Blended survivorship and palliative care for patients with advanced lung cancer receiving targeted therapy: An open pilot.

Abstract

1634 Background: Targeted therapy improves survival and quality of life for patients with advanced non-small cell lung cancer (NSCLC) with driver alterations. However, advanced NSCLC remains incurable, and the timing of progression on targeted therapy is unpredictable. Thus, many patients live with an abiding, distressing sense of uncertainty. To better support patients with advanced NSCLC receiving targeted therapy, we 1) developed and refined a blended early palliative care and survivorship intervention and 2) conducted an open pilot to further refine the intervention. Methods: We conducted a review of evidence and prior palliative care and behavioral health interventions to inform the development of POISE, a structured, supportive care intervention for patients with advanced NSCLC receiving targeted therapy, in which trained palliative care clinicians aim to enhance patient coping with uncertainty, setting lifestyle goals, and prognostic awareness. To refine POISE, we first conducted qualitative interviews with 20 community partners, including patient/caregiver advocates, palliative care clinicians, psychologists, and oncologists. We elicited feedback on POISE intervention content and delivery. We used rapid analysis to analyze interview transcripts and identified themes, with which we finalized POISE (4 monthly one-hour palliative care visits). We then conducted an open pilot study of POISE among 10 patients diagnosed with advanced NSCLC with a targetable mutation (i.e., EGFR, ALK, ROS1 or RET) in the past 6 months who were receiving care at a single academic cancer center. All participants received POISE and completed self-report surveys at baseline and at 12 and 20 weeks. Participants rated their satisfaction with POISE and completed exit interviews at 20 weeks. We used a framework approach to analyze exit interviews and identify themes for further intervention refinement. Results: Qualitative interviews highlighted a need to strengthen the POISE clinician training and supervision plan to increase palliative care clinicians’ behavior modification therapy skills. We revised the POISE manual to be more flexible to accommodate patient choice in session focus and added a list of community organizations to support ongoing behavior change. With the revised intervention, we then initiated the POISE open pilot. We approached 13 eligible patients, of whom 10 (mean age = 67 years, 5 female, 5 male) consented to participate. Most (8/10) patients completed all 4 sessions and all surveys. All (8/8) patients reported that POISE was helpful and would recommend it to others. In exit interviews, patients suggested incorporating caregivers in sessions and adding a patient-facing workbook to assist with skill acquisition. Conclusions: POISE warrants further study in a feasibility pilot randomized controlled trial. Clinical trial information: NCT04900935 .