Purpose <p>Young cancer patients face unique challenges and heightened death anxiety. This study explored how they experience and cope with death anxiety based on terror management theory (TMT).</p> Methods <p>This study employed face-to-face, semi-structured interviews with 20 young cancer patients aged 20–49 years. The interview outline was informed by TMT, and the data were analyzed using thematic analysis. The reporting adhered to the COREQ guideline.</p> Results <p>Four categories encompassing 10 themes emerged: (1) mortality salience (i.e., catastrophizing cognition, treatment-related distress, economic survival anxiety, and future uncertainty); (2) avoidance coping (i.e., cognitive avoidance and attention diversion, reflecting proximal defenses in TMT); (3) adaptive coping (i.e., achieving attachment security and maintaining self-esteem); and (4) meaning-bolstering coping (i.e., searching for meaning and seeking spiritual comfort), which constitutes a worldview defense that reinforces cultural beliefs and values to consolidate life meaning. Categories 3 and 4 reflect TMT’s distal defenses.</p> Conclusion <p>This study reveals the death anxiety experience and coping process of young cancer patients. It underscores the necessity of integrating cognitive education with symptom management and advocates for gender-differentiated interventions. Furthermore, the findings highlight the importance of implementing culturally sensitive, family-centered interventions that provide support without overprotection while promoting open communication among family members. Timely, targeted, meaning‑oriented support should be provided for young patients with advanced cancer. This research extends the applicability of TMT in the Chinese context and informs the development of tailored psychological interventions for young cancer patients.</p>