(3):445-454. (PMID: 31413463) Acad Med. 2005 Jul;80(7):648-56. (PMID: 15980081) JAMA. 2022 Jul 12;328(2):184-197. (PMID: 35819420) Eur J Cancer Care (Engl). 2016 Jul;25(4):608-15. (PMID: 27271213) Lancet Oncol. 2025 Dec;26(12):e628-e670. (PMID: 41192457) J Pain Symptom Manage. 2015 Apr;49(4):747-61. (PMID: 25261637) Palliat Med. 2014 Jan;28(1):59-70. (PMID: 23587737) J Pain Symptom Manage. 2011 Mar;41(3):604-18. (PMID: 21145202) Palliat Support Care. 2024 Oct;22(5):1226-1231. (PMID: 38124362) Patient Educ Couns. 2006 Dec;64(1-3):21-34. (PMID: 16427760) J Pediatr Nurs. 2016 Jul-Aug;31(4):404-21. (PMID: 27021596) Soc Sci Med. 2019 Jul;232:444-452. (PMID: 30409727) J Health Care Chaplain. 2026 Jan-Mar;32(1):28-45. (PMID: 40948349) Soc Sci Med. 1999 Mar;48(5):591-605. (PMID: 10080361) J Clin Oncol. 2004 May 1;22(9):1721-30. (PMID: 15117995) J Adv Nurs. 2012 Jun;68(6):1211-23. (PMID: 22221185) Support Care Cancer. 2023 Nov 30;31(12):734. (PMID: 38051407) Palliat Support Care. 2003 Mar;1(1):23-32. (PMID: 16594285) JCO Oncol Pract. 2021 Jun;17(6):e785-e793. (PMID: 33596099) J Palliat Med. 2023 Dec;26(12):1604-1609. (PMID: 37824751) Palliat Med. 2023 Dec;37(10):1520-1528. (PMID: 37830745) BMC Palliat Care. 2025 Jul 01;24(1):177. (PMID: 40598100) J Pers Soc Psychol. 1991 Apr;60(4):570-85. (PMID: 2037968) West J Med. 1995 Sep;163(3):244-9. (PMID: 7571587) Clin Geriatr Med. 2004 Nov;20(4):689-714, vi-vii. (PMID: 15541620) Int J Behav Med. 2008;15(3):194-200. (PMID: 18696313) ESMO Open. 2025 Jan;10(1):104099. (PMID: 39765188) Psychooncology. 2010 Jan;19(1):21-8. (PMID: 19274623) Eur J Cancer Care (Engl). 2017 Nov;26(6):. (PMID: 27778415) J Pain Symptom Manage. 2006 Sep;32(3):266-74. (PMID: 16939851) Ann Pharmacother. 2001 Mar;35(3):352-9. (PMID: 11261534) J Consult Clin Psychol. 2015 Feb;83(1):115-28. (PMID: 25045907) Curr Opin Psychol. 2023 Apr;50:101558. (PMID: 36822123) Am J Health Behav. 2011 Jul;35(4):402-15. (PMID: 22040587) Gen Hosp Psychiatry. 2025 May-Jun;94:184-191. (PMID: 40107200) Patient Educ Couns. 2022 Jun;105(6):1470-1487. (PMID: 34593262) Arch Intern Med. 2007 Mar 12;167(5):453-60. (PMID: 17353492) Palliat Med. 2021 Feb;35(2):315-334. (PMID: 33302783) Chest. 2009 Jun;135(6):1643-1647. (PMID: 19497899) BMC Nurs. 2025 Feb 10;24(1):156. (PMID: 39930516) J Palliat Med. 2008 Sep;11(7):1029-38. (PMID: 18788966) Cancer Nurs. 1998 Aug;21(4):226-34. (PMID: 9691503) Med J Aust. 2021 Nov 15;215(10):443-446. (PMID: 34676567) N Engl J Med. 2024 Jan 4;390(1):63-69. (PMID: 38118003) Psychol Health. 2023 Jul-Aug;38(7):847-861. (PMID: 34678104) AMA J Ethics. 2018 Jul 1;20(7):E655-663. (PMID: 30007026) Aust Fam Physician. 2005 Jun;34(6):497-8. (PMID: 15931410) Arch Psychiatr Nurs. 2009 Apr;23(2):138-47. (PMID: 19327556) JCO Oncol Pract. 2026 Feb 25;:OP2500816. (PMID: 41740061) Palliat Support Care. 2009 Sep;7(3):365-77. (PMID: 19788779) J Pain Symptom Manage. 2018 Feb;55(2):535-539. (PMID: 29030208) JNCI Cancer Spectr. 