Objective: To explore the relationship between death attitude, fear of disease progression, and quality of life in end-stage lung cancer patients, and to identify effective interventions to improve their quality of life. Methods: A retrospective analysis was conducted on 157 end-stage lung cancer patients hospitalized in the Oncology Department of the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from June 2021 to May 2024. Data on general information, Chinese version of the Death Attitude Profile, Simplified Fear of Disease Progression Scale, and the Chinese version of the Cancer Patients' Quality of Life Scale were collected. Pearson correlation coefficients were used to examine the correlations among death attitude, fear of disease progression, and quality of life. Structural equation modeling was applied to test the mediating effect of death attitude between fear of disease progression and quality of life. Results: The scores for death attitudes were as follows: approach acceptance 30.31±4.62, natural acceptance 18.06±3.35, escape acceptance 17.82±2.52, fear of death 26.09±3.19, and death avoidance 14.94±2.63. The total score for fear of disease progression was 37.99±5.37, and for quality of life was 65.69±11.30. Stratified analysis showed that women had higher natural acceptance than men, patients under 60 had higher scores across multiple dimensions, patients with different educational backgrounds had statistically significant differences in the total score dimensions of natural acceptance, escape acceptance, fear of death, death escape and fear of disease progression，patients with different monthly per capita income had statistically significant differences in death evasion and total score of quality of life， patients with different types of medical payment had statistically significant differences in the dimensions of escape acceptance and death escape(all P<0.05). Approach acceptance was negatively correlated with fear of disease progression(P<0.05) and positively correlated with quality of life(P<0.05). Escape acceptance, death fear, and death avoidance were positively correlated with fear of disease progression(P<0.05) and negatively correlated with quality of life(P<0.05). Fear of disease progression was negatively correlated with quality of life(P<0.05). Mediation analysis showed that both death attitude and fear of disease progression directly affected quality of life(P<0.05). Fear of disease progression also indirectly influenced quality of life through death attitude(P<0.05), with a mediation effect of 34.70%. Conclusion: The quality of life in end-stage lung cancer patients is generally low. Death attitude and fear of disease progression are closely related to quality of life. Fear of disease progression directly predicts quality of life and also indirectly predicts it through death attitude. Clinical interventions should aim to improve death attitude and fear of disease progression to enhance the quality of life of patients.