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This PRISMA 2020-guided systematic review synthesized qualitative evidence on meaning-making among adult cancer survivors across Scopus, Web of Science, MEDLINE, and the Psychology &amp; Behavioral Science Collection (final search: 25 November 2025). Twenty-eight qualitative studies were included and synthesized using thematic synthesis, with confidence assessed via GRADE-CERQual. Five themes were identified: confrontation with mortality and existential shock; existential suffering and biographical disruption; meaning reconstruction and reorientation; transcendence, spirituality, and faith-based meaning; and psychological adaptation, resilience, and growth. Across diverse cultural contexts, cancer survivorship consistently involved mortality awareness and existential destabilization, followed by efforts to restore coherence and purpose. Spirituality, self-transcendence, and resilience emerged as prominent coping pathways. 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