ABSTRACT
The psychosocial care of patients with advanced lung cancer (ALC) has not kept pace with current medical
treatments, creating significant gaps in care. Treatments like immunotherapy have radically changed ALC care,
yielding less toxicity and unprecedented increases in 5-year survival. However, mental health and quality of life
concerns persist, which must be addressed to fully realize the survival benefits of these medical
advancements. To meet the needs of patients in this new treatment context, psychosocial and palliative care
for ALC must shift from a predominant end-of-life framework to one of survivorship. A hope-based intervention
to support patients’ goal pursuits in their family, social, work, and leisure lives is a promising approach to
support mental health and quality of life in this current context. The long-term goal of this research is to
improve ALC patient mental health and quality of life during cancer treatment. The overall objective in this
application is to test the efficacy of a novel psychosocial intervention called “Pathways” to support personal
goal pursuit during ALC treatment. The central hypothesis is that Pathways will reduce goal disruption and
thereby improve mental health and quality of life during ALC treatment. The rationale for this project is that
Pathways, a brief, hope-based intervention delivered primarily at the point of ALC patient care by a range of
healthcare providers (e.g., nurse, occupational therapist, social worker) has demonstrated feasibility and
acceptability to ALC patients, with encouraging preliminary effects on goal disruption, mental health, and
quality of life outcomes. The central hypothesis will be tested through two specific aims: 1) Test the efficacy of
Pathways against enhanced usual care; and 2) Evaluate goal interference and goal adjustment as mediators of
intervention effects. Because ALC disproportionately affects rural, older underserved populations who have
been underrepresented in psychosocial intervention trials, Aim 3 will use mixed-methods to evaluate the reach
and effectiveness of the Pathways intervention among these subgroups. To accomplish these aims, 234
patients undergoing treatment for ALC at the University of Kentucky Markey Cancer Center will be randomized
to Pathways or enhanced usual care, with outcomes collected, pre, post, and at follow-up. The research
proposed in this application is innovative because it is testing a novel intervention with respect to intervention
focus and intervention delivery at the point of ALC care. The proposed research is significant because it will
determine the efficacy of an intervention that is responsive to patients’ needs in the current medical landscape
for ALC and has high potential for broad dissemination into routine ALC care in both high- and low-resourced
settings. Once efficacy is demonstrated, the effectiveness of the intervention will be tested in both academic
and community oncology practices with other advanced cancer patient populations, significantly advancing
psychosocial and palliative care in this new treatment era and ultimately having a large impact on the over
600,000 people living with advanced cancer in the U.S.
