Living in the twilight zone: a qualitative study on the experiences of patients with advanced cancer obtaining long-term response to immunotherapy or targeted therapy

• Published in: Journal of cancer survivorship 2024-06, Vol.18 (3), p.750-760
• Main Authors: Zwanenburg, Laura C., Suijkerbuijk, Karijn P. M., van Dongen, Sophie I., Koldenhof, José J., van Roozendaal, Anne S., van der Lee, Marije L., Schellekens, Melanie P. J.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Aged; Cancer; Cancer Survivors - psychology; Data analysis; Female; Health Informatics; Health Promotion and Disease Prevention; Humans; Immunotherapy; Life expectancy; Life span; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - psychology; Lung Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Melanoma; Middle Aged; Molecular Targeted Therapy; Neoplasms - psychology; Neoplasms - therapy; Oncology; Patients; Primary Care Medicine; Protective behavior; Public Health; Qualitative analysis; Qualitative Research; Quality of Life; Quality of Life Research; Social behavior; Social environment; Therapy; Uncertainty
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-022-01306-9

Purpose The introduction of immunotherapy and targeted therapy has drastically improved the life expectancy of patients with advanced cancer. Despite improved survival, obtaining long-term response can be highly distressing and comes with uncertainties that affect several life domains. The aim of this study is to gain a deeper understanding of long-term responders’ lived experiences with obtaining long-term response to immunotherapy or targeted therapy. Methods We conducted an exploratory qualitative study using thematic data analysis. Semi-structured in-depth interviews were conducted with 17 patients with advanced melanoma or lung cancer who had a confirmed response to or long-term stable disease while on immunotherapy or targeted therapy. Results Long-term responders are living in a twilight zone, where they neither feel like a patient, nor feel healthy. This impacts their self-image, interactions with their social environment, and feelings of uncertainty. Due to their uncertain life perspective, long-term responders are going back and forth between hope and despair, while they are longing for their ‘old’ life, several barriers, such as protective behavior of the social environment, force them to adjust to a life with cancer. Conclusion Long-term responders are facing many challenges, such as searching for a renewed identity, dealing with ongoing uncertainty, and having to adapt to a new normal. This emphasizes the importance of providing this new patient group with tailored information and support. Implications for Cancer Survivors Healthcare professionals can support patients by normalizing their feelings and providing space for varying emotions. Using patient-tailored scan frequencies could help temper fear of progression.