2023 May 2;7(3):. (PMID: 37104744) Lancet Oncol. 2020 Sep;21(9):e452-e459. (PMID: 32888474) Soc Sci Med. 2002 Feb;54(3):433-43. (PMID: 11824919) Front Psychol. 2020 Jun 25;11:1468. (PMID: 32670169) Soc Sci Med. 2025 May;372:117995. (PMID: 40138979) Ann Intern Med. 2003 Mar 4;138(5):439-43. (PMID: 12614110) Am J Geriatr Psychiatry. 2003 Jul-Aug;11(4):393-405. (PMID: 12837668) J Clin Oncol. 2005 Aug 20;23(24):5520-5. (PMID: 16110012) Oncology (Williston Park). 2012 Jan;26(1):37-43, 46. (PMID: 22393795) J Pain Symptom Manage. 2022 May;63(5):689-697.e1. (PMID: 35017018) JAMA. 2021 Oct 5;326(13):1259-1260. (PMID: 34529011) J Pain Symptom Manage. 2019 Oct;58(4):696-706. (PMID: 31216430) J Palliat Care. 2001 Spring;17(1):12-21. (PMID: 11324179) Oncology (Williston Park). 2010 May;24(6):521-5. (PMID: 20568593) Cancer. 2005 May 1;103(9):1965-75. (PMID: 15789360) Palliat Support Care. 2007 Dec;5(4):377-88. (PMID: 18044415) Annu Rev Psychol. 2005;56:393-421. (PMID: 15709941) Palliat Med. 2021 May;35(5):875-885. (PMID: 33794713) Ann Intern Med. 2000 May 16;132(10):825-32. (PMID: 10819707) Palliat Support Care. 2019 Feb;17(1):13-20. (PMID: 30600795) CA Cancer J Clin. 2006 Mar-Apr;56(2):84-103; quiz 104-5. (PMID: 16514136) N Engl J Med. 1982 Mar 18;306(11):639-45. (PMID: 7057823) Psychooncology. 2024 Mar;33(3):e6316. (PMID: 38446540) Am J Lifestyle Med. 2026 Mar 5;20(1 Suppl):52S-66S. (PMID: 41798881) Clin Gerontol. 2021 Mar-Apr;44(2):97-111. (PMID: 31913808) Cancer. 2018 Aug 1;124(15):3231-3239. (PMID: 29757459) Cancer Med. 2022 Feb;11(3):815-825. (PMID: 35122411) Lancet. 2002 Dec 21-28;360(9350):2026-30. (PMID: 12504398) J Pain Symptom Manage. 2015 Mar;49(3):595-610. (PMID: 25131888) Med J Aust. 2007 Jun 18;186(S12):S77-S105. (PMID: 17727340) J Clin Oncol. 2012 Apr 10;30(11):1242-7. (PMID: 22412145) J Pain Symptom Manage. 2013 Nov;46(5):756-9. (PMID: 24099895) J Palliat Med. 2014 Apr;17(4):463-8. (PMID: 24579823) J Palliat Care. 2008 Summer;24(2):110-6. (PMID: 18681247) Lancet. 2003 May 10;361(9369):1603-7. (PMID: 12747880) Lancet Oncol. 2011 Feb;12(2):160-74. (PMID: 21251875) J Palliat Med. 2013 Jun;16(6):601. (PMID: 23614717) J Palliat Med. 2014 Jun;17(6):642-56. (PMID: 24842136) J Clin Oncol. 2015 Mar 1;33(7):749-54. (PMID: 25646186) JAMA. 2008 Oct 8;300(14):1665-73. (PMID: 18840840) JAMA Intern Med. 2014 Dec;174(12):1994-2003. (PMID: 25330167) Int J Environ Res Public Health. 2022 Jan 29;19(3):. (PMID: 35162582) |
| Contributed Indexing: | Keywords: advanced cancer; communication; distress; hope; miracles; serious illness |
| Entry Date(s): | Date Created: 20260924 Date Completed: 20260924 Latest Revision: 20261011 |
| Update Code: | 20261011 |
| PubMed Central ID: | PMC13650341 |
| DOI: | 10.1016/j.esmoop.2026.108340 |
| PMID: | 42785913 |
| Database: | MEDLINE |
| ISSN: | 2059-7029 |
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| DOI: | 10.1016/j.esmoop.2026.108340 |