Lara Traeger, PhD

Many adults with lung cancer who are treated with curative intent face high risk of recurrence despite receiving surgery and chemotherapy. After treatment, patients face uncertainty about their future and a higher symptom burden relative to patients with other cancers, while losing the support of frequent contact with their oncology team. Research supports cognitive-behavioral interventions to improve quality of life in cancer survivors. However, lung cancer survivors are rarely included in this research and the transition from treatment with curative intent to surveillance is an understudied phase in lung cancer. Our research focuses on strengthening the evidence base for improving quality of life in patients with lung cancer during this transition phase. Our primary study aim is to assess the quality-of-life impact of the Transitions Program, a novel intervention designed to help patients with lung cancer navigate the transition from treatment to surveillance. We are enrolling up to 100 patients at the Massachusetts General Hospital and Dana Farber Cancer Institute. Study patients are randomly assigned to receive the Transitions Program or enhanced usual care. Transitions Program participants learn a theory-based, empirically supported framework of skills to cope with three critical targets: future uncertainty, residual symptom burden and gaps in social support. The study includes surveys to collect patient-reported outcomes data and exit interviews to collect patient feedback. We are actively screening, recruiting, enrolling, and engaging with study patients at our two participating hospitals. Through review of Transitions Program sessions, we have observed our study clinicians helping patients to apply new coping skills to current quality-of-life challenges and make progress on survivorship goals that are important to them. Recent changes in lung cancer care, including the addition of immunotherapy or targeted therapy to the treatment regimen for some of our study-eligible patients, have heightened the complexities of the transition to surveillance and may amplify the value of a coping skills intervention during this phase. For instance, study patients who are taking an oral targeted therapy are experiencing ongoing or unexpected side effects and have been working with their study clinicians to manage and cope with these issues. To date, our exit interviews support that the program’s focus on skills for coping with symptom burden, uncertainty and support has facilitated meaningful improvements in quality of life. The lessons we are learning will help us to strengthen the evidence base for quality-of-life interventions in patients with lung cancer amidst the evolving landscape of lung cancer treatments. Upon completion of this trial, our results will provide rich information about Transitions Program effects. We are excited to use these findings as a basis for future patient-centered research.

Update: Many adults with lung cancer who are treated with curative intent face a considerable risk of recurrence and typically do not have a curative option once their cancer recurs. During their transition from treatment to surveillance, patients face significant uncertainty about their future while experiencing residual symptoms and losing the support of frequent contact with their oncology team. This population is rarely included in quality-of-life intervention research. Our study focuses on strengthening the evidence base for improving quality of life in patients with lung cancer during their transition from curative treatment to surveillance. We are conducting a randomized controlled trial to assess the efficacy of a theory-driven, evidence-based intervention for improving patient quality of life. To date, exit interview data from study completers support that the intervention’s focus on skills for coping with symptom burden, uncertainty and support has facilitated meaningful improvements in quality of life. Results of the completed trial will lay the groundwork for a multi-site implementation trial.