Patients With Advanced Lung Cancer Prioritize Social, Relational Goals Above Treatment Outcomes

The goals of people with advanced lung cancer undergoing first-line therapy tend to be focused on relationships and living well, according to a new study. This report also shows that most people surveyed viewed their goals as attainable.

The authors of the study, published in Supportive Care in Cancer, said clinicians should use the results to think about how best to support patients undergoing cancer treatment.

One way to help people with advanced cancer maintain quality of life is to understand and support their goals, said the study authors, adding that the goals of people with cancer extend beyond their therapy.

“While cancer-related goals may be important, the continued pursuit of other valued goals (eg, meaningful experiences, social connection) is critical to ensure that individuals are living a life that is enjoyable and fulfilling,” they wrote.

Goals have been the subject of previous studies of people with cancer, but the present investigators said some of those studies had significant limitations. For instance, some involved face-to-face interviews and others asked patients to choose from predefined goal domains. The latter could inadvertently introduce bias, they said, since asking about treatment goals might “unintentionally inflate their importance.”

In hopes of adding to and improving the knowledge base around the goals of cancer patients, the authors designed a study in which 75 people receiving first-line therapy for advanced lung cancer participated in semistructured interviews about their goals. First, patients were asked to come up with their own goals and then they were told to choose the 3 most important goals. They were then asked about their perceptions related to the attainability of their goals and their control over their ability to achieve them. The investigators followed up a month later to ask participants to assess their progress and identify barriers to progress.

The participants had an average age of 64.5 years, 59% were female, and 95% were White. Eighty-eight percent of respondents had non–small cell lung cancer, and 85% had stage IV disease.

The authors compiled the resulting list of goals into 8 domains. Nearly 3 quarters of patients had at least 1 goal that fit into the “social/role/relationship” domain, and 68% of respondents had a goal in the “leisure/pleasure” domain. Only 29% of patients had a goal related to their cancer’s response to treatment.

The relatively low percentage of people who listed a treatment-related goal contrasts with a previous study that asked patients about life goals and treatment goals separately. They said the difference in methodology between that study and the current study may be instructive.

“It is possible that patients felt compelled to rank cancer-related goals as most important given demand characteristics of the interview or societal pressures to ‘beat’ the disease,” the authors said.

Of participants who did list a treatment-related goal among their top 3, most listed it as their most important goal.

When the investigators followed up with patients to gauge their short-term progress, most said they had made “some” or “a lot” of progress, and they generally said their progress aligned with their expectations. Factors such as being physically well, having social support, and having a routine were considered helpful to making progress toward goals. Physical limitations and mental health challenges were commonly identified as barriers to goal achievement.

The authors said the advent of new treatment options for people with advanced lung cancer is exciting, but they said it also brings uncertainty for patients about what they can expect from treatment. They said understanding patients’ goals—treatment related and otherwise—can help clinicians guide care, and they said simply asking patients to define their goals can be beneficial.

“Getting patients to state their goals may serve as an intervention itself, either by reinforcing how patients are living aligned with what is important to them or highlighting dissonance between goals and behavior, thus serving as an intervention opportunity,” they said.

Reference

Hyland KA, Oswald LB, Reblin M, et al. Goals and goal perceptions in patients with advanced stage lung cancer: a mixed methods study. Support Care Cancer. Published online May 1, 2023. doi:10.1007/s00520-023-07745-z