Cycling Through Uncertainty: The Psychological Experiences of Individuals With Lung Cancer Receiving Immunotherapy And/Or Targeted Therapy

BACKGROUND: The recent developments in immunotherapy and targeted therapy drugs offer a new hope for prolonging overall survival and improving quality of life in individuals with advanced lung cancer. However, treatment response to these drugs is variable and unpredictable and early research indicates that these individuals are living with distressing uncertainty and unique supportive care needs. AIMS: Qualitatively characterize the psychological experience of receiving ICI and TT. METHODS: The study design and interview guide were developed with the charitable organization Lung Cancer Canada (LCC) and a patient advisory board. A diverse group of patients with advanced lung cancer receiving immunotherapy or targeted therapy were recruited from across Canada. Qualitative interviews (n = 24) explored their unmet needs using the Supportive Care Framework in Cancer Care. A thematic analysis was conducted. RESULTS: All participants described a similar treatment "cycle" associated with similar experiences and psychological concerns at each phase. Participants described shock and distressing uncertainty in illness at the beginning of treatment and during periods of disease and treatment change. Medically stable periods of treatment response were associated with difficulties with adjustment, coping, and finding new meaning in life. Participants described fear of progression and death anxiety in response to uncertainty in disease and treatment. Various psychological (e.g., acceptance, avoidance, meaning-making) and practical (e.g., social support, information seeking) coping strategies were described. CONCLUSIONS: Advocates, clinicians, researchers, and policymakers should be aware of the unique psychological needs of this growing population. Psychological interventions must address illness uncertainty and corresponding fears and worries.