Purpose <p>Cancer as a major adverse life event may cause suffering for patients and promote meaning-making. However, not all cancer patients can successfully construct meaning in life. A comprehensive and in-depth understanding of cancer patients’ perceptions on the meaning in life is important for providing support and inspiration in clinical practice and research. This study used qualitative meta-synthesis to explore cancer patients’ perceptions of meaning in life.</p> Methods <p>A systematic search of 11 English and Chinese databases was conducted from their inception to May 2024. Two researchers independently performed study selection, quality assessment, and data extraction. The Joanna Briggs Institutes (JBI) Critical Appraisal Checklist was used to assess the methodological quality of included studies. A meta-aggregative strategy was employed to synthesize the findings, and the&#xa0;JBI ConQual approach was applied to evaluate the dependability and credibility of the research.</p> Results <p>A total of 25 eligible studies were included in the meta-synthesis, conducted across 12 countries and involving 730 cancer patients. Three synthesized findings emerged: paths to discovering meaning in life, dynamic meaning-making processes, and challenges in the meaning-making processes. These findings encompassed eight categories: power of support, blooming of self-worth, positive attitude toward facing challenges, gift of experience, normalization of life, seeking illness attribution, finding meaning in the illness, rearranging life priorities, change of value, physical challenges, psychological challenges, and practical challenges.</p> Conclusions <p>The meaning-making process of cancer patients is a dynamic and multidimensional journey, filled with transformative experiences, while also accompanied by physical, psychological, and practical challenges.</p> PROSPERO registration <p>CRD42023447664.</p>